Recognizing Separation Anxiety Disorder in Children

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Recognizing Separation Anxiety in Children

Jillian is a typical eight year old. She’s in third grade, likes her teacher and has three best friends in her class. After school, she likes playing soccer and going to ballet lessons. Right before Jillian started third grade, her parents noticed that her behavior began to change. 

In previous years, Jillian had no problems when it was time to leave to go to school. After summer break when it was time for her to start third grade, she threw tantrums and refused to go to school. When her parents were able to coax her to go to school, her teacher reported that Jillian was a good worker and got along well with others but seemed to have a lot of anxiety about being away from home and experienced headaches pretty often throughout the school day. 

When her parents plan to go to the grocery store while Jillian is at ballet lessons, she seems very nervous and worried and refuses to go to her lesson unless one of her parents accompanies her and stays throughout the lesson. More and more, her parents notice that Jillian seems increasingly unable to participate in extracurricular activities and events with children her own age when they are not there with her. 

When Jillian’s parents took her to the pediatrician, the pediatrician listened to descriptions of Jillian’s behavior and referred her to a child psychiatrist. The psychiatrist conducted a mental health evaluation and diagnosed Jillian with Separation Anxiety Disorder (SEPAD). Jillian will go on to continue treatment under the care of the psychiatrist. The psychiatrist can use the well-known evidence-based treatment of cognitive behavioral therapy (CBT) to help Jillian work through the anxieties and side effects of SEPAD.

What Is Separation Anxiety Disorder?

Separation Anxiety Disorder (SEPAD) is a particular kind of anxiety disorder that is distinct from other kinds such as Generalized Anxiety Disorder or Panic Disorder. SEPAD is recognized as a mental health disorder and can be treated in order to better control symptoms and difficulties that may result from this condition.

SEPAD is a condition that is characterized by an exaggerated reaction of nervousness, anxiety, or fear in reaction to the reality or imagined thought of being separated from a close figure like a parent, guardian, or partner. SEPAD can be diagnosed in adults, but for a long time it was primarily only diagnosed in children. Today, SEPAD is still most prevalent amongst children and affects more girls than boys.

Children with SEPAD will experience worry and fear when separated from their parents or guardians. They may worry about getting lost and permanently separated from their family or they may believe that something bad will happen to their parental figures when they are away from each other.

Symptoms of SEPAD:

  • Difficulties saying goodbye to parents
  • Excessive complaining or throwing tantrums when it’s time to separate
  • Worrying that something bad will happen to the parents when the child is away
  • Inability to be without a parent, even following them around the house at home
  • Stress and nightmares about a family tragedy
  • Exaggerated sense of needing to be in contact with the parents and know their whereabouts
  • Refusal or avoidance of events or activities without the presence of a parent
  • Difficulty sleeping at night without the accompaniment of a parent
  • Headaches
  • Stomachaches
  • Dizziness

separation anxietySEPAD is distinctly different from separation anxiety. Separation anxiety is a separate condition that is actually a very normal and expected condition that affects many young children. Separation anxiety is entirely ordinary and is considered part of the developmental process in children. According to Stanford Children’s Health: “Nearly all children between the ages of 18 months and three years old have separation anxiety and are clingy to some degree.”

Separation anxiety becomes more an issue and concern when children who are a little bit older, such as eight-year-old Jillian, have these concerns about separation from their family when going to school, clubs, or sports. According to Mayo Clinic, children usually outgrow any normal separation anxiety by age three. As an eight year old, Jillian’s case is more concerning because normal separation anxiety should not still be a typical factor or concern at her age.

SEPAD is a much more severe condition than separation anxiety. SEPAD will hamper a child’s developmental progress in a more serious way than normal separation anxiety. The disorder can inflict extreme stress and worry, preventing the child from participating in any usual childhood experiences, thus creating some obstacles to normal, healthy development.

A child needs to be experiencing symptoms of SEPAD for four or more weeks in order to be diagnosed with SEPAD. Unlike separation anxiety, SEPAD is not a condition that children will grow out of. Usually some form of treatment for separation anxiety is required in order to address this condition.

What Causes SEPAD?

The exact causes of SEPAD are not always easy to determine, especially when one attempts to give a general explanation for all SEPAD diagnoses in children.

Research into the origin of SEPAD remains forthcoming, but currently, most institutions recognize several factors that may play a role in the development of SEPAD in children. Mayo Clinic, for example, explains that SEPAD may be triggered by life stress that may result from some kind of separation from a parent or loved one. Genetics is also cited as a potential variable that could leave a child predisposed to developing SEPAD.

Stanford Children’s Health explains the causes of SEPAD in terms of two different factors: environmental and biological. They report that a child who inherits anxious tendencies could be more prone to SEPAD. Chemical imbalances (norepinephrine and serotonin) may also play a role in the development of this condition. If a child experiences a traumatic event or observes anxious behaviors or social anxiety disorders displayed by other loved ones, parents, or guardians, those events may also make a child more prone to developing SEPAD than others.

