Child and Adolescent Psychiatry Consulting

Separation anxiety disorder is treatable through collaborative efforts by a child’s medical practitioners, therapists, school staff, and family.

Treatments include psychological interventions (counseling), biological interventions (medicines), and accommodations at home and school that reduce sources of stress for the child.

Psychological Interventions (Counseling)

Counseling can help children with separation anxiety disorder, and everyone around them, to understand that their symptoms are caused by a disorder with complex genetic and environmental origins–not by flawed attitude or personality. Counseling also can reduce the impact of symptoms on daily life. A variety of psychological interventions can be helpful, and parents should discuss their child’s particular needs with their clinician to determine which psychological treatments could be most beneficial for their child.

• Individual psychotherapy is generally recommended as the first line of treatment for children and adolescents with separation anxiety disorder. Children with separation anxiety disorder may carry a sense of failure, as if the disorder was their fault. Individual psychotherapy can help reduce symptoms, and can help young people to become aware of and address their feelings of failure and self-blame.
• Cognitive Behavior Therapy (CBT) can teach young people new skills to reduce anxiety when separating from a trusted adult. In CBT, a child or adolescent is helped to become aware of and to describe negative thoughts, feelings or reactions. A trained clinician guides the child to think of new, more positive alternatives. The young person is then given a chance to practice new thoughts, feelings, or reactions outside the clinical visit, and to discuss his or her experiences with the clinician afterwards. These methods are based upon practices that have helped many children and adolescents.
• Parent guidance sessions can help parents to manage their child’s illness, identify effective parenting skills, learn how to function as a family despite the illness, and to address complex feelings that can arise when raising a child with a psychiatric disorder. Family therapy may be beneficial when issues are affecting the family as a whole.
• Group psychotherapy can be valuable to a child by providing a safe place to talk with other children who face adversity or allowing a child to practice social skills or symptom-combating skills in a carefully structured setting.
• School-based counseling can be effective in helping a child with separation anxiety disorder navigate the social, behavioral, and academic demands of the school setting.

Biological Interventions (Medications)

• Some children’s symptoms may improve with therapy alone, though many may require medication intervention as well.
• There is no “best” medicine to treat separation anxiety disorder, and the U.S. Food and Drug Administration (FDA) has not approved specific medications for the treatment of separation anxiety disorder
• Medications approved by the FDA for other uses and other age groups are prescribed for young people with separation anxiety disorder “off label”, by physicians who must depend on their best clinical judgment to make decisions about this such treatment.
• The Selective Serotonin Reuptake Inhibitors, or SSRI’s [Celexa (citalopram), Lexapro (escitalopram), Luvox (luvoxamine), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline)] are commonly prescribed to treat the symptoms of separation anxiety disorder.
• Other types of antidepressants, such as the tricyclic antidepressant Tofranil (imipramine) have also been reported helpful in some studies.

• The family, clinician and school should maintain frequent communication to ensure that medications are working as intended and to monitor and manage side effects.
• The following cautions should be observed when any child or adolescent is treated with antidepressants.
• Benefits and risks should be evaluated . Questions have arisen about whether antidepressants can cause some children or adolescents to have suicidal thoughts. The evidence to date shows that antidepressants, when carefully monitored, have safely helped many children and adolescents.
• Careful monitoring is recommended for any child receiving medication. Though most side effects occur soon after starting a medicine, adverse reactions can occur months after medicines are introduced. Agitation, restlessness, increased irritability, or comments about self-harm should be addressed immediately with the clinician if any of these symptoms emerge after the child starts an antidepressant. Frequent follow-up (weekly for the first month) is now advocated by the FDA for children starting an antidepressant.
• Different medicines or dosages may be needed at different times in a child’s life or to address the emergence of particular symptoms.
• Medications may start to reduce symptoms after 4 weeks of treatment, though it may often take as long as 12 weeks to determine whether the medication will be effective in reducing symptoms.
• Discontinuation of the medications should always be done under the supervision of a clinician.