Separation Anxiety Disorder (SAD) is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. Children with generalized anxiety disorder spend a lot of time worrying about a lot of different things. Children with social anxiety disorder feel very anxious around other people, including their peers, because they are afraid of embarrassing themselves or being disliked. Children with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. Children with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like symptoms or embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. Children with a specific phobia are very afraid of one or more objects or situations, such as flying, heights, animals, or seeing blood. Children with separation anxiety disorder are afraid of being away from a certain person or people, often a parent, often because they are afraid that something bad might happen to them or the other person if they are separated. Children with selective mutism do not speak in situations where it would be socially appropriate for them to speak, such as at school.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the child is only excessively fearful of narrow range of objects or situations. In other anxiety disorders, like GAD, the child may feel anxious a great deal of the time or about a lot of different things.
SAD is a psychiatric disorder that affects approximately 4% of children and 1 - 2% of adolescents. SAD is characterized by significant, developmentally inappropriate fear and anxiety about being separated from significant attachment figures (often one or both parents).
A child with SAD will persistently and excessively demonstrate at least three of the following for a period of a month or longer:
Children with SAD may express separation fears by "clinging" to attachment figures, including following them from room to room around the house, or requiring an attachment figure to follow the child when he or she moves to a new room. Children with SAD may refuse to fall asleep alone and may routinely move to a parent or sibling's bed in the night.
SAD severity can range from relatively mild to severely impairing. In severe cases, SAD can lead to inability to attend or perform well at school or in sports, or to engage in normative developmental activities such as sleepovers or summer camp.
SAD may cause conflict and frustration for attachment figures, who may feel pressured to comply with the child's demands for constant closeness. Many children and adolescents with SAD also have other psychiatric conditions, most commonly other anxiety disorders, including generalized anxiety disorder and specific phobia.
Little is known about the factors that contribute to the onset of SAD. SAD sometimes emerges after a major life stressor, particularly a loss (for example, loss of a relative or pet or moving to a new neighborhood or school). SAD is characterized by some respiratory abnormalities and increased rates of atopic disorders (allergies; asthma); however, any causal relationship is as yet unknown. SAD is thought to be heritable; however, a genetic predisposition to SAD does not mean that a child will develop SAD.
SAD is treatable. Currently there are no published guidelines specifically for pediatric SAD. However, published guidelines for pediatric anxiety, broadly defined, are provided by the Society of Clinical Child and Adolescent Psychology. The American Academy of Child and Adolescent Psychiatry offers historical practice parameters (last updated in 2007); new parameters are being developed.
Clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in SAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric SAD:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.
Clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in SAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric SAD:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.