Separation Anxiety Disorder (SAD)
- Feb 13, 2024
- 7 min read
As part of a series of blogs, I look at some of the many factors that can impact sleep. As an holistic sleep practitioner, I look beyond the sleep environment to unpick the root causes of
sleep issues in children.
This is the second of two posts on separation anxiety. You can read part one here.
What is Separation Anxiety Disorder (SAD)?
Almost all babies and children will go through a period of anxiety about leaving their primary caregivers. This is a totally normal developmental phase and, while it can be upsetting at the time, it will usually pass quite quickly.
However, if your child continues to experience distress and extreme worry and, where it begins to impact on daily life, they could be suffering from Separation Anxiety Disorder (SAD).
Symptoms of SAD may include:
Severe anxiety that is persistent and does not go away, no matter how hard the child or parents try to relieve it.
Anxiety that is so severe it prevents the child from interacting with peers, and functioning in school and at home.
Fear of being away from parents and loved ones.
Fear of leaving the house.
Excessive worry that they or loved ones will come to harm
Problems sleeping.
Physical symptoms, such as headaches, tummy aches or feeling sick when (or thinking about being) away from home or separated from loved ones.
For a diagnosis of SAD, symptoms need to be more severe when compared with normal separation anxiety and have been present for a number of months.
It is thought that under 5% of children experience SAD, so it is quite rare. However, If left untreated, the condition can spiral, so it is really important to seek professional advice if you feel your child’s anxiety is extreme.
What Causes Separation Anxiety Disorder (SAD).
SAD and other similar anxiety disorders have been found to be affected by environmental, genetic and biological factors. Therefore, if a parent suffers or has suffered with anxiety, the child may be more likely to experience similar issues
It can be difficult to identify the root cause or causes of anxiety. However, some of the most common triggers include:
Environmental changes - such as starting a new school or childcare provision or moving house, can prove unsettling for children and may sometimes throw a child off balance.
Stress - if the household is going through a stressful change, such as divorce or loss of a loved one or pet.
Parental anxiety - sometimes children can pick up on the worries of their parents and other primary care givers. It can be really difficult to hide stress and worry, but it is important to try to shield children as much as possible. Similarly, if a parent responds to a child’s separation anxiety with obvious anxiety themselves, the situation can become a vicious cycle.
What treatments are available for Separation Anxiety Disorder?
Treatment for SAD will vary from child to child, but typically includes therapy. Some children may also need to take medication if symptoms are particularly severe and debilitating. Whilst there are many medicines and alternative treatments available to buy online, it is important that your child only take medication prescribed by their clinician.
Cognitive Behavioural Therapy (CBT) is the most common type of therapy used with SAD. CBT can teach children to overcome thoughts and behaviours that are unhelpful. Parents can also learn ways to help their child to cope better.
Talking therapy can help children to express their feelings, to unpick the root cause. They can begin to understand their anxiety and how to cope with it.
Younger children especially can respond well to therapeutic play therapy.
With the correct treatment, most children diagnosed with SAD will experience reduced symptoms or recover completely. In some cases, a child might relapse during periods of change or under stressful circumstances. However, with early treatment, especially where there is close parental involvement, the likelihood of serious relapse will reduce significantly.
My child has been diagnosed with Separation Anxiety Disorder. How can I help?
Take steps to help your child feel safer in situations where they become anxious. Although it is tempting to allow your child to avoid the things that scare them, in the long term this only serves to make the situation worse and reinforce the anxiety.
Always be there for your child as a sympathetic ear. Do listen to and acknowledge their worries and let them know you understand how frightening being away from you is for them. Make home a super safe space for them to talk and to just relax when they need to.
Having listened to and acknowledged your child’s worries, talk about previous separations and how they coped then. Explain there is no reason to believe future separations will be any different.
