Separation Anxiety Disorder
Separation anxiety disorder is characterized by excessive anxiety about being away from home or separated from people to whom the child is attached.
Some degree of separation anxiety is normal and occurs in almost all children, especially in very young children (see Section 23, Chapter 267). In contrast, separation anxiety disorder is excessive anxiety that goes beyond that expected for the child's developmental level. Separation anxiety is considered a disorder if it lasts at least a month and causes significant distress or impairment in functioning. The duration of the disorder reflects its severity.
Some life stress, such as the death of a relative, friend, or pet or a geographic move or change in schools, may trigger the disorder. Genetic vulnerability to anxiety also typically plays a key role.
Symptoms
Children with this disorder experience great distress when separated from home or from people to whom they are attached. They often need to know the whereabouts of these people and are preoccupied with fears that something terrible will happen either to them or to their loved ones. Traveling by themselves makes them uncomfortable, and they may refuse to attend school or camp or to visit or sleep at friends' homes. Some children are unable to stay alone in a room, clinging to a parent or "shadowing" the parent around the house.
Difficulty at bedtime is common. Children with separation anxiety disorder may insist that someone stay in the room until they fall asleep. Nightmares may disclose the children's fears, such as destruction of the family through fire or another catastrophe.
Treatment
Because a child who has this disorder often avoids school, an immediate goal of treatment is enabling the child to return to school. Doctors, parents, and school personnel must work as a team to ensure the child's prompt return to school. Individual and family psychotherapy and anxiety-reducing drugs may play an important role.
 See the sidebar Effects of Stress on Children.
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