Pediatric Separation Anxiety Disorder

What is Separation Anxiety Disorder?

Separation Anxiety Disorder (SAD) includes extreme anxiety (fear and nervousness) concerning separation from parents or loved ones. Although some amount of anxiety related to separating from parents is normal, children and teens with SAD react to separation with feelings and behaviors that are not considered normal for their age. Their sense of safety is highly dependent upon their parent being present. Children with SAD often have other fears as well, including fear of thieves and robbers, car accidents, the dark or going places where they will be separated from their parents. Children and teens with SAD sometimes refuse to go to school. Symptoms must be present for at least one month for a child or teen to be diagnosed with SAD.

These are some of the most common symptoms of SAD in children:
- Refusing to go to school by themselves
- Refusing to sleep alone
- Needing a great deal of attention from parents and hanging onto their parent, in and out of the home
- Feeling extremely afraid of being left alone
- Feeling obsessively afraid of dying or death
- Having extreme concern for parents’ health and well-being
- Having nightmares or night awakenings
- Crying, screaming or having tantrums (emotional outbursts) when left alone
- Expressing sudden physical complaints (for example, stomachaches or headaches) when they fear a parent is leaving
- Expressing anger or violent behavior if they cannot be with their parent
At Children’s National Hospital, child psychologists, psychiatrists and other mental health professionals may interview the child or teen and his or her parents. We may have the patient and family fill out questionnaires about different aspects of the child’s or teen’s life, including physical health concerns, difficulties at school or behavior with friends and family.
Following a full assessment, a member of the Children’s National care team will discuss treatment options with the child or teen and his or her family. Both cognitive behavioral treatment (CBT) and certain types of medicines are helpful in treating SAD in children and teens.
- CBT includes working with a therapist to help children (and families) learn how to cope with feelings of anxiety. During treatment, children learn by gradually facing their fear of separation and learn that anxiety can be managed.
- Parents are also taught skills for managing children’s anxiety.
- Children also may learn good sleep habits.
- Medicines used most often to treat SAD are called selective serotonin reuptake inhibitors (SSRIs). These medicines affect neurotransmitters (nerve cells in the brain that carry signals) linked to anxiety.

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