Anticipate how you will cope with each separation. Does your child need extra warnings, visuals, a comforter, or a way to easily contact you if necessary? Which parent do they separate from the most easily? What does your child feel will help them? How can you make the separation as seamless as possible?
Stay calm while you are dropping your child off. Keep goodbyes short and positive and do not return once you have left, even if you can hear your child crying. If you decide to return after just a short period of time, it is much better if your child does not see this as you ‘giving in’, so do leave and then come back after a few minutes.
Help your child to participate in sports and social activities outside of the house. These will enable your child to make friendships and get used to new places whilst knowing you are there for support. Once they are used to the setting and some of the people, you could then begin to leave them for short periods of time.
Praise your child as often as possible. Even very tiny achievements, such as getting dressed without being asked, or helping you with the washing up, are great opportunities for positive reinforcement.
Be as consistent as possible. By having a predictable routine in place you can help your child feel safer and more secure. Use visuals so they know what is happening and when. If there is due to be a change in schedule, try to provide plenty of warning.
Offer your child choices where possible. For example, allow them to bring a favourite toy, choose what they will eat, wear etc.
Separation Anxiety and School
Children with separation anxiety often find school incredibly overwhelming. In some cases, they may completely refuse to go. It is important to work with the school to make reasonable adjustments for your child. These might include:
Implementing shorter days while your child is struggling.
A later start to the day. Sometimes the hustle and bustle of the morning rush can add to anxiety. Arriving when things have calmed down may help alleviate some of the worry.
Ensuring your child has a ‘safe place’ they can retreat to while at school and that all teachers and care givers are aware of your child’s need to use this.
Identifying a trusted person they can go to if things are too overwhelming.
Having a plan in place which allows your chid to contact home. While many schools understandably do not allow mobile phones, children with separation anxiety may need to know they can get in touch if they need to. It may be necessary to implement some simple guidelines, such as allocating a certain time and/or place in which to use their phone. For younger children who do not own a mobile phone, a scheduled phone call can make getting through the day slightly easier.
Some children with separation anxiety find they are further triggered by change or sensory experiences and need these to be minimised. For example:
If they find wearing school uniform tricky, ask if they can be allowed to wear their PE kit instead.
Warnings of fire bell practice and other predictable events, such as planned room or teacher changes, is also important.
Maintaining a predictable timetable and using visuals can really help.
Try popping notes or pictures in your child’s bag for them to find while at school. This helps them to know that you are thinking of them, even when you are not with them. Often something as simple as this will make a big difference to your child’s ability to cope.
Reward your child’s effort to attend school or nursery. Even if they only manage a couple of hours at first, every step in the right direction needs to be celebrated and encouraged.
And in all of this, it really is important to remember self care for yourself. It can be hugely stressful to watch your chid experience a traumatic time, but key to guiding them through it is to remain calm and clear headed. In order to cope better, do talk about your own feelings to a trusted friend or counsellor, eat well and exercise when you can. Consider practising mindfulness, yoga or other relaxation methods and try to get enough sleep. Spend time with friends and loved ones and take time out just for you, so that you are in the best possible place to support your child.
Separation Anxiety Disorder and Sleep
Sleep is usually one of the major knock-on effects of Separation Anxiety Disorder. I work with many parents whose children are struggling with sleep due to anxiety. I recommend several very gentle approaches and work with parents and carers to devise a personalised plan to suit individual needs.
Many of the parents and carers I work with have reached a crisis point. They are exhausted and really need help and support to reset the situation. Is this you?
Please know you are not alone. Do not let financial worries put you off working with me. I can offer a custom programme of support, with fixed, pay monthly or pay-as-you-go finance options. If there is nothing to suit you on my website, please do still get in touch and we can work together around your budget to ascertain your best options going forward.
Are you ready to start your sleep shaping journey? Do you need more personalised advice? Book a free Discovery Call today and we can discuss how I can help you.
For further support in the UK
Anxiety UK 03444 775 774.
Family Lives Helpline at 0808 800 2222 or
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