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What Is Separation Anxiety Disorder?

... and what can you do to help your child?

Key points

  • Kids who often need to call or come home from school may have separation anxiety disorder.
  • Separation anxiety disorder occurs when a child's "fear circuits" respond to separation more than expected.
  • Separation anxiety isn't a behavior problem and the physical symptoms are real.
  • Treatment works; proper care can help children feel better and get back to living their lives.
Elena Rostunova/Shuttestock
Elena Rostunova/Shuttestock

When I was a kid, 4th or 5th grade, I spent a lot of the school day missing my mom. There was a lot going on at home—and it felt like I had to talk to her and check on her during the day. I discovered a pay phone in a deserted stairwell, and I made sure to tuck a dime in my uniform pocket so I could call my mom during lunch.

I could feel the wave of relief come over me as soon as my mom would answer the phone. We would talk for a minute and then I would go back to the lunchroom—until Sister Margaret found me and told me, in no uncertain terms, that this was not allowed, and I was never to do it again. I was ashamed for getting in trouble—but I was more upset about being away from my mom for the whole school day.

This story makes me a dinosaur, because now many kids have phones of their own and can easily connect with their parents during the day. There may be a variety of common reasons for kids and parents to communicate during the school day—schedules, pick-ups, and forgotten clarinets, to name a few.

But a smaller number of kids will be driven to contact their parents frequently during the day—and that can interfere with their being able to focus during school, participate in class, or spend time with peers. It disrupts their function if it is happening regularly.

Some children will experience physical symptoms such as belly aches and headaches, and they may spend inordinate amounts of time in the school nurse’s office, often wanting to call home or even be sent home from school. Some children may feel such distress at the idea of being in school that they can’t go at all. They may shut down or explode in the mornings, sometimes many days in a row.

What is Separation Anxiety Disorder?

Why do some children experience such strong needs to stay connected to a parent or caregiver from school? Why do some children feel terrible at school and physically ache to be out of school and at home?

The causes vary, although there are some common themes. And identifying underlying factors—if we can—is critical in developing solutions that work.

It's important to note that this is not a “behavior” problem. Kids who have ongoing problems in these situations are not trying to be difficult. Something is getting in the way of them meeting a demand that most children their age can meet. We need to think about what that something might be.

A common way to explain these symptoms is something called separation anxiety disorder. This diagnosis is made in children who experience severe and persistent distress due to separation from, or anticipation of separation from, a caregiver. This distress is much more than expected for their age.

Symptoms outside of school can include avoiding going to friends’ houses for playdates or overnights, or melting down if parents are getting ready to go out. Physical symptoms such as nausea and vomiting often occur. Repetitive worries and/or nightmares about something terrible happening to a parent or being kidnapped (or otherwise separated from a parent) are common. Sleeping alone may be very difficult. Emotional shutdowns and explosions occur frequently.


What's Happening in the Brain and Body?

Kids with separation anxiety who explode, throw up, or sob at the idea of going to school or of parents going out aren’t trying to be difficult. Their fear centers are telling their brain and body that something dangerous is happening (even if it isn’t really a dangerous situation) and this message triggers the fight/flight/freeze response. If someone told you or me to “just do it”—to go into a situation that we perceived to be life-threatening, we would likely explode, throw up, or sob too.

The child’s fear meter is distorted by the anxiety disorder. Given the power of human fear systems, survival-level energy will overpower any sticker chart or reward system. Yelling at a child in this situation or threatening them with consequences will light up their fear circuits more, making it even harder for a child to self-soothe and change their responses.

Other Factors Can Cause Similar Symptoms

There are other reasons that children avoid school or want to call home or go home. A child may be getting bullied or harmed in some way at school, or a child may be struggling academically or socially. Sometimes something is going on at home—such as illness, conflict, or loss—and the child wants to be home to make sure everything is OK (that was my experience back in the day).

Commonly, there is a combination of a child’s physiologic vulnerability to anxiety layered with other factors. And while we may be tempted to ask our child why they feel this way, many don't know or understand it themselves. We have to accept their experience, without understanding it, if we are going to help them get better.

What's the Best Approach?

The most effective first step is to validate the child’s experience of fear. You don’t have to agree that the situation is dangerous, but you can certainly agree that they feel that way.

You can’t reason or explain a child out of this type of anxiety. These emotional brain responses are happening with speed and intensity that bypass most of their logical/thinking brain circuits. Treatment to quiet the fear circuits and improve the skills for tolerating and managing anxious thoughts and feelings will be most effective.

Separation anxiety disorder disrupts families at every level; the basics of life feel impossible to manage. Getting a diagnosis and starting treatment as soon as you can is the best way to get a handle on these problems. Cognitive behavioral therapy, (CBT) and sometimes medications such as an SSRI, are the most common interventions. Looping the school into the diagnosis and treatment plan will give you and your child opportunities to practice their CBT skills in school.

Separation anxiety may take some time to resolve, but treatment works.

To find help near you, visit the Psychology Today Therapy Directory.

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