This disorder features improper and extreme anxiety regarding separation from home or attachment figures. Separation Anxiety Disorder is marked by anxiety regarding being separated from home or parents. This behavior must last for at least one month to be diagnosed. Symptoms include fear of losing parents, refusal to go to school, nightmares about being separated, clinging to parents, and manifestation of physical symptoms when separated.

Children with this disorder often display internalizing behaviors. Extreme compliance and perfectionism are common characteristics. These children are at risk for other anxiety disorders later in childhood or as adults.

Separation Anxiety Disorder is not usually seen before the age four (after the period of normal separation anxiety). It is usually recognized in early to middle childhood.

A thorough assessment needs to be done to understand the problems. If the child refuses to go to school, you should do what you can to get the child back to school as soon as possible. It is important to separate school phobia from Separation Anxiety. You should then establish a working rapport with the family. An interview with the parents will be necessary, to get a full clinical history in relation to the nature of the problem. The parents will be able to provide you with the types of interventions they have tried on their own and what successes they have or have not had. Obtain releases and talk to the child's teachers and then rule out any co-existing mental disorders. A referral to a physician would be helpful to rule out any general medical conditions and possible underlying somatic symptoms associated with the disorder (you will need a release). You will want to have discussions with the parents regarding treatment goals and strategies since they probably have come to you because the school or their physician asked them to. You will need to be insistent, firm, and empathetic as well as furnishing consistent positive bolstering for desired behaviors. Anti-depressant medication is often helpful in treating this disorder. Alternatively, SSRIs and benzodiazapines may be used effectively. However, benzodiazapines are quite addictive and should be used with caution. Finally, you may need to refer the family to a support group.

Parents with anxiety or mood disorders may need their own psychiatric and/or psychological treatment. Both parents and children may present with overly good or nice behavior. Clinicians should watch for overly compliant behavior. This should not be mistaken for understanding or change that is more substantial. Therapeutic "coercion" to return to school can be effective if applied with sensitivity if the child does not have panic disorder or a mood disorder.