Diagnosing SEPAD in Children

To properly identify and diagnose a child with SEPAD, a child must be seen by a psychiatrist or another mental health professional. As is common with most mental health conditions, mental health evaluations that evaluate behavior and thought processes are used to diagnose mental illness and other conditions.

separation anxiety disorderSometimes, SEPAD can cause physical symptoms like headaches, dizziness, and stomaches. If you suspect your child may have SEPAD and they are experiencing physical symptoms, the best course of action is to first meet with your child’s pediatrician. This way—just like our story about Jillian—the pediatrician can hear the whole story and listen to your concerns. It’s important that a pediatrician can rule out any other potential conditions before referring someone to a child psychiatrist or psychologist for a mental health evaluation.

Don’t hesitate to consult with your child’s pediatrician if you have concerns about your child’s behavior or health! Remember: SEPAD is not really a condition that you can grow out of. Even adults can suffer from this condition. Treatment is important to help manage this condition and can be very effective in doing so! By seeking help from a pediatrician or mental health professional, you can help ensure your child remains in good health.

Types of Treatment and Other Kinds of Help for Children With SEPAD

Like many other mental health conditions, SEPAD is usually treated through the use of psychotherapy. Sometimes, a particular case of SEPAD may warrant the use of medication. A child psychiatrist or child psychologist will assign medication if a child truly needs it and could benefit from it.

Psychotherapy involves discussion between the therapist and the child about the condition and the kinds of feelings, thoughts, and behaviors that the child exhibits as a result of the condition. A therapist will help the child understand the condition and can assist the child in learning new methods of coping and engaging in healthy behaviors.

Cognitive Behavioral Therapy: 

Cognitive behavioral therapy (CBT) is one of the most common evidence-based forms of psychotherapy. This kind of therapy is used in the treatment of a variety of mental health conditions and addiction treatment. In CBT, the therapist will address an individual’s negative or inaccurate portrayals of reality alongside negative patterns of thinking. 

The basic idea behind CBT is that behaviors and thinking are learned. Therefore, a person has the potential to unlearn negative and harmful thought patterns and replace this kind of worst-case scenario thinking with more positive and realistic thoughts and behaviors. CBT is particularly helpful in learning how to manage stress and negativity in a healthy way. The overall goal of CBT is to help the patient reverse negative mindsets and learn the tools needed to handle complex and difficult situations with a healthy attitude and actions.

Medication: 

Medication is commonly associated with therapy, but it’s important to keep in mind that medication isn’t suitable for everyone! Just because an individual has a certain condition, medicine is not necessarily the best course of action for their individual situation. Each individual and situation is unique and every qualified healthcare professional should be able to recognize when medication is appropriate for a patient.

For children with severe cases of SEPAD, medication can be helpful in controlling symptoms. Medication, however, is not a wonder cure or ultimate solution to SEPAD. Usually, psychotherapy is the first approach to SEPAD treatment. If a therapist believes medication could help a patient make greater progress, then medication might be prescribed. Together, medication and psychotherapy can help ensure successful treatment and control symptoms more effectively.

A common category of medication that is prescribed for SEPAD are called selective serotonin reuptake inhibitors (SSRIs). SSRIs are antidepressants that work to boost and regulate serotonin levels. Several mental illnesses can cause chemical imbalances in the brain that lead to conditions like depression or severe anxiety disorders. This kind of medication is not typically prescribed for young children and is usually reserved for older children and adults due to side effects and other risk factors.

Family support: 

Parents or guardians who have a child that struggles with SEPAD can play an active and supportive role in the treatment process. One of the first steps is taking action. If you think your child displays some tendencies of SEPAD and has been having a difficult time engaging with typical childhood activities like sports, school, and spending time with children their own age, you should seek the opinion of your child’s pediatrician. By seeking help early on, you can get your child treatment faster and can ensure your child will continue to grow and develop with a better quality of life. 

family supportParents and parental figures can also support your child by taking the advice of the pediatrician or child psychologist. Sticking to the plan of treatment will ensure that your child is engaging with the most effective individualized treatment for their condition. Remaining consistent is much better than sporadically seeking treatment or distributing medication. Especially in regards to medication, randomness should be avoided as much as possible.

Parents should feel free to ask the child’s therapist any questions or concerns they have regarding their child. A therapist will create a plan of action tailored to your child, but they can also offer advice on how you can best support your child during this time. For example, common suggestions for parents include remaining calm and consistent and practicing saying goodbye in order to reassure the child.

Feel free to also keep track of situations in which your child seemed particularly stressed or agitated. Identifying potential triggers can help your child’s therapist better understand the situation. The more a therapist knows, the more accurate and helpful psychotherapy can be. Remain engaged in your child’s treatment!

Education:

Whenever any mental health condition or physical illness affects your child, it can be a scary and worrying experience. One of the best things parents can do to relieve some anxiety and ensure the child’s treatment is being properly addressed is to research and read up on the condition that affects the child! 

