The first-line treatment for the majority of separation anxiety cases is behavioral psychotherapy;cognitive behavioral therapy in particular is used with great success on mild to moderate cases. In more severe cases and with kids who don’t respond well to CBT or other psychotherapeutic approaches, a course of medication may be indicated.
Psychotherapeutic: One technique used to manage separation anxiety goes by the moniker “contingency management,” which involves a “contract” and rewards. When the affected child performs the agreed upon behavior—not crying when dropped off at school, waiting a set period of time to call an attachment figure—she receives points towards a reward; this is a classic example of positive reinforcement, and has been shown to have a great effect on anxiety of all sorts. Progress can be slow, and patience is necessary. A therapist may also use exposure therapy: introducing a child in a controlled way to the stress of separation to gradually reduce and master the anxiety response.
Pharmacological: When psychotherapy and behavioral interventions are not adequate to manage symptoms, medication may be prescribed to alleviate a child’s distress and facilitate therapy. A variety of medications have been shown to be effective in treating separation anxiety disorder; the first-line medication is one of the SSRIs, or selective serotonin reuptake inhibitor family. Typical anxiolytics—or anti-anxiety medications—like the benzodiazepines are also effective, though they can be habit forming.
Anxiety is a normal part of growing up—between 6 months and a year of age, kids usually go through “stranger anxiety,” distress at the presence of people other than caregivers. And between a year and a half and three years, “separation anxiety” at being away from a parent for even a short period of time is normal. But when anxiety interferes with age-appropriate behavior, like going to school or sleeping in a room alone, it may be a disorder.
Will my child grow out of it?
In some cases, but not in most. And the longer the disorder goes untreated, the more resistant it becomes to treatment, particularly if a child has missed a lot of school or social activities because of her anxiety. And given that separation anxiety disorder is tied to other anxiety disorders and to depression, treating symptoms as early as possible is advisable.
Is it the result of a bad experience?
Many cases of separation anxiety disorder appear to be triggered by life changes or adverse events—particularly “late onset cases” that can come on after a move or a loss in the family, through death or divorce. But though change can trigger the onset of the disorder, it appears that a predisposition can be passed down from parents to children, either genetically or through other shared family experiences.
Is it my fault?
Social anxiety disorder is more common in kids with parents who themselves have or had the disorder. And by trying to help and accommodate an anxious child, caring parents can paradoxically make the disorder worse. It’s not bad parenting to empathize with your child, but since protective parenting could be enabling your child’s disorder, it’s important to seek treatment.
How long is treatment?
If a case is caught early, a child can respond rapidly to behavioral treatment, sometimes in a manner of days. And pharmacological interventions can produce results in as little as a week or two, though the prescribing physician will usually recommend continuing with the medication for at least 6 months. Generally, the duration of psychotherapeutic interventions via cognitive behavioral or desensitization therapy, among others, will vary based on the severity of the case—but experts council that it will be more effective and less onerous if treatment begins early and the family is engaged in the process.