​It’s normal for a young child to get anxious and cry when away from home or separated from a parent or caregiver.

However, when a child persistently displays excessive anxiety and fear in such situations, or simply in anticipation of a separation, the child could be suffering from separation anxiety disorder.

“Separation anxiety disorder is characterised by developmentally inappropriate and excessive fear or anxiety concerning separation from a close caregiver, that persists for at least 4 weeks, and significantly interferes with a child’s school, social activities or overall daily functioning,” says Dr Lois Teo, Senior Psychologist, Psychology Service, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.

Separation anxiety disorder decreases in prevalence from childhood through adulthood, and is the most prevalent anxiety disorder in children younger than 12 years.

Separation anxiety disorder is believed to be caused by a combination of genetic, physiological and environmental factors. The risk increases if one of the parents suffers from an anxiety disorder.

“A child who suffers from a chronic illness or has a long break from school may develop separation anxiety disorder,” says Dr Teo. A traumatic incident such as the death of a family member or a pet, changing schools or shifting homes, can also trigger separation anxiety.

Separation anxiety disorder symptoms

A child suffering from separation anxiety often has a fear of being lost or abandoned. The child may also display excessive concerns about a parent, family member or caregiver, fearing that something “bad” will happen to the person during or because of the separation.

Additionally, the child may display some of the following symptoms:

  • Panic attacks / tantrums when separating from parents or caregivers
  • Fear of being alone
  • Fear of sleeping alone or sleeping away from home
  • Nightmares related to separation
  • Fear of going to school
  • Stomach aches, headaches, muscle aches before separation and at the prospect of separation
  • Excessive concerns about personal safety
  • Excessive "clinginess" while at home
  • Bedwetting

Separation anxiety disorder can be diagnosed based on a detailed psychiatric evaluation of the child.

Difference between separation anxiety disorder and normal separation anxiety

Normal separation anxiety: The child shows anxiety and fear on the first day of school and pleads to stay at home. This behaviour may continue for a couple of days after which the child settles and is able to adjust and engage in schoolwork and play activities.

Separation anxiety disorder: The child displays excessive and persistent fear, anxiety or avoidant behaviours lasting at least 4 weeks. The child may become physically ill and unable to focus on schoolwork. Neither the parent nor the schoolteacher is able to soothe the child’s anxiety.

Separation anxiety disorder treatment

Separation anxiety disorder treatment primarily focuses on helping the child to feel more secure and acquire positive coping skills. Treatment options include:

  • Psychotherapy and cognitive-behaviour therapy (CBT): Therapy is the preferred treatment for separation anxiety disorder. The therapist teaches the child, as well as his family, to:
    • Identify and express feelings of fear and anxiety.
    • Adopt new healthy thought patterns to replace the anxious and fearful ones.
    • Adopt coping strategies such as deep breathing to control the anxiety and relax the body and mind.
  • Family therapy: This focuses on parents and caregivers so that they can support the child during the treatment process. Family support has been found to be very beneficial in the treatment of separation anxiety disorder.
  • Anti-anxiety medication: This may be used in severe cases, in addition to psychotherapy. Such medication is mostly prescribed by psychiatrists.

Most children with separation anxiety disorder improve with therapy, and don’t need medication. They are able to attend school and continue on with their daily activities without much difficulty.

“Early diagnosis and treatment improve the child’s chances of recovery as well as quality of life,” says Dr Teo.

Ref: R14​