Separation anxiety disorder (SAD)

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Separation anxiety disorder (SAD) is defined as excessive worry and fear about being apart from family members or individuals to whom a child is most attached. Children with separation anxiety disorder fear being lost from their family or fear something bad happening to a family member if they separated from them. Symptoms of anxiety or fear about being separated from family members must last for a period of at least four weeks to be considered SAD. It is different than stranger anxiety, which is normal and usually experienced by children between 7 and 11 months of age. Symptoms of SAD are more severe than the normal separation anxiety that nearly every child experiences to some degree between the ages of 18 months and 3 years of age.


Anxiety disorders are believed to have biological, family, and environmental factors that contribute to the cause. A chemical imbalance involving two chemicals in the brain (norepinephrine and serotonin) most likely contributes to the cause of anxiety disorders. While a child or adolescent may have inherited a biological tendency to be anxious, anxiety, and fear can also be learned from family members and others who frequently display increased anxiety around the child. A traumatic experience may also trigger anxiety.

Whose affected

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears are developmentally inappropriate concerning separation from home or family, separation anxiety disorder may be present. Reports indicate that SAD occurs equally in males and females. The first symptoms of SAD usually appear around the third or fourth grade. Typically, the onset of symptoms occurs following a break from school such as Christmas holidays or an extended illness. It is estimated that about 4 percent of younger children have SAD, while the estimate for adolescents is slightly lower. Children of parents with an anxiety disorder are more likely to have an anxiety disorder.


The following are the most common signs of SAD. However, each child may experience symptoms differently. Symptoms may include:

  • Refusal to sleep alone
  • Repeated nightmares with a theme of separation
  • Excessive distress when separation from home or family occurs or is anticipated
  • Excessive worry about the safety of a family member
  • Excessive worry about getting lost from family
  • Refusing to go to school
  • Fearful and reluctant to be alone
  • Frequent stomach aches, headaches, or other physical complaints
  • Muscle aches or tension
  • Excessive worry about safety of self
  • Excessive worry about or when sleeping away from home
  • Excessive "clinginess," even when at home
  • Symptoms of panic or temper tantrums at times of separation from parents or caregivers

The symptoms of separation anxiety disorder may resemble other conditions or psychiatric problems. Always consult your child's physician for a diagnosis.


A psychological assessment is usually recommended to diagnose anxiety disorders in children or adolescent, with therapy generally being the first line of treatment. If the patient is in danger due to suicidal thoughts or attempts and/or severe impairment in functioning, then they might need medication first to stabilize them. Parents who note signs of severe anxiety in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.


Specific treatment for separation anxiety disorder will be determined by your child's physician based on:

  • Your child's age, overall health and medical history
  • Extent of your child's symptoms
  • Your child's tolerance for specific medications or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Anxiety disorders can be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy for the child, with the focus being to help the child or adolescent learn skills to manage anxiety and to help master the situations that contribute to the anxiety. Some children may also benefit from treatment with antidepressant or anti-anxiety medication to help them feel calmer. Parents play a vital, supportive role in any treatment process. Family therapy and consultation with the child's school may also be recommended.


Preventive measures to reduce the incidence of separation anxiety disorders in children are not known at this time. However, early detection and intervention can reduce the severity of the disorder, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with separation anxiety disorder.