When Is Separation Anxiety a Serious Problem? What’s Normal and When to Be Concerned
All children may get upset when a parent or caretaker leaves, but when is this behavior typical and when is it something more concerning? Dr. Jack Maypole, M.D., Educational Advisory Board Member for The Goddard School has some guidance.
Worries and fears are a natural part of development for all children. Children who follow a typical developmental progression will manifest some separation anxiety around 7-12 months. This is especially likely to occur when their primary caretakers hand them to someone less familiar or step away from their child. Most of these children can be redirected with mild distraction or soothed quickly by another familiar loved one. In toddlers and preschoolers, children may cry at the school drop-off, but it is usually brief and can be redirected with play or other distractions.
Seasoned clinicians and veteran teachers alike agree: to help children adapt to a playdate or school environment, make such transition times quick and loving. This will support the new caretaker and will avoid sending any unclear signal that mom or dad will come back or linger if the child cries. Leaving fast is better for everybody.
However, if your child gets so upset for so long that their anxiety is interfering with the ability to carry out regular activities, there may be a deeper problem, but don't panic. Anxiety disorders, including separation anxiety, are the most common childhood onset psychiatric disorders, with 10-30% of kids experiencing some type of anxiety disorder at some point in childhood.
Some children arrive on the planet significantly impacted by separations, even during the toddler years. Younger kids may show a reluctance to fall asleep without being near a parent. Other times, they may show excessive distress (e.g., tantrums) when separation is imminent, or report nightmares about separation-related themes. Older children may claim homesickness (i.e., a desire to return home or make contact with the primary caregiver when separated) when at school. Older kids and even teens may report frequent physical or somatic symptoms, such as abdominal pain and heart palpitations when separated from their primary caregiver.
For a diagnosis of a true separation anxiety disorder, your child must demonstrate at least three of the following:
- recurrent excessive distress when anticipating separation
- persistent reluctance to go to school or anywhere else because of separation fears
- persistent reluctance to be left alone or without major attachment figures in other
- repeated physical symptoms when separation is anticipated
- persistent worrying about losing a major attachment figure
- persistent worry about an untoward event that will lead to separation from a major
- persistent reluctance to go to sleep without being near a major attachment figure
- repeated nightmares about being separated
It is also important to note that what appears to be separation anxiety can sometimes be explained by other issues, such as autism spectrum disorder or phobia, such as agoraphobia or the fear of going outside.
For families struggling with separation, Dr. Maypole recommends keeping a consistent routine when separating whenever possible. For children of any age, consistency and successful separation experiences over time should lessen fear and anxiety over separation from a parent or other beloved caregiver. For children facing more significant challenges with separation, there are some behavioral health approaches that can be used when needed. For example, parent-child interaction therapy has been adapted to treat separation anxiety. Persistence, attention, and a loving approach all work well together.
For most families with children with separation anxiety, those times of tears and crying can be difficult, but thankfully soon become a forgotten ‘phase’ of early childhood. For the small subset of kids who have a separation anxiety disorder, their fears and fussing may become chronic if they are unrecognized or left untreated.
If you are worried that your child may be showing signs of a true separation anxiety disorder, contact your child's primary care provider for further assessment.
Take a deep breath and know that this too shall pass – and that help is available if you need it!