Separation anxiety disorder (SAD) is an anxiety condition most often seen in children, though it can also affect adolescents and adults. It involves excessive fear or worry about being separated from loved ones or familiar environments, leading to distressing symptoms such as constant worry, fear of harm or abandonment, physical complaints (e.g., headaches, stomachaches), and avoidance of separation situations.
Some separation anxiety is a normal stage of development. Around 8 months, infants develop object permanence—they understand people still exist when out of sight, but are not always certain caregivers will return.
This can trigger separation anxiety, which usually resolves naturally by age 3–4 as children mature emotionally. If intense anxiety persists beyond this age or appears in older children and adolescents, it may indicate SAD, which is more disruptive and intrusive.
Disclaimer:
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you are concerned that your child may be experiencing separation anxiety disorder or any other mental health condition, please consult a qualified healthcare provider or licensed mental health professional.
SAD can significantly interfere with daily functioning, well-being, school performance, and physical health.
Its symptoms sometimes overlap with those of other anxiety disorders, including panic disorder. Research suggests SAD is the most common anxiety disorder in children, accounting for about half of childhood anxiety diagnoses (Ehrenreich et al., 2008).
Prevalence estimates are around 3–4% in children (Walker et al., 2009) and up to 6.6% in adults (Silove et al., 2010). While some adults with SAD have a history of childhood symptoms, others may first experience it later in life.
Signs of Separation Anxiety Disorder
The symptoms of separation anxiety disorder (SAD) are more intense than what’s expected for a child’s age and can cause significant distress at home, school, and in daily life.
Symptoms vary from child to child, and experiencing just one or two does not mean a child has SAD.
Common symptoms include:
- Excessive worry about losing a parent or something bad happening during separation
- Distress before or during separation, sometimes with nightmares about being apart
- Clinginess or refusal to be alone, go to school, or sleep without a caregiver
- Physical complaints such as headaches, stomachaches, nausea, or trouble sleeping
- Behavioral signs like tantrums, crying, meltdowns, or pretending to be sick to avoid school
Some children may also seem shy, withdrawn, or overly dependent on staying close to a parent, even at home.
| Type | Examples |
|---|---|
| Cognitive | Excessive worry about losing a parent, fears of harm, nightmares about separation |
| Behavioral | Clinginess, tantrums, refusal to go to school, avoiding being alone or sleeping alone |
| Physical | Headaches, stomachaches, nausea, vomiting, trouble sleeping, bedwetting |
Consequences of Separation Anxiety
There are many complications that can manifest as a result of a child having separation anxiety:
- Poorer school performance
- It can result in other anxiety disorders if left untreated
- Low social performance and high social anxiety
- Difficulty initiating and maintaining friendships
- Family activities are limited by behaviors associated with SAD
- Parents of children with SAD have little to no time for themselves or each other
- Siblings become jealous of all the extra attention given to the child with SAD
💡 Did You Know?
While separation anxiety disorder is most often diagnosed in children, adults can experience it too. In adulthood, SAD may interfere with work, concentration, and relationships. Adults with the condition might struggle with being apart from partners or friends, sometimes appearing “clingy” or overly worried about loved ones’ safety.
What can cause separation anxiety disorder?
Several potential causes or risk factors can contribute to the development of separation anxiety disorder.
Environmental factors
Separation anxiety may manifest in children due to environmental factors, such as:
- A change in caregiver
- Change in routine
- Following a traumatic event
- Change in parent availability
- Change in family structure, e.g., through divorce or illness
- Moving house
- Starting a new school
- After any life change, even if it’s a positive change
Parenting style
Attachment styles may affect whether a child develops separation anxiety.
Having an insecure attachment style may affect a child’s ability to bond with others and feel safe away from their loved ones, compared to children who form secure attachments to their caregivers.
Likewise, parenting that is overly critical, controlling, or overprotective may interfere with a child’s normal development of autonomy, as well as contribute to anxiety disorders.
Economics
Children from low-income households may be more likely to develop separation anxiety disorder compared to those from middle to upper-income families (Vine et al., 2012).
This could suggest that the financial stress within a family could be a contributing factor for young children to develop separation anxiety.
Mental health or neurodiversity
Separation anxiety may be related to another underlying mental health condition, such as delusions from psychotic disorders or fear of change relating to being autistic.
Individuals with a history of other anxiety disorders or mood disorders, such as generalized anxiety disorder or major depressive disorder, may be at an increased risk of developing separation anxiety disorder.
Temperament
Those with timid or shy personalities may be more at risk of developing separation anxiety compared with more outgoing or extroverted children.
Studies have found that introversion combined with high neuroticism may play a role in the onset of anxiety disorders (Gershuny & Sher, 1998; Griffith et al., 2010).
Family history
Some research suggests that there may be a genetic component to separation anxiety disorder, meaning that individuals with a family history of anxiety disorders may be more susceptible to developing separation anxiety.
Data suggests that SAD is 20-40% heritable from a biological parent (Fox & Kalin, 2014); therefore, a child may be likely to develop anxiety from their parents.
Diagnosis
Only a qualified mental health professional can diagnose separation anxiety disorder (SAD).
Part of the process involves distinguishing between normal developmental separation anxiety and a disorder that significantly interferes with a child’s daily life.
A pediatrician may first rule out any physical conditions before referring families to a child psychologist or psychiatrist.
Assessment often includes a psychological evaluation, structured interviews, and input from parents about the child’s behavior.
