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Separation Anxiety Disorder in Children: Symptoms, Causes & Treatment

Separation Anxiety Disorder in Children

Separation anxiety disorder is a chronic psychological condition that occurs when a separation from a loved one (i.e. parent, relative, close friend, etc.) causes a child to become overly anxious, apprehensive and/or “panicky.” In addition, it is common for children with this condition to develop an intense fear of monsters, nighttime, animals, kidnappers, heights, the unknown, car accidents, death, burglars or other situations that they deem dangerous or harmful to loved ones.

Separation anxiety symptoms may include: a reluctance to go to school or attend public events, temper tantrums when separated from loved ones, preoccupation with death and dying, clinginess, illogical fear of abandonment and a “doom and gloom” mentality. 

It can be quite frustrating to watch your child go through separation anxiety. Moreover, it can be especially challenging to watch your child grapple with separation anxiety disorder. In most cases, separation anxiety subsides in a quick time; but in some cases, the anxiety persists through adolescence. 

Most, if not all, children experience some degree of separation anxiety. The difference between “normal” separation anxiety and separation anxiety disorder is that “normal” separation anxiety is a temporary response to being separated from a loved one or placed in a new and unfamiliar environment, while a separation anxiety disorder is a long-term condition that interferes with the child’s ability to function at school and at home.

Mild separation anxiety is a “normal” part of the development process. In fact, this type of anxiety not only prepares children for temporary separations, it also helps build their self-esteem and self-confidence.

Children who exhibit symptoms of separation anxiety disorder are more likely to have a preoccupation with death and dying. These children may also have a habit of avoiding school or other public venues. In other words, they may throw tantrums when it is time to go to school or attend social events. Refusing to attend school can cause a decline in grades and social isolation (i.e. reclusivity).

Moreover, children with this condition may report feeling unloved. These children may also state that they want to die. Furthermore, the thought of being separated from their loved ones may cause them to lash out (i.e. kicking, biting, hitting, etc.) in anger at the person or people they hold responsible for the separation. In addition, young children may report seeing supernatural beings like: ghosts, angels, demons, monsters and/or aliens.

Approximately 5% of American children, between the ages 7 and 11 years old, experience some degree of separation anxiety when separated from a loved one or confronted with an unfamiliar situation. Although this type of anxiety typically occurs in children under the age of 12, it can also affect teenagers, and in some cases, young adults. In fact, approximately 2% of American teenagers have or will experience separation anxiety at some time during their development.

This type of anxiety generally affects females and males equally. While it is normal for an adolescent (i.e. child or teenager) to experience temporary separation anxiety, if it persists, reoccurs or worsens over time, it may signal a separation anxiety disorder.

Children who exhibit separation anxiety disorder symptoms should be examined by a trained mental health professional who can teach them how to manage and/or improve their condition.

This article will help you better understand separation anxiety and get to the root of separation anxiety disorder in children, so you can help your child live a carefree and confident life. This article will also help you determine what treatment can best help your child overcome a separation phobia.

Symptoms of Separation Anxiety Disorder in Children

Separation anxiety disorder symptoms vary depending on the child’s mental and physical health, family dynamics or age. One of the main differences between “normal” separation anxiety and separation anxiety disorder is that separation anxiety disorder interferes with a child’s ability to function. In other words, this condition prevents children with disorder from experiencing “normal” emotional and social growth and development.

The intense fear prevents these children from thinking and behaving like children. Even the thought of being away from loved ones terrifies anxious children to the point that they are paralyzed with fear. During a separation-related anxiety attack, these children may also complain of physical ailments such as: a headache or stomachache. It is important to note that “normal” separation anxiety is temporary, while a separation anxiety disorder is chronic (i.e. recurrent).

Listed below are common symptoms associated with separation anxiety disorder in children:
  • Refusal to go to school and/or attend social events: Children with separation anxiety disorder will do whatever it takes to avoid going to school or attending a social event (i.e. a party, get-together, holiday celebrations, etc.). These children are afraid to leave loved ones for fear that something tragic will happen to them.
  • Reluctance to go to sleep: It is not uncommon for children with this condition to be reluctant to go to sleep, either during nap time or at bedtime. In fact, many children with separation anxiety disorder complain of feeling tired and sleepy during the day because they were unable or unwilling to go to sleep at night. These children believe if they go to sleep they will not wake up or a loved one will die – leaving them alone.
  • Chronic aches and pains: Children with separation anxiety disorder may constantly complain of physical ailments like: stomachaches, headaches or migraines, muscle aches or cramps, etc. when separated from a loved one or faced with a new or unfamiliar situation. These ailments may “pop up” before or during the separation.
  • Clinginess: Children with separation issues may mercilessly cling to a loved one. They may also follow the loved one around the house – never letting that person out of their vision. If the loved one leaves, these children may experience an anxiety attack.
  • Unrelenting fear that a loved one will be harmed or killed: One of the most common fears associated with separation anxiety disorder is an unrelenting fear that a loved one will be harmed or killed. This not only creates feelings of hopelessness and helplessness, it also triggers an anxiety attack. These children obsess and worry that something horrible will happen to loved ones outside of their presence. For example, children with this condition may constantly worry that a parent will be hurt or killed in a car accident.
  • Illogical fear of abandonment: It is common for children with separation anxiety disorder have an illogical fear of abandonment. In other words, children with this condition may fear that something will happen to loved ones that prevent them from returning. For example, these children may worry that their mother will be killed, die from illness, be kidnapped or simply leave and not return.
  • Chronic Nightmares or Night Terrors: Children with separation anxiety disorder may experience nightmares or night terrors, in which “bad things” happen to loved ones. These “bad things” may include death, murder, injuries, etc.

