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Separation Anxiety Disorder (SAD)
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:
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Extreme, excessive distress upon routine separations from home,
parents and/or loved ones
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Crying, clinging, panic, disorganization upon separation or in
anticipation of separation
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Worry about losing, or about possible harm befalling parents or
other family members
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Fears of getting lost or being kidnapped
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Great difficulty separating at night, may attempt to sleep with
parent or sibling
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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
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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
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Nightmares about harm, danger, death, separation
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Over-concern with loved one-needs reassurance that loved one is
ok
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Panics if parent late for pick ups; frequent reassurance about
pick-up plan
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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.
