Overwhelming fear in children may be a sign of separation anxiety disorder

Most children experience some degree of apprehension and excitement as the first day of school approaches, but what does it mean when a child is overcome with fear at the thought of separating from parents and caregivers to go to class?  

This overwhelming fear may be a sign of separation anxiety disorder, a condition characterized by a school-aged child's extreme fear and nervousness of separating from loved ones.

"Upwards of 5 percent of children between the ages of 7 and 11 years old suffer from separation anxiety disorder in the United States. In severe cases this condition can hamper a child's academic performance and social interactions and even make it difficult for a child to develop physically and emotionally," says Dr. John Walkup, director of child and adolescent psychiatry at NewYork-Presbyterian/Weill Cornell Medical Center. "Early detection and treatment is the best way to ensure full recovery."

As parents prepare for the new school year, here are a few telltale signs that a child may be experiencing separation anxiety:

• Worrying that bad things will happen when separated. Separation fears can be triggered when the child leaves for school or when the parents leave for work or go out for dinner.

• Refusing to go to school. Dropping your child off at school usually entails long tearful drop-offs and may escalate to tantrums or a complete refusal to go to school.

• Difficulty concentrating on schoolwork. Watch for signs of academic difficulties such as inability to follow directions, focus during class or complete assignments. If a child is overcome by worries related to separation anxiety, schoolwork may suffer.

• Avoiding activities outside of the home. In an effort to limit time spent away from home, a child may avoid participating in activities such as play dates, sleepovers at other children's homes or school trips.

• Trouble sleeping. A child may have trouble falling asleep without a parent or caregiver present and may come into the parent's bedroom at night with separation fears. In some instances the child may have nightmares about separation.

• Frequent physical complaints. A child may experience headaches, fear of choking or vomiting, difficulty swallowing – especially swallowing pills – and stomach aches in the morning on school days. Once at school the child may visit the nurse's office several times in one day seeking to return home.

Although parents and school staff can make accommodations for children with separation anxiety disorder, many children continue to suffer even after substantial accommodations have been made.  

There are proven treatments for separation anxiety that can make a big difference in a child's life, school functioning and relationships with parents. Treatments can include specific forms of psychotherapy called cognitive behavioral therapy and medication used alone or in combination with psychotherapy.