Tools such as the Children’s Separation Anxiety Scale (CSAS) may also be used to explore worries and separation-related distress.
According to the DSM-5, SAD is defined as a developmentally inappropriate and excessive fear of separation from attachment figures.
Symptoms must be persistent—lasting at least 4 weeks in children and adolescents (and 6 months or more in adults)—and cause significant distress or impairment at home, school, or in social settings.
Because SAD can overlap with other mental health conditions, only a professional evaluation can determine whether a child’s anxiety meets the criteria for diagnosis.
Treatment Options
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) helps children recognize and challenge unhelpful thoughts and develop healthier coping strategies.
Sessions often include relaxation techniques and gradual practice facing separation fears. Parents may be involved to learn how to support independence in encouraging ways.
Parent-child interaction therapy
Parent-child interaction therapy may also be useful for those with SAD. This therapy usually has three main treatment phases:
- Child-directed interaction – focuses on improving the quality of the parent-child relationship with the aim of strengthening the child’s feelings of safety.
- Bravery-directed interaction – educates the parents about why their child feels anxious. The therapist will develop a bravery ladder that shows situations that cause anxious feelings and establishes rewards for positive reactions.
- Parent-directed interaction – this teaches parents how to communicate clearly with their child so they can help manage unhelpful behaviors from their child.
Contingency management
This type of treatment for SAD is used on children and is based on positive reinforcement. The child and the parent will agree on a set of goals.
When these goals are met, the parent can reward the child. This reward can be anything that the child values, such as stickers or extra TV time.
The goal of this treatment operates on the principle that positive behaviors that get rewarded will get repeated.
Exposure therapy
Exposure therapy works on the idea that confronting your fears gives the person a chance to see that their fears are irrational. This usually involves gradually exposing someone to their feared situation, such as being left without a loved one.
This can start small, such as talking about the idea of being left alone, before working up towards being left alone for increasingly longer amounts of time until the person feels comfortable being away from their loved one.
Many times, CBT is often paired with exposure-based treatments, whilst providing people with SAD with ways of coping other than escape and avoidance.
Medication
Medication is not usually the first treatment for children. In some cases, doctors may prescribe antidepressants (such as SSRIs) if other treatments are not effective, but this requires careful monitoring.
Support groups
Support groups may also be useful for those who have SAD. People who join these groups can gain assistance with learning techniques for reducing SAD symptoms in a group environment.
Everyday Coping Tips for Parents (Home & School)
These tips, drawn from pediatric psychologists and behavior experts, can help reduce your child’s separation anxiety even outside therapy.
Home & Drop-Off Routines
- Quick, predictable goodbyes. Dr Wendy Sue Swanson suggests keeping drop-offs short and consistent—same phrases or ritual each time. This helps establish trust in your child’s independence.
- Practice short separations. Dr Becky Kennedy suggests starting small—leave your child with a grandparent, or step out for a few minutes—to build confidence gradually.
- Use transitional objects. Let your child bring a favorite toy, blanket, or photo to feel connected when away from you.
School-Related & Communication Tips
- Build routine with the school. Dr Barbara Bentley suggests meeting teachers ahead of time or visiting the classroom before the school year starts so your child knows what to expect.
- Reassure, but don’t overdo it. Say something like, “I know it’s hard, but I’ll see you after school,” rather than offering repeated vague promises. This lets children feel heard without reinforcing anxious thinking.
If your child’s anxiety is intense, doesn’t improve with these strategies, or causes serious disruptions, please seek help from a pediatrician or child psychologist.
Do you need mental health support?
USA
If you or a loved one are struggling with symptoms of an anxiety disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline for information on support and treatment facilities in your area.
1-800-662-4357
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Availiale 24 hours day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
References
Administration SA and MHS. Table 15, dsm-iv to dsm-5 separation anxiety disorder comparison. Updated June 2016.
Dabkowska, M., Araszkiewicz, A., Dabkowska, A., & Wilkosc, M. (2011). Separation anxiety in children and adolescents. In Different views of anxiety disorders. IntechOpen.
Ehrenreich, J. T., Santucci, L. C., & Weiner, C. L. (2008). Separation anxiety disorder in youth: Phenomenology, assessment, and treatment. Psicologia conductual, 16(3), 389.
Fox, A. S., & Kalin, N. H. (2014). A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. American Journal of Psychiatry, 171(11), 1162-1173.
Gershuny, B. S., & Sher, K. J. (1998). The relation between personality and anxiety: findings from a 3-year prospective study. Journal of abnormal psychology, 107(2), 252.
Griffith, J. W., Zinbarg, R. E., Craske, M. G., Mineka, S., Rose, R. D., Waters, A. M., & Sutton, J. M. (2010). Neuroticism as a common dimension in the internalizing disorders. Psychological medicine, 40(7), 1125-1136.
Silove, D. M., Marnane, C. L., Wagner, R., Manicavasagar, V. L., & Rees, S. (2010). The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC psychiatry, 10(1), 1-7.
Vine, M., Stoep, A. V., Bell, J., Rhew, I. C., Gudmundsen, G., & McCauley, E. (2012). Associations between household and neighborhood income and anxiety symptoms in young adolescents. Depression and anxiety, 29(9), 824-832.
Walker, L. S., Beck, J., & Anderson, J. (2009). Functional abdominal pain and separation anxiety: helping the child return to school. Pediatric annals, 38(5), 267.