Causes of Separation Anxiety Disorder in Children

One of the best ways to help your child effectively cope with separation anxiety disorder is to determine the cause of the condition. Offering children with this condition love and support can go a long way in helping them feel more confident, secure and self-assured.

Although the cause of separation anxiety varies, factors like growth and development, chemical imbalances, genetics and normal bodily reactions can contribute to its development and progression.

Listed below are possible causes of separation anxiety disorder in children:

Healthy Growth and Development: This may sound odd, but separation anxiety is an essential part of the “normal” aging process. In other words, temporary separation anxiety is not only healthy, but important for a child’s growth and development. During the infancy stage of development, babies develop a fear of sudden movements and loud noises. This fear comes in handy as the children grow because it protects them from danger.

It is also “normal” for infants and toddlers to experience distress when separated from a loved one (i.e. parent or caregiver). Although this can be unnerving for parents, it is a sign of healthy growth and development. Temporary separations not only teach your child how to function independently, they also help your child develop self-esteem and self-confidence..

Chemical Imbalances: Chemical imbalances can also cause separation anxiety in children. In other words, a chemical imbalance in your child’s brain can trigger separation anxiety attacks or separation anxiety disorder. Neurotransmitters like dopamine and serotonin (brain chemicals that transmit messages from the brain to tissues and organs) help regulate your child’s thoughts, emotions and behaviors.

A neurotransmitter imbalance can cause mood swings, depression and anxiety. Children who experience anxiety attacks every time you leave them or who become physically ill (i.e. tummy aches, muscle aches, fatigue, insomnia, headaches/migraines, etc.) at the thought of being separated from you – may need professional help.
 
Genetics and Environmental Influences: Although, it is not a proven fact, genetics and environmental influences appear to contribute to separation anxiety in children. In other words, some children have a higher risk of developing separation anxiety than others. Why? If a mental illness or psychological disorder (i.e. anxiety disorders or depression) runs in your family, your child will have a higher chance of developing a similar, if not the same, condition.

In particular, if you have a family history of anxiety, your child may be more susceptible to developing separation anxiety or separation anxiety disorder. Moreover, if fear or anxiety is modeled within the home, your child will more than likely exhibit those same behaviors. Furthermore, children who were excessively clingy or irritable as babies may have a harder time separating from loved ones than children who were even tempered as babies.

Automatic Bodily Reactions: As mentioned previously, it is “normal” for children to experience some degree of separation anxiety. This anxiety is temporary, and typically subsides the children “settle down” and relax. This anxiety stems from a natural, automatic bodily reaction (i.e. fight & flight mechanisms) to a perceived danger, which in this case is the fear of losing a loved one and being abandoned. The fear of harm or danger provokes a natural reaction such as: a racing heart, dilated pupils and perspiration.

The purpose of this reaction is to alert the children to a possibly dangerous situation so they can protect themselves. These children may not understand what is happening to them and become fearful and anxious. If this reaction occurs every time the children are separated from loved ones or confronted with a new and unfamiliar situation, they may begin to associate being separated from loved ones with this automatic bodily reaction. It is important to note that separation anxiety should decline as the children age and start to feel more independent, exploratory and protected.

Treatments for Separation Anxiety Disorder in Children

Contrary to popular belief, separation anxiety is a “normal” part of childhood development. During this phase, children become worried, concerned or anxious when separated from their parents or placed in an unfamiliar situation or environment.

It is quite common for children under the age of three to develop mild separation anxiety. As children age, they may experience separation anxiety as a result of a medical condition, changing schools, relocating to another state or country, starting a new school, going through a divorce, losing a family member, friend, pet or gaining a new sibling.

Mild cases of separation anxiety rarely require treatment, but moderate-to-severe cases (that interfere with the child’s ability to function) can require counseling or medications.

Treatment for children with moderate-to-severe separation anxiety may involve helping them understand why they are experiencing separation anxiety, improving their self-esteem and self-confidence and reassuring them that the separation is only temporary. Remember, mild separation anxiety is healthy and “normal.” It is only when it gets to the point, that it interferes with your child’s ability to function that you should seek medical advice.

