Separation Anxiety Disorder (SAD)

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Brief description

Children with SAD suffer excessive distress in the face of actual or imagination separations from their parents. While it is typical for young children to go through some difficult adjustments to separations such as going to school, or staying with a babysitter, children with SAD do not make these adjustments. Some children may feel safe as long as they are home with Mom or Dad, others may be unable to tolerate any physical distance and will shadow their parents around the house. They often find it hard to be on one floor of the house if the parent is not there as well. Many children have trouble going to sleep on their own and may sleep in their parents' room or bed. They may have a lot of trouble on school mornings complaining about aches and pains they feel, or cry, or get very angry. These children are often afraid to go play over other children's houses and can't attend sleepovers, field trips, or drive in someone else's car.

Red flags:
The following symptoms are considered a problem if the interfere with a child's functioning and last more than 4 weeks:

  • Extreme, excessive distress upon routine separations from home, parents and/or loved ones
  • Crying, clinging, panic, disorganization upon separation or in anticipation of separation
  • Worry about losing, or about possible harm befalling parents or other family members
  • Fears of getting lost or being kidnapped
  • Great difficulty separating at night, may attempt to sleep with parent or sibling
  • Physical symptoms (such as headaches, stomachaches, nausea or vomiting) when separation occurs, or in anticipation of separations
  • Inability to be alone; shadows parents around the house, even to the bathroom
  • Inability to be on a separate floor from parent
  • Needing reassurance of parents' presence, panics and calls for parent if parent has left the room or is not visible
  • Disinterest in social activities; preference to spend time with parent
  • Nightmares about harm, danger, death, separation
  • Over-concern with loved one-needs reassurance that loved one is ok
  • Panics if parent late for pick ups; frequent reassurance about pick-up plan
  • Inability to attend birthday parties or field trips independently
  • Frequent "I love you's" and other checking-in mechanisms with parent
  • Great difficulty tolerating disapproval of parent

Treatment focus:

The treatment focus for SAD is quite similar to GAD addressing physical symptoms, identifying anxious thoughts and the development of coping thoughts, and problem solving. Coping thoughts often focus on being safe, knowing parent will return, and other possible explanations for where parent is. With SAD, there is often more direct work with the parents about how to address separation experiences and how to slowly build the child's confidence in being able to be apart from the parents. A first exposure step might be one parent going out for a 15 minute errand while leaving child with the other parent building up to both parents going out and leaving the child with a babysitter for a few hours.

Brought to you by The Children's and Adult Center for OCD and Anxiety.


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