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Young children hate to be separated from their parents. These fears appear toward the end of the first year, when they begin to sense that their parents will not always be with them and give signs of discomfort in the presence of people they don’t know well. This normal separation anxiety peaks around age 2 and persists, slowly diminishing, through age 6 or 7. If the fear of being apart from parents lasts for more than a month or persists in an older child and creates serious problems for the child or the family, it’s called separation anxiety disorder. Fortunately, good treatments are available, and most families don’t have to suffer long.
Children with separation anxiety disorder may be afraid to sleep at a friend’s house or even stay at a daycare center or attend a birthday party. They have nightmares about separation and may try to climb into bed with their parents at night. They may express fears that if they are apart, their parents will die by accident, illness, or crime, or they themselves will be lost or kidnapped. Threatened with separation, they cry, cling to their parents, throw tantrums, and develop physical symptoms—headaches, stomachaches, and sore throats.
Separation anxiety disorder is oft en first diagnosed at age 6 or 7, when a child goes to school. Some children develop the disorder around age 12, on moving from elementary to middle school. The problem is more common in girls, and it is associated with depression and other anxiety disorders, especially social anxiety (incapacitating shyness) and panic disorder. A recent national survey found a lifetime rate of 4%.
Anxiety disorders run in families, and twin and adoption studies show that heredity is a factor in separation anxiety disorder. Some children, probably for genetic reasons, are "behaviorally inhibited." Even at the age of four months, their hearts beat faster, and they shrink back when they encounter strangers. These children are most likely to suffer from separation anxiety disorder as they grow older. Events and circumstances can bring on the symptoms—especially big changes like moving to a new neighborhood, the appearance of a new baby, or a death in the family.
Attachment and separation
Children who are insecurely attached— lacking this confidence in their parents—are more likely to develop anxiety disorders, especially separation anxiety. And parents who are anxious and depressed themselves, or failing in other ways, promote insecure attachment. Some parents are overprotective, reluctant to permit a degree of independence appropriate to the child’s age. Others—people who are abusive, neglectful, or alternating unpredictably between affection and rejection—have not responded consistently to the child’s distress signals. Some simply don’t know how to provide the extra encouragement and special coaching that a timid child may need. Then the child may be afraid to tear himself away, fearing abandonment or exaggerating the dangers in the world outside the family.
Adolescents and adults with separation anxiety may worry about leaving someone close or going away on a trip. They may be anxious when unable to speak to someone close regularly on the telephone. They may fret about events that might separate them from people close to them; have nightmares about being away from home; find it difficult to sleep alone; and even develop physical symptoms before going to work. These symptoms overlap with other anxiety disorders, especially panic disorder and agoraphobia.
In both children and adults, traumatic or complicated grief is related to separation anxiety. The symptoms of this disorder include obsessive yearning after the dead person, imagining that he or she is alive or feeling his or her presence, ruminating about the events preceding the death, and blaming oneself or others for the death. Complicated grief is a greater risk for a person who has always been anxious about parting.
Help in negotiating separation
Parents can be educated about the problem and instructed on how to facilitate therapy, for example, by rewarding the child for overcoming fears. If family troubles are a source of the anxiety or the child is emulating an anxious parent, joint family therapy including the child may help. Studies have found that both individual and group cognitive behavioral therapy are effective, as is added parental involvement.
No drugs are approved for separation anxiety in children. Selective serotonin reuptake inhibitors (Prozac and its cousins), the standard drug treatment for adult anxiety disorder, may be helpful, but little is known about their long-term risks and benefits in children. Physicians have become more reluctant to prescribe antidepressants for children because of concerns about the drugs’ potential for causing suicidal thoughts and behavior. An antidepressant may help if the child with separation anxiety is also depressed.
Symptoms of childhood separation anxiety disorder
Adapted from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 2000.The article above contains foundational information. Articles below contain optional updates.
- Separation Anxiety. Harvard Mental Health Letter, Jan 2007.
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