Behavioural and Emotional Disorders

Separation Anxiety Disorder

Is my child clingy? Or does my child have Separation Anxiety Disorder?

“Mummy… Daddy… Don’t go!” 

Most of us have seen children crying at the gates of a school, clinging to their mother or father, and appearing highly distressed at the thought of being separated from their parents for even a few hours. If you’re a parent, you may have even experienced this firsthand! 

Separation anxiety is a common fear that children experience regarding separation from parents or other close attachment figures, like grandparents or domestic helpers. It often peaks at the age of 1 and can last all the way till the age of 3. This is all a normal part of growing up and almost everyone goes through this stage of separation anxiety in their childhood! In fact, separation anxiety is important for a young child’s survival, and a lack of separation anxiety at this age may be indicative of an insecure attachment or other problems.  

Under normal circumstances, separation anxiety should not pose too much of a concern and parents should not be too alarmed by it as children eventually outgrow their separation anxiety as they grow older. 

However, some children continue to display recurrent, high levels of anxiety long after the age in which it is typical or expected, and it is severe enough to interfere with normal daily routines such as going to school or participating in recreation activities. When this occurs, it may be indicative of Separation Anxiety Disorder.

Separation Anxiety Disorder: When Separation Anxiety Becomes Maladaptive and Disabling 

Separation anxiety becomes worrying when a child displays developmentally age-inappropriate, excessive, and disabling distress that stems from separation from their parents and the fear of being alone. 

Here are some red flags to help you identify the symptoms of Separation Anxiety Disorder in children: 

Ψ Worries that he/she might be losing you or that you might get hurt
Ψ Refuses to be away from home (e.g., going to school) and fuss, scream, or cry if the parent leaves
Ψ Reluctant, or an inability, to go to sleep without being near you
Ψ Complaints about feeling physically ill (e.g., headaches, stomachaches, nausea, vomiting) when separated
Ψ Experiences repeated nightmares involving the theme of separation (e.g., being kidnapped, the death of a parent)
Ψ Excessive demands for parental attention (e.g., clinging to parents, following them around all the time) 

Given all these drastic symptoms displayed by children with Separation Anxiety Disorder, it is unsurprising that parents become highly distressed (meaning, you aren’t alone!).

What causes Separation Anxiety Disorder? 

In some cases where a child encounters a stressful life event (e.g., the loss of a relative or pet or an abrupt change in living environment), he/she may develop separation anxiety disorder.

Seeking Help: Early Intervention is Key 

Children with Separation Anxiety Disorder may become increasingly withdrawn, depressed, and are at a heightened risk of developing a variety of other anxiety disorders during adolescence and even adulthood. Additionally, Separation Anxiety Disorder is commonly associated with school reluctance and refusal, which takes a toll on their school performance and even peer interaction. 

School refusal behaviour is the refusal to attend classes or difficulty remaining in school for an entire day. It includes children who resist going to school in the morning but eventually attend, those who go to school but leave at some point during the day, those who attend with great dread that leads to future pleas for nonattendance, and those who miss the entire day .

Given the long-term consequences stemming from separation anxiety disorder, early intervention is key. Consult a professional if you find that your child has been experiencing these red flags for at least 4 weeks and/or if the disturbance causes significant distress or impairment in you or your child.

How is Separation Anxiety Disorder Addressed?

Can Separation Anxiety Disorder be addressed? Yes! Managing it often involves psychotherapy and in more severe cases, medication may also be prescribed (in conjunction with psychotherapy) to help alleviate some of the anxiety symptoms.  

Cognitive behavioural therapy (CBT) is commonly used. In CBT, a child is taught strategies to cope with their fear and anxiety. The child is equipped with strategies such as relaxation training and strategies to identify unhelpful (and often inaccurate) thinking styles that may underlie the anxiety they are experiencing.  

Intervention may also include some exposure exercises where the child is gradually exposed to situations or settings which are anxiety-provoking and/or situations which they may have previously avoided. In exposure therapy, children are given the opportunity to “practice” what they’ve been taught during CBT. Exposure therapy also helps to emphasize that the child’s distressing thoughts are just thoughts, and not fact. The aim is to allow children to become more comfortable with unpleasant feelings or experiences by gradually increasing exposure to feared situations in a controlled and supervised environment.