The main purpose of separation anxiety treatment is to help your child overcome illogical or excessive fears, worries and concerns. These children need to feel loved and protected in their environments (i.e. school, home or church.) in order to trust themselves and others. Moreover, these children must feel confident that they will see you again, if separated.

The treatment plan may consist of psychotherapy, lifestyle changes, medications or a combination of all three. One of the most common psychotherapeutic treatments for separation anxiety is cognitive behavioral therapy. This treatment method helps children understand how their thoughts influence their behaviors.

During a cognitive-behavioral therapy session, the therapist helps these children restructure their thought processes so that they can behave in a healthier and more positive way. Family therapy is another highly effective way to treat separation anxiety in children.

This treatment approach involves the whole family in the treatment process. During a family therapy session, the therapist helps the family improve its communication and problem-solving skills so that issues can be resolved in a healthier and more productive way. In other words, the purpose is to improve family dynamics so that these children feel more confident and secure within their family context.

The therapist also educates family members on separation anxiety and teaches them ways (i.e. activities and exercises) to help these children overcome their fears, worries and phobias. In some cases, the therapist may suggest that their diets be altered, a set bedtime be established or exercises be incorporated into their daily routine.

It is important to note that in some cases, sugary, fatty or salty foods can trigger or aggravate anxiety attacks. In addition, not getting enough sleep or exercise can cause a child to become anxious or panicky. If psychotherapy and lifestyle changes do not work alone, the therapist may recommend (depending on the age of your child), anti-anxiety or anti-depressant medications.

These medications are only used in severe separation anxiety cases. When medications are used to treat separation anxiety in children they are normally combined with psychotherapy (i.e. individual, groups or family counseling) and lifestyle changes. Anti-anxiety and antidepressant medications have serious side-effects so they are typically the last case option.

Psychotherapy

Cognitive Behavioral Therapy
 
A treatment that is beneficial for children with separation anxiety is cognitive behavioral therapy (CBT). A cognitive-behavioral therapist teaches children how to identify their triggers and recognize the signs of separation anxiety so that they can counter the effects. In other words, children are taught how to connect their feelings with their behaviors. The therapist teaches these children healthier and more positive coping skills for when they are separated from you. The purpose of these coping skills is to prevent or alleviate anxiety. A cognitive behavioral therapist may also incorporate play therapy (i.e. puppets, dolls, Lego, trucks, figurines, paints, etc,) into the counseling sessions as a way to help these children express themselves and model new skills and behaviors.

Family Therapy
 
As mentioned previously, family therapy is highly effective in helping children overcome separation anxiety. A family therapist examines the entire family in an effort to understand why the child is experiencing separation anxiety.

Is there dysfunction within the family?
Child abuse or neglect?
Is the child adopted?
Has the child been placed in multiple foster homes?
Does the parent spend time with the child?
Does the family have a history of mental illness?
Does the child have any health problems?
Are there other children in the home?
Is the family going through a divorce or remarriage?
Did someone close to the child die recently?

A family therapist can provide the family with the tools needed to help these children work past their separation fears and worries. It is important to remember that separation anxiety is not just the child’s problem, it is the whole family’s problem.
 
Stress-Management Techniques

Desensitization
 
Stress-management techniques can be especially helpful for children suffering from separation anxiety. One particularly effective stress-management technique is desensitization. This treatment modality teaches children how to cope with separation anxiety by assigning increasingly difficult tasks for them to complete. These tasks involve fears, worries, concerns and phobias.

A mental health professional assigns anxiety-provoking tasks such as: spending 60 minutes away from you, 120 minutes away from you, a few hours away from you, a day away from you, etc.) until the children do not experience an anxiety attack every time they are separated from loved ones. Over time they become more comfortable being away from you.

Relaxation Techniques

Relaxation techniques are very valuable when treating children with separation anxiety. These techniques may involve: deep breathing exercises, meditation, writing in a journal, calling a friend or practicing yoga. These relaxation techniques can help children relax when they feel an anxiety attack approaching and when they are separated from you.

Medications

While psychotherapy, lifestyle changes and stress–management techniques may be sufficient when treating some children with separation anxiety, other children may also benefit from medications. Although the U.S. Food and Drug Administration (FDA) have not sanctioned specific medications for the treatment of separation anxiety in children, some FDA medications, used to treat other child-related mental health conditions, have shown success when treating children with separation anxiety.

The FDA allows medical professionals to determine whether or not a child-related psychotropic medication is an appropriate treatment for separation anxiety disorder.

As mentioned previously, psychotropic medications (i.e. anti-depressants and anti-anxiety medications) are only used in severe cases of separation anxiety disorder. Medications that are sometimes prescribed to children with severe separation anxiety include: Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft and Tofranil. Research suggests that the most effective treatment for severe cases of separation anxiety in children is a combination of psychotherapy and medication.


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