Separation Anxiety Disorder

Separation anxiety disorder, or SAD, is is a mental health disorder and is defined as excessive worry and fear about being separated from family members or individuals to whom a child is most attached. Approximately 4 to 5 percent of children and adolescents suffer from SAD. Symptoms of SAD are more severe than the normal separation anxiety that nearly every child experiences to some degree between the age of 18 months and 3 years. Symptoms must last for a period of at least four weeks for the individual to be considered to suffer with SAD.

The most common symptoms of SAD include: repeated excessive anxiety about something bad happening to loved ones or losing them; inordinate concern about either getting lost or being kidnapped; constant hesitancy or refusal to go to day care or school or to be alone or without people the child is attached to; persistent reluctance or refusal to go to sleep without being close to a figure of attachment; repeated nightmares about being apart from adult loved ones; and recurrent physical ailments such as headaches or stomach aches caused by the fear of separation. SAD differs from stranger anxiety, which is considered normal and is usually experienced by children aged between 7 and 11 months.

School refusal, or school phobia, may be a symptom of SAD, but it can also be a sign of other anxiety disorders and is not a diagnosis by itself. Anxiety disorders are believed to be caused by a mixture of biological, family and environmental factors. A chemical imbalance of chemicals in the brain (norepinephrine and serotonin) is considered among the reasons of anxiety disorders. A display of anxiety and fear by family members in the presence of the child or the inherited biological tendency to be anxious also contribute to the cause.

A traumatic experience may also touch off anxiety. SAD is more common in children with a family history of anxiety and in children whose mothers are under stress during their pregnancy. Up to 75 percent of children with SAD come from homes of low socioeconomic status. It has been estimated that SAD occurs equally in males and females, with the first symptoms usually becoming apparent around the 3rd or 4th grade. Symptoms usually appear following a holiday break from school or an extended period of illness.

Anxiety disorders in children are diagnosed by a child psychiatrist or other qualified mental health professional following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety in their child or teen can help by seeking evaluation and treatment early to prevent future problems.The assessment most often involves an interview of both the child and the parent. Separate interviews are recommended because children and parents may see the situation differently. Apart from trying to discern specific symptoms of anxiety, the professional will likely attempt to find out whether the child has symptoms of any other mental disorder.

There are no known preventive measures to reduce the frequency of separation anxiety disorders in children. However, the severity of SAD can be reduced by early detection and intervention.The effective treatment of SAD calls for a comprehensive evaluation of the child and family. The treatment may include cognitive behavioral therapy (CBT) to help the child manage anxiety and master the situations that contribute to the anxiety. Antidepressant or anti-anxiety medication may also be prescribed.

Parents play an important role in the treatment process by supporting the child throughout the procedure. Counseling takes precedence over medication in the treatment of milder forms of SAD. Should counseling alone be insufficient in alleviating the symptoms, treatment may consist of a combination of approaches. An amalgam of psychotherapy, medication, and parent counseling are three methods that have been found to be effective in the treatment of SAD. If left untreated, SAD may lead to depression and anxiety problems in adulthood, as well as to personality disorders, in which anxiety is a major symptom.

Separation Anxiety Disorder: Selected full-text books and articles

Intersections with Attachment By Jacob L. Gewirtz; William M. Kurtines Lawrence Erlbaum Associates, 1991
Librarian's tip: Chap. 15 "Attachment, Separation, and Phobias"
Anxiety and the Anxiety Disorders By A. Hussain Tuma; Jack Maser Lawrence Erlbaum Associates, 1985
Librarian's tip: Chap. 20 "Childhood Separation Anxiety and Adult Agoraphobia"
Phobic and Anxiety Disorders in Children and Adolescents: A Clinician's Guide to Effective Psychosocial and Pharmacological Interventions By Thomas H. Ollendick; John S. March Oxford University Press, 2004
Librarian's tip: Chap. 10 "Separation Anxiety Disorder"
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