Separation Anxiety Disorder: Planning Treatment

When planning treatment for separation anxiety disorder (SAD), the primary care physician initially must distinguish it from normal developmental separation anxiety. The parents, child, and teachers play integral roles in making this assessment.

Separation anxiety is a normal developmental milestone in infancy. It first appears at age 6 to 8 months, peaks at 10 to 18 months, and subsides by 2 to 3 years of age. Along with the development of object permanence and the need to feel secure, infants develop attachment to primary caregivers. The infant’s success in re-engaging the caregiver, the stability of object permanence, skills for coping with separation, and the response of the caregiver to the infant’s separation protest all contribute to the infant’s development of trust and a secure attachment. It is this secure attachment that allows longer intervals of separation from primary caregivers and the development of self-comforting behaviors by the infant. If a secure attachment occurs between the infant and the primary caregivers, the normal separation response disappears by age 2 …