It started when my 11-year-old's father started leaving town on business trips.  She began worrying about something bad happening when she was in her room at night.  She hated the dark, but was still scared when I left the light on.  She would cry and cry until I finally broke down and let her sleep with me.  It was a lot easier to just give in and let her sleep with me.  When her father got back in town she went back to normal, but would still try to sleep with her sister if she could.  Once my husband left again, the whole cycle would start.  It was so exhausting and frustrating.

Although separation anxieties are normal among infants and toddlers, they are not appropriate for older children or adolescents and may represent symptoms of separation anxiety disorder.

To be diagnosed for separation anxiety disorder (SAD), the DSM-IV specifies that the anxiety or fear must cause distress or affect social, academic, or job functioning and must last at least 1 month.

Children with separation anxiety may cling to their parent and have difficulty falling asleep by themselves at night. When separated, they may fear that their parent will be involved in an accident or taken ill, or in some other way be “lost” to the child forever. Their need to stay close to their parent or home may make it difficult for them to attend school or camp, stay at friends’ houses, or be in a room by themselves. Fear of separation can lead to dizziness, nausea, or palpitations.

Separation anxiety is often associated with symptoms of depression, such as sadness, withdrawal, apathy, or difficulty in concentrating, and such children often fear that they or a family member might die. Young children often experience nightmares or fears at bedtime and then later refuse to sleep by themselves.

About 4% of children and young adolescents suffer from SAD. Among those who seek treatment, separation anxiety disorder is equally distributed between boys and girls. However, in survey samples, the separation anxiety disorder is more common in girls. The disorder may be over diagnosed in children and teenagers who live in dangerous neighborhoods and have reasonable fears of leaving home.

The remission rate with SAD is high, meaning that many children will "grow out of it."  However, there are periods where the illness is more severe and other times when it remits.

Sometimes the condition lasts many years or is a precursor to panic disorder with agoraphobia. Older individuals with separation anxiety disorder may have difficulty moving or getting married and may, in turn, worry about separation from their own children and partner.

The cause of SAD is not known, although some risk factors have been identified. Affected children tend to come from families that are very close. The disorder might develop after a stress such as death or illness in the family or a move. Trauma, especially physical or sexual assault, might bring on the disorder The disorder sometimes runs in families, but the precise role of genetic and environmental factors has not been established.

At the Florida Anxiety Clinic, we treat Separation Anxiety Disorder using a combination of cognitive-behavioral therapy, family therapy, and play therapy. 

In cognitive-behavioral therapy, our therapists teach children to challenge their negative thoughts, develop new, balanced thoughts, and practice alternative behaviors.  Cognitive restructuring is combined with behavioral reinforcement so that children are encouraged to overcome their problem.

In family therapy, parents learn how to manage their child's separation anxiety disorder and learn effective parenting skills.  Strategies for helping siblings cope with the changes in the patients' behavior are also taught.  Family therapy also involves removing unhealthy family patterns that might reinforce SAD and foster an environment of teamwork in overcome the problem.

Play therapy uses art materials, toys, puppets, games, and story time to help children resolve their fears, express their feelings, and practice new behaviors.