What it is
It is common for toddlers through preschool-aged children to experience anxiety upon separation from their parents, as displayed by crying or clinging behavior. Usually, toddlers and young children can often be soothed or distracted from their anxiety. Their anxiety usually subsides as they become acquainted with the new environment. Some children continue to display separation anxiety long after it is expected or typical and may have separation anxiety disorder.
Separation anxiety disorder is characterized by age-inappropriate, excessive fear of being away from parents or home. Children with this disorder experience great distress when they separate or anticipate separating from loved ones or home. They continue to experience distress throughout the duration of the separation and may complain of physical symptoms, such as stomachaches or headaches. Children with separation anxiety disorder often refuse to attend school, sleepovers, or play-dates, unless their parents attend with them. If they do attend activities without their parents, they may frequently “check-in” with their parents via telephone calls or texts. When they are at home with their parents, they may follow their parents around the house, become upset when they are in a different room from their parents, and sleep near or with their parents. Often, children with separation anxiety disorder worry about something bad happening to them or their parents during separation, such that they would never see their loved ones again. Approximately 4% of children have separation anxiety disorder. The onset of this disorder typically occurs in early or middle childhood and is more common in girls than boys.
Avoiding separation brings quick relief, but it keeps the fear going:
Symptoms
According to the DSM IV-TR, the following are symptoms of Separation Anxiety Disorder. It can be considered a problem if the child is struggling with three (or more) of these symptoms and that the symptoms are interfering with a child's functioning and last more than 4 weeks.
- Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.
- Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.
- Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped).
- Persistent reluctance or refusal to go to school or elsewhere because of fear of separation.
- Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings.
- Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.
Red flags to watch for
These are some red flags that can be seen in Separation Anxiety Disorder
- Cries, screams or begs to stay even in routine separations from home, parents and/or loved ones (like when leaving for school or to a birthday party, or if a parent is going out for dinner or away overnight).
- Worry about something bad happening to a parent or loved one if they are not together
- Trouble separating at night, may attempt to sleep with parent or sibling
- Physical symptoms (such as headaches, stomachaches, nausea or vomiting) when separation occurs, or in anticipation of separations
- Fears of getting lost or being kidnapped
- Doesn’t like to be alone in the house even on a separate floor, staying close to mom or dad and checking that they are present from time to time.
- Disinterest in social activities; preference to spend time with parent
- Nightmares about harm, danger, death, separation
- Over-concern with loved one-needs reassurance that loved one is ok
- Panics if parent late for pick ups; frequent reassurance about pick-up plan or checks the clock to see what time parent will be coming.
- Inability to attend birthday parties, field trips independently, can’t stay for a sleepover
- A lot of “safety behaviors” like carrying a cell phone in case they miss mom and want to talk to her, or making a plan to see mom in the middle of a party in case they miss her.
- Trouble going to or staying in school (after 6 years old).
Free tools
Finding help
Get treatment with our team
The OCD & Anxiety Institute, founded by Dr. Muniya Khanna, offers evaluation and CBT with exposure for kids, teens, and young adults with anxiety and OCD, in person in Berwyn, PA and by video across Pennsylvania.
Find a provider
Looking for care in person or outside of Pennsylvania? Start with a directory below.
Referral NetworkCoping Cat trained clinicians worldwideSearch by location or specialtyFind a clinician →
If you are unable to find a treatment provider through these or other websites, you can:
- Contact the psychiatry department at a local medical school or a university psychology department.
- Contact your county mental health department, a local hospital, or a community mental health center and ask about mental health clinics or staff psychiatrists.
- Search through your insurance company for local behavioral health or psychiatry providers.
- Search the American Psychological Association provider database.
Disclaimer: We do not endorse the references or providers listed. We list available resources as a service.
Books
Books for kids
A reading list for children and teens, organized by age.
Reading level 4 to 8 10 books
- First Day Jittersby Julie Danneberg. Whispering Coyote Press, 2000.
- Wemberly Worriedby Kevin Henkes. Greenwillow Books, 2010.
- Scary Night Visitors: A Story for Children with Bedtime Fearsby Irene Wineman Marcus, Paul Marcus, & Susan Jesche. Magination Press, 1990.
- I Don’t Know Why…I Guess I’m Shy: A Story About Taming Imaginary Fearsby Barbara Cain & J. J. Smith-Moore. Magination Press, 2000.
- Into the Great Forest: A Story for Children Away from Parents for the First Timeby Irene Wineman Marcus. Magination Press, 1992.
- Night Light: A Story for Children Afraid of the Darkby Jack Dutro & Kenneth Boyle. Magination Press, 1991.
- Cat’s Got Your Tongue? A Story for Children Afraid to Speakby Charles E. Schaefer & Judith Friedman. Magination Press, 1992.
