Separation Anxiety Disorder

Separation anxiety symptoms are considered developmentally inappropriate after toddlerhood; average age of onset of symptoms consistent with disorder is 7. Separation anxiety disorder may be diagnosed when symptoms that cause clinically significant distress in social, academic, or other important areas of functioning persist longer than four weeks in children/adolescents.
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Characterized by...
At least three of the following behavioral or physical symptoms:​​
     Behavioral Symptoms:

• Extreme distress concerning separation from attachment figures that is developmentally inappropriate, or occurring past toddlerhood.
  • Worry that something bad will befall the caregiver while they are separated (illness, injury, disasters etc.)
  • Worry about an event which could cause separation (being kidnapped, becoming lost etc.)
  • Fearful of sleeping away from the caregiver 
  • Fearful of remaining at home alone
  • Fearful of going places without the caregiver
• Constant need for reassurance of caregiver’s presence and/or safety
  • Frequent calls and checking-in with caregivers
• Difficulty sleeping at night
  • Children may try to sleep with parents or a sibling
  • Children may be reluctant to attend camp, sleepovers at friends
• Children may have repeated nightmares about separation situations (ie: family destroyed by fire, murder, or other catastrophe)

     Physical Symptoms:

• Complaints of physical symptoms occur when separated from attachment figures or anticipated separation from attachment figures.
• Can include: headaches, dizziness, nausea, vomiting, or heart palpitations

Differential:

• Social anxiety disorder and other anxiety subtypes
• Panic disorder
• Agoraphobia
• PTSD
• ODD
• Depressive disorder
• Bipolar disorder
• Conduct disorder
• Bereavement
• Personality disorders

Separation Anxiety Screening and Assessment

Child Report:

• Screen for Child Anxiety Related Disorders (SCARED) - Child Form (ages 8-18)
• Spence Children’s Anxiety Scale - Child Version (ages 3-18)
• Separation Anxiety Avoidance Inventory for Children (SAAI-C) (ages 4-18) ($)

Parent/Caregiver Report:

• Screen for Child Anxiety Related Disorders (SCARED) - Parent Form 
• Spence Children's Anxiety Scale - Parent Version
• Spence Preschool Anxiety Scale - Parent Version
• Separation Anxiety Avoidance Inventory for Parents (SAAI-P) ($)

Treatment

Psychotherapeutic:

• Cognitive Behavioral Therapy (first-line treatment)
• Mindfulness-based Stress Reduction Therapy
• Mindfulness-based Cognitive Behavioral Therapy
• Meditation

 Pharmacological (off-label for children under 6):

• Selective Serotonin Reuptake Inhibitors (SSRIs)

Articles

Resources

For Parents/Caregivers:

• What to Do (and Not Do) When Children Are Anxious (Child Mind Institute)
• Separation Anxiety Disorder in Children, Summary for Families (Cedars Sinai Hospital)
• Coping Cat for Parents
• Worry Wise Kids

Organizations for Professionals:

• Anxiety and Depression Association of America
• American Academy of Child & Adolescent Psychiatry Anxiety Disorders Resource Center

*Separation anxiety content originally curated by Catherine Cheely, BSN, RN, CPN and M. Ryan Goldstone, BSN, RN.