CINCINNATI—It’s a familiar back-to-school scenario: While some students happily march into the classroom, others have trouble making the transition from parent to teacher. Tears might ensue, or even the dreaded "meltdown.”
Separation anxiety is normal, a UC Health specialist in child and adolescent psychiatry says, and no cause for added concern. But separation anxiety can emerge as a disorder, and that’s when clinical intervention might be necessary for the child’s emotional and educational well-being.
"It’s important to distinguish between separation anxiety, which is a normal developmental process where a preschool child has trouble being away from mom or dad, and separation anxiety disorder, which often involves school-age children,” says Jeffrey Strawn, MD, a UC Health psychiatrist and assistant professor in the UC Department of Psychiatry and Behavioral Neuroscience.
"The key is whether or not it interferes with functioning,” he adds. "When the child is not able to do what would be normal, developmentally appropriate things—going to school, staying with grandparents, being in a separate room from mom and dad in the house—that’s when it becomes a problem that should be addressed.”
Separation anxiety disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as excessive and persistent fear or anxiety concerning separation from those to whom the individual is attached. Research indicates that about 4 percent of children (younger than 12) in the United States experience separation anxiety disorder, placing it among the most prevalent anxiety disorders in children.
Physical symptoms may accompany separation and include headaches and nausea, as well as cardiovascular symptoms such as palpitations, dizziness and feeling faint. The manual notes that separation anxiety associated with reluctance or refusal to attend school may lead to academic difficulties and social isolation.
Strawn also notes that separation anxiety can happen after a significant event such as a divorce, a severe car accident or natural disaster.
Treatment generally takes a psychotherapeutic approach, Strawn says, with a therapist working with the child on cognitive aspects as well as attachment problems. In addition to counseling, attachment-directed interventions might be very specific. For example, children might be provided with a photo from home that they can keep with them as a reminder that mom and dad are still there.
"One of the things that can also be helpful is working with the parent or parents as well as the child,” Strawn says, with all parties in the same room.
In some situations where there are severe symptoms, medications might be helpful, Strawn says, while noting that there are no FDA-approved medications specifically for separation anxiety disorder in children. Medication treatment would therefore involve serotonin-specific reuptake inhibitors (SSRIs), which are typically used for treatment of depression and anxiety disorders.