Separation Anxiety Disorder

Written by Shannon Johnson
Medically Reviewed by George Krucik, MD

What Is Separation Anxiety Disorder?

Separation anxiety is a normal part of childhood development. It occurs in babies between 8 and 12 months old. It usually disappears around age of 2.

Some children have symptoms of separation anxiety during their grade school and teenage years. This condition is called separation anxiety disorder or SAD. Three to four percent of children suffer from SAD (Walker, et al., 2011).

SAD tends to be indicative of general mood and mental health issues: Around one-third of children with SAD will be diagnosed with mental illness as an adult. Approximately half of childhood mental health referrals are for suspected SAD (Ehrenreich, et al., 2008).

Symptoms of Separation Anxiety Disorder

Symptoms of SAD occur when a child is separated from parents or caregivers. Fear of separation can also cause anxiety-related behaviors. Some of the most common behaviors include:

  • clinging to parents
  • extreme and severe crying
  • refusal to do things that require separation
  • physical illness, such as headaches or vomiting
  • violent, emotional temper tantrums
  • refusal to go to school
  • poor school performance
  • failure to interact in a healthy manner with other children
  • refusing to sleep alone
  • nightmares

Risk Factors for Separation Anxiety Disorder

SAD is more likely to occur in children with:

  • a family history of anxiety/depression
  • shy, timid personalities
  • low socioeconomic status
  • overprotective parents
  • a lack of appropriate parental interaction
  • problems dealing with kids their own age

SAD can also occur after a stressful life event such as:

  • moving to a new home
  • switching schools
  • divorce
  • the death of a close family member

How Is Separation Anxiety Disorder Diagnosed?

Children that experience three or more of the above symptoms may be diagnosed with SAD. Your doctor may order additional tests to confirm the diagnosis.

Your doctor might also watch you interact with your child. This shows whether your parenting style affects how your child deals with anxiety.

How Is Separation Anxiety Disorder Treated?

Therapy and medication are both used to treat SAD. Both treatment methods can help a child deal with anxiety in a positive way.


The most effective therapy is cognitive behavior therapy (CBT). With CBT, children are taught coping techniques for anxiety. Common techniques are deep breathing and relaxation.

Parent child interaction therapy is another way to treat SAD. Parent child therapy can be broken into three main treatment phases:

  • Child-Directed Interaction (CDI), which focuses on improving the quality of the parent/child relationship. It involves warmth, attention, and praise. These help strengthen a child’s feeling of safety.
  • Bravery-Directed Interaction (BDI), which educates parents about why their child feels anxiety. Your child’s therapist will develop a bravery ladder. The ladder shows situations that cause anxious feelings. It establishes rewards for positive reactions.
  • Parent-Directed Interaction (PDI), which teaches parents to communicate clearly with their child. This helps to manage poor behavior.

The school environment is another key to successful treatment. Your child needs a safe place to go when he or she feels anxious. There should also be a way for your child to communicate with you if necessary during schools hours or other times he or she is away from home. Finally, your child’s teacher should encourage interaction with other classmates. If you have concerns about your child’s classroom, speak with the teacher, principle, or a guidance counselor.


There are no specific medications for SAD. Antidepressants are sometimes used in older children with this condition. However, children must be monitored closely for side effects.

Effects of Separation Anxiety Disorder on Family Life

Emotional and social development are both seriously affected by SAD. The condition can cause a child to avoid experiences crucial to normal development.

SAD can also affect family life. Some family problems associated with SAD are:

  • family activities that are limited by negative behavior
  • parents with little to no time for themselves or each other, resulting in frustration
  • siblings that become jealous of the extra attention given to the child with SAD
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