Continuing to learn more about SEPAD—or any condition—can help parents better understand their child’s behavior and ways of thinking. Recovery in mental illness or physical illness is almost always made better and more positive when loved ones are closely involved in supporting the individual through continued learning. Through continued education on SEPAD, parents can learn about a variety of ways to support and encourage their child. 

Differences Between Separation Anxiety and Separation Anxiety Disorder

Separation Anxiety DisorderSeparation anxiety and separation anxiety disorder (SEPAD) may seem to have lots of overlap. So what’s the difference between them? Are they just different names for the same thing?

It’s true that separation anxiety and SEPAD have similar symptoms. Children with separation anxiety can get irritable, disgruntled, and nervous if they are separated from their parents. Children with SEPAD can also feel anxious and become nervous during a separation from their parents.

The differences lie in the severity of the conditions and the demographics that are affected. 

Separation anxiety is a completely normal part of being an infant or a toddler. The condition is nothing to be overly concerned about. Usually children can experience separation anxiety up to the age of three, at which point they typically outgrow it. For example, think of the general example of a mother letting her friend take care of her two year old while she goes to a doctor’s appointment. It’s a fairly common assumption to think that the child might get cranky and irritated when he’s apart from his mother, maybe even rebuffing any attempts from his mother’s friend to soothe him. It’s not hard to imagine that the child will calm down once he’s reunited with his mother.

Society has come to recognize that very young children are simply very attached to their parents and can be clingy. This is probably not a great surprise to anyone who has or knows someone with young children. Young children often demand a lot of attention and desire to be very physically close to their parents.

SEPAD is much more severe of a condition than separation anxiety. Even the name distinguishes the two conditions, with the more severe one being labeled a disorder. SEPAD is not a part of normal childhood development. This disorder can be brought on by trauma, an inherited predisposition to anxiety, or chemical imbalances in the brain.

Separation anxiety becomes a disorder when it begins to interfere with a child’s ability to properly engage in usual activities like going to school or going to a friend’s birthday party. When a child has SEPAD, they will experience a very exaggerated and inflated sense of anxiety and nervousness at leaving their parents. They may even be concerned that something bad, like a car accident, could happen to their parents during the time they are separated. The child may have a lot of difficulty in doing activities without the presence of a parent. As in Jillian’s example, a child could throw a tantrum and refuse to go to school so that she doesn’t have to leave her parents.

Frequently Asked Questions:

What is separation anxiety in child development?

Separation anxiety is a normal condition during a child’s development until the age of about three. Separation anxiety is considered a very ordinary and expected behavior in toddlers and infants. Many children this age have a tendency to be a clingy to a certain degree with their parents and guardians. They may become fussy and irritable if they are separated from their parents or caretakers. Usually children outgrow this condition.

Separation anxiety should not be mistaken for separation anxiety disorder (SEPAD). These two conditions share some similar traits but are entirely unique conditions.

SEPAD can plague children or adults, though children disproportionately are diagnosed with SEPAD. SEPAD involves many of the same worries as separation anxiety, such as worrying about separation from a parent or guardian. However, SEPAD is much more severe and intense than typical separation anxiety. SEPAD is more likely to make a big impact on how a child can function at school or attend extracurricular activities. The worries and anxieties about separation from parents are also much more excessive and extreme than the worries of separation anxiety. Unlike separation anxiety, SEPAD is not a condition that can be outgrown; it requires professional treatment to be properly managed and cared for.

Can a seven year old have separation anxiety?

Children usually grow out of separation anxiety by age three. If you believe your child has recently been behaving in a different matter and displaying a lot of anxiety in their daily life, you may want to consult your child’s pediatrician on the matter.

Lingering separation anxiety could be an indication of separation anxiety disorder. Don’t hesitate to contact your pediatrician for a thorough examination. The earlier that SEPAD can be treated, the better it is for your child in the long run.

How do you help a child with separation anxiety?

Separation anxiety is a normal part of child development. Children generally grow out of separation anxiety once they reach age three. Most young children have a certain degree of clinginess and desire being around their parents a lot. Try to engage your child in activities when you are around them. Sometimes, young children also exhibit a desire to be held or picked up and get agitated if you put them down. It’s never a negative thing to hold your child when they desire to be held.

If your child doesn’t grow out of separation anxiety and increasingly can’t attend things like soccer practice or sleep alone at night without your company, your child might have separation anxiety disorder. If this is the case, your child will need psychotherapy to help treat the condition. Consult with your child’s pediatrician for a proper diagnosis and treatment plan.

Why is my five year old having separation anxiety?

Separation anxiety is typical in very young children. By age five though, most children have usually grown out of the expected phase of separation anxiety. It’s possible that there may be some factors that have triggered this reaction of separation anxiety. Try to identify instances in which your child seems most stressed and observe what seems to help soothe your child.

If you think the separation anxiety is getting to a point that is very detrimental to the way your child engages with the world through school or other activities, consult your pediatrician for a proper examination. There could be many factors at play that trigger separation anxiety. Your pediatrician may have some recommendations that can help your child, or the pediatrician might recommend you to a child psychologist if the situation warrants it.