Separation Anxiety in Children

Separation anxiety is loosely defined as the fear of being away from the primary caregiver. The most common way for children to act out their fears of separation is through tantrums and clinging.

Separation anxiety is a healthy and normal part of your child's development between the ages of 8 and 14 months. Separation anxiety disorder, on the other hand, is a diagnosis for children who fall outside the boundaries of this otherwise normal developmental stage.

While separation anxiety has historically been thought of as an issue in childhood only, the DSM-V updated the diagnosis to be inclusive of adults as well.

Symptoms

The symptoms of separation anxiety as a developmental stage are considered normal until the age of 2 and always include elements that cause the parent to question leaving, including:

• Excessive crying
• Forcefully holding onto the caregiver's body or clothes
• Refusal to engage with a caregiver or other children
• Screaming

Separation Anxiety vs. Separation Anxiety Disorder

It is normal for some older children, particularly those who are shy, to go through a phase of not wanting their parents to leave. However, a caregiver can typically redirect the child to engage in group activities. Children over the age of 2 who don't respond to redirection or demonstrate severe symptoms may be struggling with separation anxiety disorder, an anxiety disorder that includes the following symptoms:

• Age-inappropriate separation anxiety in older children or adults
• Excessive fears or worry that something will happen to either the parent or child while the two are separated
• Flatly refusing to participate in separate activities and inconsolable crying for the duration of the separation
• Headaches
• Stomach distress

Diagnosis

Separation anxiety disorder is a specific psychological disorder that is different from normal separation anxiety, although it can be difficult to tell the difference because symptoms can overlap. While separation anxiety was once considered a condition diagnosed only until age 18, the DSM-5 has expanded the definition to also include adults.

To be diagnosed with separation anxiety disorder, your child must exhibit symptoms for at least six months and they must cause significant stress and impair functioning at home, at school, at work, or with peers.

Causes

While experts have not identified the underlying causes of separation anxiety, there are several external triggers that are known to worsen the anxiety, including:

• New situations that take children out of their routine, including a new caregiver, a recent move, or a new sibling
• Family difficulties, such as marital problems or financial issues, that put stress on the adults in the home can have a negative effect on children
• A family history of anxiety or other mental illnesses

Treatment

While developmentally-appropriate separation anxiety in children doesn't require treatment, separation anxiety disorder may require professional intervention with a trained mental health professional.

Psychotherapy

Psychotherapy or "talk therapy" can help treat your older child with separation anxiety or separation anxiety disorder.

Be sure to gather as much information as possible before your first therapy visit, including details about your child's behavior both when you leave and while you are away. A good therapist will become part of the team that includes you, your child, and the caregiver.

Medication

If psychotherapy is not enough, or if your child is suffering from a co-occurring disorder like depression, an antidepressant medication like a selective serotonin reuptake inhibitor (SSRI) or anti-anxiety medication may be prescribed to help manage severe symptoms.

Coping

Normal separation anxiety is manageable by a joint effort between parents and caregivers. Setting a routine is the most critical component to success. Do not give in to the temptation to sneak away, as this can make children more fearful. The next time your child gets anxious before you leave:

• Explain what will happen in simple, direct terms, including where you're going, who will be in charge, and when you will return.
• Give your child time to adjust by visiting a new school or babysitter's house together a few times. Let them get used to the new person before you leave.
• Remain calm and upbeat and focus on the fun that your child will have; treat the separation as a normal occurrence.
• Say goodbye once no matter how much your child screams or cries, give them a big hug and kiss, say goodbye, and walk out the door. 
• Build on small successes by leaving them for only an hour or two the first day and gradually adding to the length of time, always returning when you promised.