What is Separation Anxiety Disorder?

While separation anxiety is a normal and healthy stage of child development, separation anxiety disorder is not. Some level of separation anxiety can be expected in most children between the ages of one to four, and even in older children at times. When you drop your children off at daycare for the first time, when they go to their first day of preschool, or when they spend their first weekend at Grandma and Grandpa’s house, your child may cry, cling to you, or want to call you from time to time just to hear your voice. These can be totally normal signs that growth and healthy independence are just around the corner! However, if your child has separation anxiety disorder, your child is experiencing a different level of anxiety altogether.

Researchers say that separation anxiety disorder (SAD) is classified as “an exaggeration of otherwise developmentally normal anxiety manifested by excessive concern, worry, and even dread of the real or anticipated separation from an attachment figure.” The difference between “normal” separation anxiety and being diagnosed with SAD depends significantly on both the context of the situation and the age of your child, as well as the level of distress your child experiences when they are away from their primary caregiver. The average age of onset for children with SAD occurs around approximately 6-7 years old. Unfortunately, while SAD is prevalent in 1-4% of the general pediatric population, it often goes undiagnosed. 

Children going undiagnosed with separation anxiety disorder has serious negative implications for their quality of life because not only can this affect your child’s success in social settings, create difficulty in building new relationships, and hinder their ease of learning, but your child can also carry on their childhood separation anxiety disorder (CSAD) into adulthood, also known as adult separation anxiety disorder (ASAD), which is prevalent in about 6.6% of the U.S. adult population. So, how do you know if your child has “normal” separation anxiety, or separation anxiety disorder? And how can you help your child overcome it?

Signs Your Child May Have Separation Anxiety Disorder

If your child is experiencing any of these symptoms, you may want to monitor their behavior to determine whether you should talk to their doctor about separation anxiety disorder:

1) Not wanting to fall asleep. If your child is refusing to fall asleep at night or refusing to sleep away from you, they could have anxiety about you leaving them when they are asleep, as well as feelings of dread or panic about when you inevitably have to drop them off at school or daycare the next morning. Many anxious thoughts and feelings could be racing through your child’s mind at night, such as being concerned that you will not be there when they wake up, so severely delayed sleep, crying, or tantrums at night before bed can be a sign of separation anxiety disorder.

2) Not wanting to go to school. The same can be true if your child repeatedly and consistently cries about, or physically resists, going to daycare or school. While not wanting to go to school can have other implications, such as not being academically challenged enough or being bullied, if your child clings to you and does everything in their power to not let you leave them at school over a long period of time, this could be a telling sign of onset SAD.

3) Clinging to parents and other caregivers. Your child may cling to you, cry, or have a tantrum for several minutes on the first day or even the first couple of weeks that you drop them off at school or leave them with a new caregiver. This can be a sign of normal and healthy attachment to you or other familiar guardians while they learn to trust their new caregivers and settle into their new environment. However, if your child’s clinginess and tantrums continue to escalate over days or even weeks, they may have SAD. One of the first signs of SAD can be your child following you around the house everywhere you go, constantly clinging to your legs or wanting to be in your lap more often than not, or showing extreme distress whenever you try to leave the house.

4) Constant worrying about adults not coming back. If your child has a habit of asking where you or your partner are going and when you will be back, this could simply be a display of normal curiosity. However, if your child constantly cries whenever one of you leaves the house or even the same room they are in within your house, your child may have SAD. Children with SAD may also ask further questions about whether you will definitely be coming back and express great concern about how they can know for sure that you will be coming back to them.

5) Constant fear that bad things will happen to a caregiver or themselves. A common fear of children with SAD is that something bad will happen to their primary caregiver. If your child is constantly concerned that something will happen to you while you two are apart that will cause you to never be able to see them again, this is one of the most common signs of SAD. Your child could conversely be worried that something bad will happen to them, causing them to never be able to see you again as well. This could be expressed concerns of someone taking them away from you permanently (such as being kidnapped or a government agency taking away custody), or a fear that they will get lost and never be able to find their way home to you again.

6) Consistent complaints of headaches, stomach aches, nausea, chest pain, shortness of breath, or dizziness. If your child has consistent complaints of headaches, stomach aches, or other physical ailments that occur just before a situation in which you two will be separated, these could be legitimate physiological symptoms of the anxiety your child is feeling. Your child’s anxiety can cause these symptoms of feeling physically ill, which are only exacerbated by their anticipation of separation from their primary caregiver. On the other hand, your child can be feeling anxious about separation and only claim they feel these physical symptoms in hopes that you will stay with them and care for them for the day, when in reality their body feels relatively healthy.

Common Causes of Separation Anxiety Disorder

Now that the warning signs of separation anxiety disorder have been highlighted, it is also important to note the common root causes of SAD. While these causes have been shown to cause the most distress among children with SAD, your child’s SAD diagnosis could be caused by other, less dramatic situations, which is why it is important to always consult with your child’s pediatrician or a licensed child counselor!

1. Insecure attachment to adults. One of the many causes commonly found in children diagnosed with SAD is an insecure attachment style to their primary caregiver or other influential adults. In one 2004 study of infant-parent attachment, “secure attachment” is described as such: 

“Infants whose caregivers consistently respond to distress in sensitive or ‘loving’ ways, such as picking the infant up promptly and reassuring the infant, feel secure in their knowledge that they can freely express negative emotion which will elicit comforting from the caregiver.”

If a child doesn’t feel free to express negative emotions as an infant due to consistently receiving a negative response from their primary caregiver, they may develop SAD later in life.

2. Overly accommodating or protective caregivers. Does your child react negatively to having independent play time, preferring to cling to your leg rather than have some time alone? If they are used to being coddled, held, tended to, and the center of their caregiver’s attention every waking moment of the day, they likely will not respond well in moments when their caregiver isn’t available. If your child doesn’t learn how to self-soothe as an infant, they won’t easily be able to self-soothe and explore their independence as a toddler and beyond.

3. Stress or unpredictability in the home. If a child’s life at home doesn’t provide stability and predictability, such as a guardian coming and going from the home for days or weeks at a time, a child can experience intense distress every time an unpredictable guardian leaves. Children thrive in consistent environments, with stable daily routines!

4. A drastic change in their environment. Sometimes SAD can be triggered simply from having a change in your child’s environment! We as adults know that moving to a new house or new school can be a nerve-wracking experience. If your child recently had a significant change in their daily life, this can cause SAD because you are their one constant in life and a source where they receive instant comfort!

Read on to part two of our two-part series on child separation anxiety disorder for physician-approved techniques on how to lovingly and effectively help your child with separation anxiety! Part two will offer guided tips for you and your child to use in social settings such as daycare or school for healthy separation, and teach you how to know when you should get your child clinical help with separation anxiety disorder.