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Childhood Separation Anxiety Disorder


Criteria for childhood separation anxiety disorder

Okay. One thing to keep in mind is that when the DSM V came out, separation anxiety disorder was moved to an anxiety disorder and is no longer considered a disorder of childhood. That is actually pretty important for adults who might suffer from this, not so important if you are trying to learn how to help your child. 

Lets look at the actual diagnostic criteria for Separation Anxiety Disorder. This is straight from the DSM V. 

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.

3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.

4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.

7. Repeated nightmares involving the theme of separation

8. Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

D. The disturbance does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and, in adolescents and adults, is not better accounted for by panic disorder with agoraphobia.

To help you figure out if this is a problem without understanding all the clinical terms, ask yourself some questions.

Is your child:

  • Refusing to go to school?
  • Having trouble sleeping or nightmares?
  • Complaining about frequent stomachaches or other physical problems?
  • Afraid to be away from you?
  • Worrying about you being harmed?
  • Having some much worry that it is interfering with your work or daily activities?
  • Afraid they might come home and you won’t there?
  • Forcing you to alter your activities or work schedule because of the anxiety?

If this describes your child he or she is most likely suffering from Childhood Separation Anxiety Disorder.

Well, that’s almost true. What if your child is seven months old? What if they are four and just started preschool?

It is important to consider both the circumstances and your child’s age when evaluating how much of a problem the anxiety actually is.

Click here if you are interested in learning about treatment for separation anxiety

There is a distinction between childhood separation anxiety and childhood separation anxiety disorder. The information below will help you to decide when to seek help.

Infant or Baby Separation Anxiety

Developmental issues are important to consider when evaluating if separation anxiety is a problem. Infants normally will show signs of distress during the latter half of the first year of life, the second and sometimes third year of life as well. This can be normal and is not necessarily a disorder. Actually, baby separation anxiety is a sign of healthy attachment to the mom, so this is a good thing!

In fact, if we didn’t see some anxiety in infants during a mom's absence  it would probably be of more of a concern. However, if you feel your baby’s anxious behavior is excessive and is not easily alleviated  trust your instinct, it may be a sign that your child is in some kind of physical distress. Check in with a medical doctor at this point if you have still concerns. Click here to learn more about infant separation anxiety

Separation Anxiety in Toddlers

Separation Anxiety is also  often seen around toddler years and preschool ages as well. Children may act distressed or upset at this age when separated from you but this usually is temporary. If your child can be involved in other activities, or the separation anxiety goes away soon after you leave, then this is probably not separation anxiety disorder.Many children experience symptoms of anxiety when separated from their caregiver, especially when they are going to preschool or kindergarten. Moms experience separation anxiety too! This is healthy and normal, but watch your anxiety! Any of your anxiety can add to childhood separation anxiety.

If your child's anxiety is not disruptive to your life or your child's daily routine it may not be too concerning. However, anxiety at this age that is more disruptive to daily routine such as excessive crying after you leave preschool for hours at a time,  refusing to  refusing participate in play activities with other children, especially if this persists for weeks  after they start preschool is more concerning behavior.  

It is time to seek some help. Sometimes in two to three sessions, you will have some solid techniques that help to alleviate the stress your child is going through. Therapy can also provide you with the peace of mind to know it isn’t a major mental health issue.

Even in the most serious of cases therapy is very likely to help with childhood separation anxiety. Just make sure if you seek help that you find a professional that specializes in, or has experience working with young children.

CHILDHOOD SEPARATION ANXIETY IN OLDER CHILDREN

If your child is five or six and separation anxiety develops suddenly, seems severe and disruptive, or has lasted throughout the toddler years well into kindergarten you should probably be concerned. A good way to tell if it’s a problem is to ask yourself if it is interfering in your child’s ability to be happy and successful at home, socially or academically.

If your child avoids pleasant activates that other children engage in, is afraid to go to school, or frequently expresses irrational fears about you dying or leaving them, the anxiety should be evaluated by a professional. The good news is most kids with separation anxiety disorder who get help are just fine!

Click here if you are interested in learning about treatment for separation anxiety

Click here if you are interested in learning about sleep problems related to childhood separation anxiety

Click here if you are interested in learning about causes of childhood separation anxiety

Teenage Separation Anxiety

Teenage and young adult separation anxiety, although less common, can also be an issue. This anxiety can prevent teens from establishing the independence and self reliance that is so critical at this point.

Most cases of teenage separation anxiety may have had  an earlier onset that went undiagnosed. Although the The DSM IV stated that the onset of separation anxiety must be prior to 18, changes in the DSM 5  include a late onset and are beginning to  expand our understanding of the illness. We are awaiting new research to help us with treatment advances. 

Teens and with separation anxiety:

 Avoid being alone away from the person they are attached to

 May be preoccupied with being separated from a loved one

 May worry about someone they care about being harmed

 May worry about some event occurring which may cause separation from their loved one

 May want to stay by the loved ones side and be resistant to situations which cause them to be separated from the person they are attached to.

You can imagine how disruptive this could be to a teens life! Not only may these feelings prevent them from going to school, but from working, having normal social and peer relationships, and accomplishing the tasks of normal adolescents.

Adolescence is a time when children separate from their parents and define their individuality, and they come to identify more with their peers that their family. Separation anxiety can disrupt this entire process and prevent the normal development necessary for teens to become happy fulfilled and productive adults.

It may be that panic disorder or social anxiety is confused with separation anxiety and so it is important that the teen’s anxiety is actually a result of fear of being separated from an attachment figure for that diagnosis to be made. Regardless of the actual diagnosis, a teen experiencing anxiety which is interfering in their ability to be successful in any arena of their life needs help!

Treatment for teens with separation anxiety

Treatment for separation anxiety in teens consists of:

  • Cognitive Behavior Therapy:The teen is taught how to  change the unhealthy thinking that contributes to anxiety, the teenager is helped to recognize the thoughts driving the anxiety, and learn how to interfere in that cycle by changing those thoughts. Other techniques would be taught to help the teen cope with and manage that anxiety.
  • Relaxation/ Systematic Desensitization:The teen is taught how to relax physically while imagining the fearful situations that cause them so much stress thus aiding in the decrease of the anxiety. This is called systematic desensitization.
  • Exposure: The teen is encouraged with the help of the family to gradually face and conquer the fears that are preventing them from enjoying a normal life.

Check out our online facebook support community for parents of kids with mood disorders 

American Psychiatric Association. (2013). Anxiety Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

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