Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Key Features

Essentials of Diagnosis

  • Persistent excessive worry about losing or being separated from attachment figures, due to harm, illness, or death befalling either the attachment figure or the patient

  • Reluctance or refusal to leave the attachment figure or sleep away from the attachment figure

  • Fear of being home without attachment figure

  • Physical complaints when separation occurs or is anticipated

General Considerations

  • Anxiety about separation from attachment figures is part of early normative development

  • More prevalent in younger children (4% 6-month prevalence compared with 1.6% 6-month prevalence in adolescence)

Clinical Findings

Symptoms and Signs

  • Must be distinguished from normal development

  • Must occur for more than 4 weeks for children

  • Must lead to impairment or significant distress

  • Younger children may not be symptomatic until the separation is imminent, and may not experience explicit fears related to separation

  • As children get older, they may experience specific fears such as fears of kidnapping, parents getting into car accidents, being separated due to natural disasters, etc

  • In addition to appearing anxious, children with separation anxiety can appear sad, aggressive, or experience physical symptoms when facing the anxiety provoking separation

Differential Diagnosis

  • Other anxiety disorders

  • Mood disorders

  • Oppositional defiant disorder

  • Conduct disorder

  • Psychotic disorder

  • Personality disorders


  • Pediatricians are likely to encounter children with school refusal, a common behavioral manifestation of separation anxiety

  • Symptoms of school refusal often include physical symptoms and or behavioral outbursts as school time approaches

  • Parents often notice symptoms abate on the weekend, vacations, or if the child is no longer expected to attend school


  • Mild cases may be handled with the help of the pediatrician's office, but more severe cases may need the help of a mental health specialist

  • Cognitive-behavioral therapy that is modified to address the developmental level of the child

  • Children who do not respond to therapy may require medication such as a selective serotonin reuptake inhibitor

  • Children younger than school age generally are not treated with medication



  • Separation anxiety often abates by adolescence, but adolescents who experienced separation anxiety disorder in childhood are at increased risk for other disorders


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, American Psychiatric Association; 2013.
Beesdo-Baum  K, Knappe  S: Developmental epidemiology of anxiety disorder. Child Adolesc Psychiatric Clin N Am 2012;21:457–478
[PubMed: 22800989] .
Ghandhi  B, Cheek  S, Campo  JV: Anxiety in the pediatric medical setting. Child Adolesc Psychiatric Clin N Am 2012;21:643–653
[PubMed: 22800999] .
Ginsberg  GS, Kendall  PC, Sakolsky  D ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.