Answer: You didn't mention how your daughter explains her distress when it's time to get out of the car. Is she worried about something or someone at school? She may be having difficulty with a particular subject or a teacher, she may have an upcoming test or project, she may be being bullied, or she may have had a break with a favorite peer. Or, is she worried about something or someone at home? If she or someone else was recently ill or injured, or there has been conflict among family members, she may be worried about that.

Anxiety is a standard part of development; we all experience these feelings, and a small amount can even be productive. However, when worry becomes excessive, persistent and developmentally inappropriate, there may be an emerging anxiety disorder. Separation anxiety disorder is defined as unwarranted worry and fear about being apart from family members or individuals to whom a child is attached. Other symptoms can include the following:

• Reluctance to sleep without being near a parent or caregivers
• Nightmares with a theme of separation
• Excessive distress, panic or temper tantrums when separation from home or family occurs or is anticipated
• Excessive worry about the safety of a family member or the self
• Excessive worry about getting lost from family
• Frequent stomach aches, headaches, nausea or other physical complaints
• "Clinginess," even when at home

Symptoms from family members must last for a period of at least four weeks to be considered separation anxiety disorder. This disorder can be successfully treated, and intervention should begin with a comprehensive evaluation of the child and family by a qualified mental health professional. Treatment recommendations may include therapy for the child, with a focus on helping her learn skills to manage her anxiety. Some children may also need treatment with anti-depressant or anti-anxiety medication to help them feel calmer. Parents are a critical part of treatment, and consultation with the child's school will be important.

Dr. Stacie Bunning, Psy.D, is a licensed clinical psychologist in the St. Louis, Missouri, area. She has worked with children, adolescents and their families in a variety of clinical settings for 20 years. She also teaches courses in child psychology, adolescent psychology and human development through the lifespan at Maryville University in St. Louis.

Advice from our experts is not a substitute for medical or other professional advice and services from a qualified health-care provider familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's medical or emotional condition.

March 2007