Separation anxiety disorder in childhood

Separation anxiety disorder in children is a persistent, intense, and developmentally inappropriate fear of separation from a person to whom the child has a strong attachment (usually the mother). Children desperately try to avoid such separations. If a child is forcibly separated from an attachment figure, the child will be preoccupied with being with that person again. Diagnosis is based on history. Treatment includes behavioral therapy for the child and family; in severe cases, SSRIs are used.

Separation anxiety is a normal emotion in children between the ages of 8 and 24 months; it usually disappears as the child matures and develops a sense of permanence and the knowledge that parents will return. In some children, separation anxiety persists longer or reoccurs after it has disappeared, and may be severe enough to be considered an anxiety disorder.

ICD-10 code

F93.0 Separation anxiety disorder in children.

Causes and pathogenesis of separation anxiety disorder in children

Separation anxiety disorder in childhood usually occurs in vulnerable, sensitive, anxious, suspicious, sickly children who are extremely attached to their mother. The presence of abnormal parent-child relationships plays a significant role.

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Symptoms of Separation Anxiety Disorder in Children

Like social phobias, separation anxiety disorder often manifests as school (or preschool) refusal. However, separation anxiety disorder is more common in younger children and is rare after puberty. Separation anxiety is often exacerbated by the mother's anxiety. Her own anxiety increases the child's anxiety, leading to a vicious circle that can only be broken by careful and appropriate treatment of both mother and child.

Typically, dramatic scenes develop during the separation of the child from the parents; during separation, the child fixates on being with the person to whom he/she feels attachment (usually the mother) again and often worries that something may have happened to her (e.g., an accident, a serious illness). The child may also refuse to sleep alone and may even insist on always being in the same room as the person to whom he/she is attached. Farewell scenes are usually painful for both mother and child. The child often cries, screams, and begs not to be left with such desperation that the mother cannot leave him/her, which leads to prolonged episodes that are even more difficult to interrupt. The child often develops somatic complaints.

The child's behavior is often normal in the mother's presence. This normal behavior can sometimes give the false impression that the problem is less than it actually is.

Mild anxiety in response to threatened or actual separation from the mother is a normal reaction in infants and preschool-aged children. So-called separation anxiety is usually observed in children from 6 months of age, but can also occur at an earlier age.

The key diagnostic sign of department anxiety is excessive anxiety, the severity of which exceeds the normal age range. Anxiety can take various forms. For example, anxiety about the fact that the person to whom the child is attached may leave and not return manifests itself in a stubborn reluctance to be in the kindergarten. Only after waking up, children begin to be capricious, whine, complain of feeling unwell. On the way, children cry, resist, and even show aggression towards their mother. In the kindergarten, they do not want to undress, cry and scream sometimes throughout their stay, refusing to obey the general regime. Often, psychosomatic symptoms such as nausea, abdominal pain, vomiting, headache, cough, etc. join this. This condition continues for months, forcing parents to take the child out of the kindergarten. Much less often, similar symptoms are observed in children during the period of school adaptation.

Another form of separation anxiety is fantasies about a misfortune that may happen to a child left without parents at home or in an organized children's group (they will steal, kill, etc.). Unrealistic fears can extend to absent parents (they will get hit by a car, be killed by bandits, etc.).

Often children refuse to sleep in the absence of a person to whom they feel a great affection. Often children have recurring nightmares about separation from their parents. When they wake up at night, they run to their parents' bed in fear and refuse to return to their own bed.

In rarer cases, the child becomes lethargic, apathetic, with a suffering expression on his face. Usually, appetite disappears, sleep is disturbed. The psychosomatic disorders listed above can be observed.

Shown for consultation with other specialists

The long-term, protracted nature of departmental anxiety, the development of psychosomatic disorders, the presence of persistent social maladjustment are indications for consultation with a psychiatrist to decide on the nature of treatment.

Diagnosis and Treatment of Separation Anxiety Disorder in Children

Diagnosis is based on anamnestic data and observation of the child's behavior during separation.

Treatment involves behavioral therapy, which systematically practices separations between the child and the person to whom he or she is attached. The farewell scenes should be as short as possible, and the child's mother should be prepared to respond to protests in a dry and unemotional manner. It may be effective to help the child develop an attachment to an adult at the preschool or school. In extreme cases, anxiolytics, such as an SSRI, may be effective. However, separation anxiety disorder often develops in children around age 3 or younger, and experience with these drugs in very young children is limited.

When treatment is successful, children tend to relapse after holidays and breaks in school attendance. Because of these relapses, it is often wise to schedule regular separations during these periods so that the child gets used to the mother's absence.

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Forecast

Generally favorable. With a sufficiently long course, erased anxiety, asthenoadynamic and ideational disorders are noted even outside of separation situations.

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