While every case of separation anxiety disorder is unique, most are treatable with therapy or a combination of medication and therapy.
It’s natural for a baby to cry when they’re separated from their primary caregivers or for a young child to feel anxious about going off to preschool. In fact, separation anxiety is an expected milestone among infants and toddlers alike.
Separation anxiety usually begins at around 6 months, peaks at around 18 months, and subsides by about 3 years of age.
When an older child experiences separation anxiety beyond the preschool years, it may be a sign of separation anxiety disorder (SAD).
Separation anxiety disorder is characterized by excessive fear and worry either during, or in anticipation of, separation from your most significant other(s). It’s the most commonly diagnosed anxiety disorder among children.
While many people view separation anxiety as a developmentally inappropriate condition that occurs during childhood, it can also occur in adolescence and even adulthood.
As research from 2014 notes, symptoms of separation anxiety disorder during childhood can seep into adulthood and lead to other anxiety disorders. As such, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), lifted its age restriction on separation anxiety disorder to include adults.
Although separation anxiety disorder is most commonly diagnosed in childhood, the DSM-5 provides diagnostic criteria for both children and adults. Symptoms, which are frequent and recurring, include the following:
- concern that something bad will happen to a parent or loved one
- complaints of physical symptoms, such as headaches, stomachaches, nausea, or vomiting
- distress when separation is anticipated
- fear of being alone without major attachment figures at home
- frequent nightmares about separation
- reluctance to leave the house
- reluctance to go to sleep without major attachment figures nearby
- school avoidance or refusal
- worry that a tragic event will occur that will cause separation
According to Amy Nasamran, PhD, a licensed psychologist and parent coach specializing in child behavior and anxiety at Atlas Psychology, most cases of separation anxiety can be treated with therapy. She says that therapy for separation anxiety is a type of experience-based learning that medication alone cannot provide.
“For young children with anxiety, being exposed to the fear paired with the right support and coping skills is the most effective way for them to learn how to overcome the fear,” Nasamran says. “It’s important for children to experience and learn that they can separate from a parent, as well as learn coping skills to help overcome the fear and anxiety.”
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a well-researched, evidence-based method of treatment for separation anxiety disorder. A therapist teaches a child valuable skills, such how to recognize feelings of anxiety and any corresponding physical symptoms that may arise.
Children are taught to identify their anxious feelings during circumstances involving separation and are given tools and coping strategies to adapt to the situation. The therapist also teaches the child to evaluate their successes as they effectively cope in these scenarios, after which the child receives praise and validation from both the therapist and their parents.
While the therapist works directly with the child during CBT sessions, parents may also attend as needed. For some younger children, however, CBT may not always be the best form of treatment.
“While there’s some evidence that CBT can be effective for kids at this age, some concepts related to thoughts, feelings, and behaviors can be abstract and difficult for kids to grasp,” Nasamran says. “They may learn some coping skills and helpful information, but without parent support, will have a very difficult time generalizing skills to different situations.”
Parent-child interaction therapy (PCIT)
Nasamran, who is also a certified parent-child interaction therapist, says that during PCIT sessions, therapists teach parents certain therapeutic skills they can use with their child to support them in their everyday routines. Under the guidance of the therapist, parents essentially become their child’s therapist at home to ensure they’re supported both in and outside of their therapy sessions.
“Parents learn how to create a strong and secure bond with their kids, reinforce appropriate behavior and coping skills, build children’s self-esteem, and even decrease tough behaviors like tantrums and aggression,” Nasamran says. “Parents learn how to decrease anxiety symptoms and set their children up for success in feared situations.”
Research shows that PCIT, along with its separation anxiety adapted form — CALM (Coaching Approach Behavior and Leading by Modeling) — is effective for children ages 2 to 7 years old.
Parent-mediated therapy (PMT)
Similar to PCIT, parent-mediated or parent-implemented therapy (PMT) sessions involve a mental health professional teaching therapy techniques to parents, which they will practice with their child.
Nasamran says that parent-mediated (or parent-implemented) therapy can be helpful during situations in which a child is experiencing anxiety, depression, or other behavioral concerns related to a mental health condition.
Depending on a child’s situation, family therapy may be considered to flesh out any family dynamics that may be a source of the child’s separation anxiety. Parents, siblings, or other members of the household or immediate family may attend. These sessions may also help to address how the child’s separation anxiety is affecting the rest of the household.
In some cases, a combination of therapy and medication is recommended for the treatment of separation anxiety disorder.
While there’s evidence that medication alone can effectively treat anxiety disorders in adults, more research is still needed to show that medication can have the same effect in youths.
Research from 2012 shows that early intervention is key to treating separation anxiety disorder in children.
When separation anxiety disorder is left undiagnosed or untreated, symptoms could worsen and interfere with daily life and social activities.
“Untreated separation anxiety can also lead to more mental health concerns like general anxiety, panic disorder, or depression, and can prolong into adolescence and adulthood,” Nasamran says.
If you and your child are working together with a PCIT- or CBT-certified therapist, you may already have a number of tools and resources available to you to teach your children how to cope with their separation anxiety.
There are also many kid-friendly mindfulness apps you can try that are accessible and easy to use at home in between therapy sessions. Nasamran recommends the popular meditation app Headspace as well as Breathe, Think, Do with Sesame.
In addition, Nasamran recommends the following do’s and don’ts to help your child manage their symptoms:
What to do
Nasamran suggests practicing your coping skills with your child in short bursts when everyone is calm so that learning can be facilitated.
“Even 3 to 5 minutes daily is helpful to building a routine and proficiency with the skills,” says Nasamran. “That way, when anxiety strikes, your child will already have skills to fall back on instead of trying to learn them during a challenging moment.”
Consider rewarding your child when they successfully employ their coping mechanisms. If they’re going to school and are nervous about separating, you might help them get settled, remind them of any fun activities in store that day, and tell them you’re excited to hear all about it when they’re back at home.
What to avoid
It’s best to avoid rescuing your child from feared situations. While this may lower their anxiety in the moment, it also teaches them that there’s something to potentially be afraid of and prevents your child from learning how to overcome their fears.
It’s also recommended to avoid any sudden changes in plans or other surprises. If your child exhibits negative behavior as a result of their separation anxiety or fear, try to diffuse the situation without punishing them for their actions, if possible.
To treat your child’s separation anxiety, start by getting involved. The more of an active participant you are in your child’s treatment, the more likely your child will be to start finding relief from their symptoms.
“Kids are brilliant and so capable of learning, but they also need support from the most important adult(s) in their lives to learn how to generalize skills to outside-of-therapy situations,” says Nasamran.
When armed with the right skills and tools, you can support your child as they learn how to identify and manage their symptoms and, with practice and patience, teach them how to apply their coping tools in real-life situations on their own.
You can also try connecting with the following resources for additional support: