About Separation Anxiety Disorder
This disorder develops in cases where a child does not move beyond the normal separation anxiety phase of development. This phase normally begins at around the eighth month of life, when a child begins to associate home and safety with a primary caregiver. As part of the child’s normal development, he or she will show signs of stress and anxiety when away from home or when separated from the primary caregiver. In a supportive home environment, where the child has the chance to bond with other adults, separation anxiety will begin to reduce at around two years of age.
Sometimes, however, signs of separation anxiety persist beyond this point. A child with separation anxiety disorder becomes extremely stressed and anxious when away from home, or when separated from the primary caregiver. The child also tends to have unrealistic ideas about the safety of the primary caregiver, and often worries unreasonably about the safety of the caregiver when he or she is absent. The child might have tantrums or other behavioral problems when separation is imminent, and might show physical signs of stress such as nausea, headaches, stomach pains, dizziness, and vomiting.
The main treatment for child separation anxiety disorder is one or more types of therapy. Generally the most effective treatment is cognitive therapy. In this treatment, the child learns new ways of thinking that allow him or her to adapt to separation from home and the primary caregiver. These new ways of thinking replace the abnormal thinking that is characteristic of the disorder. In addition the child learns how to identify and recognize anxiety and other symptoms, and learns behavioral techniques that aid in staying calm.
In psychodynamic therapy, the child participates in two or more sessions per week for several months, in which he or she is allowed to work through feelings about separation and stressful situations, and work on new types of behavior. For younger children, play therapy is the mode of treatment whereas a combination of talk therapy and play therapy might be used for older children.
Other types of therapy include family therapy and social therapy. In family therapy, information about the child’s family is gathered by the psychotherapist, to look at whether any dysfunctions in the family are contributing to the child’s separation anxiety. Social therapy works on a similar principle, but in this case the child’s wider social network is also examined. This latter approach is often considered in cases where a child is refusing to attend school, to determine whether events at school are contributing to the child’s anxiety.
Medication is used as a treatment for child separation anxiety disorder only when symptoms are particularly severe, or when therapy-based treatments are ineffective. Medication is rarely used as the sole treatment.
Anti-anxiety medications such as Xanax can be used for children with severe symptoms, but due to the risk of dependency these are used only as a short-term medication.
Antihistamines are sometimes used to treat children with abnormal sleeping patterns, as these medications help induce drowsiness. These can be used in conjunction with behavioral modification for children who have separation anxiety issues at bedtime.
Antidepressants are used in some situations to help reduce anxiety and stress; however these are typically a last resort, especially in young children, due to possible risks and side effects. SSRI antidepressants are used only for treating children over 12 years of age, and only under very close supervision, due to safety concerns over side effects. Tricyclic antidepressants are approved for use in children in some countries (including the U.S.)
Bettina E Bernstein, DO, for eMedicine: Anxiety Disorder, Separation Anxiety and School Refusal
Children’s Hospital, Boston: Separation Anxiety Disorder
Mental Health Help Guide: Separation Anxiety Disorder
National Institute of Health MedlinePlus: Separation Anxiety
Psych Net UK: Separation Anxiety Disorder Information Sheet
Watkins, C., and Brynes., G. Anxiety Disorders in Children and Adults. From Northern County Psychiatric Associates web site.