The words “separation anxiety” are often used during the early toddler years. As toddlers become more aware of their surroundings and begin to understand the world around them, they struggle to separate from caregivers. A toddler who once transitioned to a nanny or daycare setting with ease screams and cries when the caregiver leaves. Though difficult for the caregiver to witness, this part of childhood development is fairly common and there are ways to ease these transitions.

What parents aren’t always prepared for is the return of separation anxiety in “big kids.” Both school-age children and adolescents can struggle with separation anxiety and, in some cases, it can result in Separation Anxiety Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Separation Anxiety Disorder is seen in 4% of children and 1.6% of adolescents, making it the most prevalent anxiety disorder among children under the age of 12.1

While a few tears at drop off and after school meltdowns are fairly common among children and should not raise red flags, symptoms of Separation Anxiety Disorder are a cause for concern. School refusal, sleep disturbance, and excessive distress, when faced with separation, can negatively affect a child’s day-to-day living.

Symptoms of Separation Anxiety Disorder

The defining feature of Separation Anxiety Disorder is excessive fear or anxiety concerning the separation from home or attachment figures. This fear or anxiety exceeds what is to be expected of the individual given his/her developmental level.2

Children and adolescents with Separation Anxiety Disorder experience at least three of the following symptoms:

  • Recurrent excessive distress when anticipating or experiencing separation from home or attachment figures (parents or other caregivers)
  • Persistent and excessive worry about losing an attachment figure or possible harm to them by illness, accident, disasters, or death
  • Persistent worry about experiencing an unexpected separation from an attachment figure (kidnapping, accident, becoming ill)
  • Refusal to go out or away from home, including to school or other activities, due to fear of separation
  • Excessive fear of being alone or without attachment figures
  • Refusal to sleep away from home or go to sleep without being near an attachment figure
  • Nightmares about separation
  • Physical complaints including headaches, stomachaches, and/or vomiting when away from attachment figures

Symptoms of Separation Anxiety Disorder in children and adolescents last for at least four weeks and cause significant distress. School refusal is common with children and adolescents struggling with the disorder and can result in poor school attendance and poor academic functioning. Separation Anxiety Disorder can also impair social relationships and family relationships.

Children with Separation Anxiety Disorder tend to shadow parents around the house, have difficulty playing or being alone, and have difficulty at bedtime. They often require a parent or caregiver to stay with them when they fall asleep and make their way into the parents’ bedroom when they wake during the night.

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Treatment of Separation Anxiety Disorder

There are several commonly used treatments for Separation Anxiety Disorder. With children and adolescents, the sooner you intervene and seek professional help, the more likely your child will experience a positive treatment outcome.

Finding a psychotherapist who specializes in children and adolescents is the first step toward helping your child cope. There are different types of psychotherapy that can be effective in treating Separation Anxiety Disorder.

  • Cognitive Behavioral Therapy (CBT)

    This is the primary type of psychotherapy recommended for treatment of Separation Anxiety Disorder. Through CBT, children learn how to recognize their anxious feelings and their physical responses to anxious thoughts. They learn to identify their triggers and the thought patterns that contribute to their anxious feelings. Through a variety of techniques, children learn strategies to manage their anxious thoughts and feelings and cope with their emotions.

  • Family therapy

    Incorporating parents and other family members into the treatment process can improve outcomes for the child. In family therapy, parents and siblings can learn new ways to interact with the child and tease out patterns of behavior. They can also learn useful strategies to help the child when anxiety spikes.

  • Play therapy

    Younger children can have difficulty connecting the dots between thoughts, feelings, and actions. For these children, play therapy can help them demonstrate and process their emotions and learn to cope with them.

Relaxation training is essential for children and adolescents struggling with Separation Anxiety Disorder. Deep breathing, guided relaxation, and progressive muscle relaxation can also help children and adolescents learn to self-soothe during anxious times.

Some children and adolescents continue to struggle with symptoms of Separation Anxiety Disorder even during treatment. If symptoms continue to negatively affect your child and make it difficult for your child to attend school or even leave the house, medication might help. It’s important to seek a medication evaluation from a child and adolescent psychiatrist, as medications can have significant side effects for children.

How Parents Can Help Children at Home

There are things parents can do to help children and adolescents learn to manage their anxious feelings. Parent support plays a key role in helping kids learn to cope independently. Try these strategies at home to help your child succeed outside of the home:

    • Make a plan to help your child transition to school in the morning (arrive early, act as the teacher’s helper before the other kids arrive, get some exercise on the playground before the bell rings)
  • Help your child reframe anxious thoughts by coming up with a list of positive thoughts (it even helps to write these on cards and put them in the backpack)
  • Write daily lunchbox notes that include positive phrases
  • Avoid overscheduling. Focus on playtime, downtime, and healthy sleep habits
  • Alert your child to changes in routine ahead of time
  • Empathize with your child and comment on progress made


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Last Updated: Aug 6, 2019