Background
The origins of separation anxiety disorder stem from attachment theory which has roots in the attachment theories both of Sigmund Freud and John Bowlby. Freuds attachment theory, which has similarities to learning theory, proposes that infants have instinctual impulses, and when these impulses go unnoticed, it traumatizes the infant. The infant then learns that when their mother is absent, this will be followed by a distressing lack of gratification, thus making the mothers absence a conditioned stimulus that triggers anxiety in the infant who then expects their needs to be ignored. The result of this association is that the child becomes fearful of all situations that include distance from their caregiver. John Bowlbys attachment theory also contributed to the thinking process surrounding separation anxiety disorder. His theory is a framework in which to contextualize the relationships that humans form with one another. Bowlby suggests that infants are instinctively motivated to seek proximity with a familiar caregiver, especially when they are alarmed, and they expect that in these moments they will be met with emotional support and protection. He poses that all infants become attached to their caregivers, however, there are individual differences in the way that these attachments develop. There are 4 main attachment styles according to Bowlby; secure attachment, anxious-avoidant attachment, disorganized attachment, and anxious-ambivalent attachment. Anxious-ambivalent attachment is most relevant here because its description, when an infant feels extreme distress and anxiety when their caregiver is absent and does not feel reassured when they return, is very similar to SAD.
The results suggested that cognitive therapy for children suffering from separation anxiety (along with social phobia and generalized anxiety) should be aimed at identifying negative cognition of ones own behavior in the threat of anxiety-evoking situations and to modify these thoughts to promote self-esteem and ability to properly cope with the given situation.Cognitive procedures are a form of treatment found to be ideal for older children with SAD. The theory behind this technique is that the childs dysfunctional thoughts, attitudes, and beliefs are what leads to anxiety and causes anxious behavior. Children who are being treated with cognitive procedures are taught to ask themselves if there is "evidence" to support their anxious thoughts and behaviors. They are taught "coping thoughts" to replace previously distorted thoughts during anxiety-inducing situations such as doing a reality check to assess the realistic danger of a situation and then to praise themselves for handling the situation bravely. Examples of such disordered thoughts include polarized thinking, overgeneralization, filtering (focusing on negative), jumping to conclusions, catastrophizing, emotional reasoning, labeling, "shoulds", and placing blame on self and others. Sometimes therapists will involve parents and teach them behavioral tactics such as contingency management. Medication
The use of medication is applied in extreme cases of SAD when other treatment options have been utilized and failed. However, it has been difficult to prove the benefits of drug treatment in patients with SAD because there have been many mixed results. Despite all the studies and testings, there has yet to be a specific medication for SAD.