Separation Anxiety Disorder

Medically Reviewed by Renee A. Alli, MD on September 23, 2024
Written by WebMD Editorial Contributors
5 min read

Separation anxiety disorder (SAD) is a condition in which a child becomes fearful and nervous when away from home or separated from a loved one -- usually a parent or other caregiver -- to whom the child is attached. Some children also develop physical symptoms, such as headaches or stomachaches, at the thought of being separated. The fear of separation causes great distress to the child and may interfere with their normal activities, like going to school, playing with other children, eating, or sleeping.

Separation anxiety is normal in very young children (those between 8 and 14 months old). Kids often go through a phase when they’re "clingy" and afraid of unfamiliar people and places. When this fear affects a child over age 6 years, is heavy, or lasts longer than 4 weeks, the child may have separation anxiety disorder.

Separation anxiety affects approximately 4%-5% of children in the U.S. ages 7 to 11 years. It is less common in teenagers, affecting about 1.3% of American teens. It affects boys and girls equally.

Following are some of the most common symptoms of separation anxiety disorder:

  • An unrealistic and lasting worry that something bad will happen to the parent or caregiver if the child leaves
  • An unrealistic and lasting worry that something bad will happen to the child if they leave the caregiver
  • Refusal to go to school in order to stay with the caregiver
  • Refusal to go to sleep without the caregiver being nearby or to sleep away from home
  • Fear of being alone
  • Nightmares about being separated
  • Unwillingness to sleep alone
  • Bed-wetting
  • Complaints of physical symptoms, such as headaches and stomachaches
  • Repeated temper tantrums or pleading
  • Intense fear or guilt

Possible causes and risk factors for SAD include:

  • A significant stressful or traumatic event in the child's life, such as a stay in the hospital, the death of a loved one or pet, or a change in environment (such as moving to another house or a change of schools)
  • Children whose parents are overprotective may be more prone to separation anxiety. In fact, it may not necessarily be a disease of the child but a sign of parental separation anxiety as well -- parent and child can feed the other's anxiety.
  • Children with separation anxiety often have family members with anxiety or other mental health diagnoses, which suggests that a risk of getting the disorder may be inherited.
  • Insecure attachment to parents or caregivers
  • Stress
  • Other anxiety disorders, like panic attacks, social anxiety disorder, phobias, or agoraphobia
  • Children with SAD may also have obsessive-compulsive disorder (OCD) or depression.

The doctor will check your child for signs and symptoms of separation anxiety disorder. If they’re present, the doctor will ask about your child’s medical history and give them a physical exam. 

The doctor will also ask you, the caregiver, to complete screeners or assessments that ask further about behaviors you are observing. These screeners assist with diagnosing separation anxiety disorder and other types of anxiety.

Although there are no laboratory tests to specifically diagnose separation anxiety disorder, the doctor may use various tests -- such as blood tests and other laboratory measures -- to rule out physical illness or medication side effects as the cause of the symptoms.

If they don’t find signs of a physical illness, the doctor may refer your child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illness in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor bases a diagnosis on reports of the child's symptoms and their observation of the child's attitude and behavior.

Treatment is based on the impairment of the child and family. Most mild cases of separation anxiety disorder are treated with therapy that identifies goals and creates a strategy to achieve them and doesn’t need medical treatment. In more severe cases, for example, when the child refuses to go to school, treatment involves more intense therapy, usually by a therapist, and may include the addition of medications. The goals of treatment include reducing anxiety in the child, developing a sense of security in the child and the caregivers, and educating the child and family/caregivers about the need for natural separations. Treatments that may be used include:

  • Cognitive behavioral therapy (CBT): Also known as talking therapy, this is the main form of treatment for separation anxiety disorder. The focus is to help the child handle being separated from their caregiver without the separation causing distress or interfering with function. This therapy works to reshape the child's thinking (cognition) so that their behavior becomes more appropriate. Family therapy also may help teach the family about the disorder and help family members better support the child during periods of anxiety.
  • Medication: Antidepressants or other anti-anxiety medications may be used to treat severe cases of separation anxiety disorder.
  • School intervention: Mental health practitioners at your child’s school can offer therapy to help them manage SAD symptoms and can help foster a supportive environment for the child.
  • What parents can do: Talk with your child’s therapist to better understand how SAD affects them in their daily lives. Make sure your child is able to attend therapy appointments on schedule. Regular treatment will lead to better results. Find out what triggers your child’s anxiety symptoms, and apply therapy techniques to help your child manage their feelings at home or in school.

 

There’s no known way to prevent separation anxiety disorder, but recognizing and acting on symptoms when they appear can ease distress and prevent escalation of symptoms and further impairment. In addition, reinforcing a child's independence and self-esteem through support and approval may help prevent future episodes of anxiety.

Most children with separation anxiety disorder get better, although their symptoms may come back for many years and in various formats, particularly during stressful times. Treatment that starts early and involves the entire family is most likely to be successful.