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Separation Anxiety

It is normal and even natural for young children to feel anxious when saying goodbye to their parents. Crying, throwing a tantrum, or being clingy are often typical reactions to separation and part of a child’s healthy development [1]. Although the intensity of reactions to separation vary from each child, worrying over leaving a parent/caregiver is normal for children [1]. However, some children experience separation anxiety that does not go away or fade as they get older, even with helpful strategies from parents and caregivers. When separation anxiety becomes excessive enough to interfere with school, friendships, and lasts for months, this may be a sign of separation anxiety disorder [1]. 


What is separation anxiety disorder?

According to the DSM-5-TR, separation anxiety disorder is characterized by developmentally inappropriate and excessive fear/anxiety in regards to separating from individuals the person is attached to [2]. This may be evidenced by recurrent and excessive distress when experiencing separation (e.g., crying, tantrums, bursts of anger), persistent worry about losing attachment figures or harm done to them, persistent worry about events that cause separation, reluctance to go out or away from home, resistance to being alone, refusal to sleep away from home, nightmares about separation, and physical symptoms when separation occurs [2]. 


How common is Separation Anxiety Disorder?

Separation anxiety disorder is one of the most common anxiety disorders in children under 12 and affects boys and girls equally [4]. It is estimated that 4.1% of children will experience a clinical level of separation anxiety [3] and that about 4% will experience separation anxiety during the school year [4]. One-third of  children with clinical separation anxiety will have symptoms persist into adulthood if left untreated [2]. 


Separation anxiety disorder tends to decrease in prevalence from childhood through adolescence and adulthood [2]. The onset of separation anxiety peaks throughout development, which includes entering Kindergarten, between the ages of 7-9, and upon entering either middle school or high school [4]. Therefore, it is important to understand the signs of separation anxiety disorder so we can support children accordingly. 


Signs of Separation Anxiety Disorder

Although separation anxiety disorder may manifest differently across different children, the following are some potential signs of separation anxiety disorder:

  • Recurrent and excessive fear that something may happen to a loved one [1, 2]

  • Persistent and excessive worry about an event that might lead to separation, such as being kidnapped [1, 2]

  • Persistent reluctance/refusal to go to school or away from home [1, 2]

  • Persistent reluctance or refusal to sleep away from home or to go to sleep [1, 2]

  • Experiencing physical symptoms such as headaches or stomach pain at the time or separation or when anticipating separation [1, 2]

  • Repeated nightmares of separation [2]

  • Persistent and excessive fear or reluctance about being alone or not in the presence of an attachment figure [2]

  • Recurrent excessive distress before separation or when experiencing separation [2]


It is also important to seek the help/advice from a psychologist or mental health professional in order to best support your child and to determine whether your child has separation anxiety disorder, or if there are other underlying factors/concerns that should be addressed.


What can parents and caregivers do?

There are various strategies that may be helpful for parents and caregivers to try to help support their child with separation anxiety. The following are some strategies that may be beneficial:



Another helpful strategy is the "three c's" [5]:



Pick a few of the strategies above to try with your child. Remember that every child is different and some strategies may work well for some children, but may not work as well for others. See what works best for your child and yourself and don’t hesitate to reach out to one of our team members if you are experiencing challenges with separation.


Conclusion

Overall, feeling anxious or upset upon separating from a parent or caregiver at a young age is a normal reaction. It is healthy for a child to learn how to separate from their parent/caregiver and helps to foster independence. However, if the fear of separating persists for a long period of time and begins to interfere with daily tasks, school, or friendships, this is when you may want to consider seeking advice from a mental health professional. 


References

[1] Robinson, L., Segal, J., & Smith, M. (2023). Separation anxiety and separation anxiety disorder. HelpGuide. Retrieved from https://www.helpguide.org/articles/anxiety/separation-anxiety-and-separation-anxiety-disorder.htm

[2] American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision DSM-5-TR). Washington, DC: Author.

[3] Ehrenreich, J. T, Santucci, L. C., & Weiner, C. L. (2008). Separation anxiety disorder in youth: phenomenology, assessment, and treatment. Psicologia conductual, 16(3), 389-412. https://doi.org/10.1901/jaba.2008.16-389

[4] Anxiety Canada. (2024). Separation anxiety in children. Retrieved from 

[5] Creed, T. A., Reisweber, J., & Beck, A. T. (2011). Cognitive therapy for adolescents in school settings. New York: Guilford Press.


Blog post written by Kassandra Burk and Dr. Andrea Stelnicki.


The information contained in this blog post is based on a narrative review of available literature. Some studies may have been unintentionally omitted. You are advised to speak with a healthcare professional to determine if the information is appropriate to your specific circumstances.


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