Separation Anxiety Disorder Symptoms & Causes

What causes separation anxiety disorder?

Nearly all children experience brief feelings of anxiety about being away from a parent and display clingy behavior. Typically these normal bouts occur when a child is between 18 months and 3 years old, although older children can have passing feelings of separation anxiety during times of stress. The difference between these normal feelings of anxiety and a disorder like SAD is that a child with separation anxiety disorder will experience an extended and extensive period of fear and distress about being apart from familiar people and places and the degree of anxiety or fear is notably out of proportion to the reality of the situation. Anxiety disorders like SAD are linked to biological, family and environmental factors.

Biological factors
The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.

Family factors
Just as a child can inherit a parent’s hair color, a child can also inherit that parent’s anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. Parents can also contribute to their child’s anxiety without realizing it by the way they respond to their child. For example, allowing a child to miss school when they are anxious about going, likely causes the child to feel more anxious the next school day.

Environmental factors
A traumatic experience (such as a divorce, illness, or death in the family) may also trigger the onset of separation anxiety disorder.

Who is affected by separation anxiety disorder?

About 4 % of younger children have SAD, while the estimate for adolescents is slightly lower. Girls are affected more often than boys.

What are the symptoms of separation anxiety disorder?

Separation Anxiety Disorder (SAD) is a condition that causes a child to feel intense worry and fear at the prospect of being away from family members, other people, and even places (most commonly home) that he cares about. Children with SAD can’t just “put their worries aside” no matter how hard they try. They feel much more anxious, and for a much longer period of time, than other children in the same situations.

Common fears experienced by children with SAD Include:

  • Worry about separation
  • Worry about death or harm to a loved one
  • Worry about something bad happening to herself
  • Worry about being alone
  • Worry about sleep and nightmares

The consistent factor in any worry associated with SAD is that the child’s fear is unrealistic. What she fears will happen is very unlikely to happen.

Physical symptoms usually occur when there is a separation or anticipated separation. They may include:

  • Nausea/ vomiting
  • Quick breathing or difficulty catching one’s breath
  • Muscle aches (especially stomach and headaches)
  • Fatigue

How common are anxiety disorders?

Anxiety disorders are among the most common mental, emotional and behavioral problems affecting children. About 13 out of every 100 children ages 9 to 17 years old experience some kind of anxiety disorder, such as separation anxiety disorder. Approximately 4% of children suffer from separation anxiety disorder.

How can I tell if my child has separation anxiety disorder?

All kids experience some separation anxiety. For infants and toddlers it is a normal stage of development which is connected to developing an attachment to parents and other caregivers. In older children, certain separation fears and worries are typical for their age. For example, let’s say your child is starting his first day of kindergarten. He is likely to show some anxiety and discomfort when getting up and ready for school and going into the school for the first time. He may even cry when he comes home and say he wants to stay home and not return to school. If this period of anxiety is minor (he is comforted by reassurance), lasts only a few days, and is replaced by a return to his normal mood and activities, this is probably normal separation anxiety. However, if your child remains significantly distressed about being away from you during the school day (to the point where he is physically ill, can’t focus, isn’t soothed, and is disrupted in other activities), this may be separation anxiety disorder.

What is the difference between separation anxiety disorder in children and in adults?

Separation Anxiety Disorder is uncommon in adults. With anxiety in general, children usually don’t realize how intense or abnormal their feelings of anxiety have become. It can be difficult for a child to know that something is “wrong.” How can I prevent separation anxiety disorder?

While anxiety disorders such as SAD cannot be prevented altogether, seeking treatment as soon as you notice that your child has a problem can reduce the severity of the problem and improve your child’s quality of life. Some other tips include:

  • Stay calm in front of your child, as she often looks to you for how to react in new and uncertain situations.
  • Avoid providing an excessive amount of reassurance since this may signal more, not less, to worry about.
  • Teach your child how to problem solve, cope, and reassure herself.
  • Limit the avoidance of activities. Though avoidance may temporarily reduce distress, it will allow the anxiety to grow and make things more difficult for your child in the future.
  • Provide support and praise for small victories in separation rather than consequences for the difficulties, since consequences tend to increase anxiety.

What is the long-term outlook for a child with an separation anxiety disorder?

With proper treatment, the majority of children diagnosed with separation anxiety disorder experience a reduction or elimination of symptoms. Symptoms of SAD can recur when new developmental challenges emerge. When treatment is started early and involves the parent as well as the child, the child’s chance of recovery without multiple recurrences improves.

Where can I go to learn more?

Please note that neither Boston Children’s Hospital nor the Children’s Department of Psychiatry unreservedly endorses all of the information found at the sites below. These links are provided as a resource.

Anxiety Disorders Association of America (ADAA)
Anxiety Disorders Resource Center