- Outsmart Your Worry Tool Kit for Kids, Ages 5-11by Tool Kits for Kids, LLC, 2008.
- Lions Aren’t Scared of Shots: A Story for Children About Visiting the Doctorby Howard J. Bennett. Magination Press, 2007.
- Sometimes I’m Scaredby Jane Annunziata & Marc Nemiroff. Magination Press, 2009.
Reading level 9 to 12 8 books
- Nobody’s Perfect: A Story for Children about Perfectionismby Ellen Flanagan Burns. Magination Press, 2009.
- What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxietyby Dawn Huebner. Magination Press, 2006.
- What to Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCDby Dawn Huebner. Magination Press, 2007.
- Up and Down the Worry Hill: A Children’s Book about Obsessive-Compulsive Disorder and its Treatmentby Aureen Pinto Wagner & Paul A. Jutton. Lighthouse Press, Inc., 2004.
- I Bet I Won’t Fret: A Workbook to Help Children With Generalized Anxiety Disorderby T.A. Sisemore. New Harbinger, 2008.
- Outsmart Your Worry Tool Kit for Kids, Ages 11-18by Tool Kits for Kids, LLC, 2009.
- Kissing Doorknobsby Terry Spencer Hesser. Laurel Leaf, 1999.
- Blink, Blink, Clop, Clop: Why We Do Things We Can’t Stopby E. Katia Moritz. Weston Press, 2011.
For teens 5 books
- My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panicby Michael A. Tompkins, Katherine A. Martinez, & Michael Sloan. Magination Press, 2009.
- Outsmart Your Worry Tool Kit for Kids, Ages 11-18by Tool Kits for Kids, LLC, 2009.
- Free From OCD: A Workbook for Teens With Obsessive Compulsive Disorderby T.A. Sisemore, 2010.
- Perfectionism: What’s Bad About Being Too Goodby Miram Adderholdt & Jan Goldberg. Free Spirit Publishing, 1999.
- Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way", and Parents Say "Way to Go"by John March, 2006.
Books for parents & caregivers
Books to empower those who support children and teens.
Anxiety 11 books
- The Resilience Recipeby Muniya Khanna & Philip Kendall (2021). New Harbinger Press.
- You and Your Anxious Child: Free Your Child from Fears and Worries and Create a Joyful Family Lifeby Anne Marie Albano, with Leslie Pepper. A Lynn Sonberg Book with Avery/Penguin Press, 2013.
- The Coping Cat: Parent Companionby Philip C. Kendall, Jennifer Podell, & Erika Gosch. Workbook Publishing, 2010.
- The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Themby Elaine Aron. Three Rivers Press, 2002.
- Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries and Phobiaby Tamar Chansky. Broadway Books, 2004.
- Freeing Your Child from Negative Thinking: Powerful, Practical Strategies to Build a Lifetime of Resilience, Flexibility and Happinessby Tamar Chansky. Da Capo Lifelong Books, 2008.
- Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Childrenby John Dacey & Lisa Fiore. Jossey-Bass, 2001.
- Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parentsby Andrew R. Eisen, Linda B. Engler, & Joan Sparrow. New Harbinger Publications, 2006.
- The Worried Child: Recognizing Anxiety in Children and Helping Them Healby Paul Foxman. Hunter House, 2004.
- Help for Worried Kids: How Your Child Can Conquer Anxiety & Fearby Cynthia Last. Guilford Press, 2006.
- Helping Your Anxious Child: A Step-by-Step Guide for Parentsby Ronald Rapee, Susan Spence, Vanessa Cobham, & Ann Wignall. New Harbinger Publications, 2008.
OCD 3 books
- Freeing Your Child from Obsessive Compulsive Disorder: A Powerful, Practical Program for Parents of Children and Adolescentsby Tamar Chansky. Three Rivers Press, 2001.
- OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manualby John S. March & Karen Mulle. Guilford Press, 1998.
- What to Do When Your Child Has Obsessive-Compulsive Disorder: Strategies and Solutionsby Aureen Pinto Wagner. Lighthouse Press, 2002.
References
Show 4 references
- Albano, A. M., Chorpita, B. F., & Barlow, D. H. (1996). Childhood anxiety disorders. In E.J. Marsh & R. A. Barkley (Eds.), Child psychopathology (pp. 196-241). New York: Guilford Press.
- Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatric Clinics of North America, 32(3), 483-542.
- Last, C. G., Perrin, S., Herson, M., & Kazdin, A. E. (1992). DSM-III-R anxiety disorders in children: Sociodemographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1070-1076.
- Shear, K., Jin, R., Ruscio, A. M., Walters, E. E., & Kessler, R. C. (2006). Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication. American Journal of Psychiatry, 163, 1074-1083.
