Effectiveness of Therapeutic and Educational Interventions for Childhood Separation Anxiety: A Scoping Review

ABSTRACT

Background

Separation anxiety disorder (SAD) is a common childhood condition characterised by excessive distress related to separation from attachment figures, often leading to social, emotional, and academic difficulties. If untreated, SAD can increase the risk of future psychopathology, highlighting the importance of effective interventions.

Aim

This scoping review systematically maps and analyzes the current evidence on intervention strategies to reduce separation anxiety and promote emotional and social well‐being in children.

Method

Following Arksey and O'Malley's framework and PRISMA‐ScR guidelines, a comprehensive search was conducted across multiple databases (PubMed, PsycINFO, Scopus, etc.) for studies published from 2005 to 2025. Inclusion criteria focused on original peer‐reviewed research evaluating therapeutic, parental, or educational interventions targeting separation anxiety in children.

Result

Eight studies from diverse settings demonstrated that interventions such as child‐centred group play therapy, attachment‐based play, art therapy, storytelling, laughter yoga, and schedule‐based paradoxical therapy effectively reduced separation anxiety symptoms. These approaches also improved social‐emotional skills, resilience, and parent‐child relationships. Combining therapies and involving parents enhanced outcomes, while the importance of school transition strategies was highlighted.

Discussion

Findings suggest that multimodal, relationship‐focused interventions are most effective in alleviating separation anxiety and fostering broader emotional development. Incorporating expressive activities and strengthening attachment bonds are crucial, and tailored, culturally sensitive approaches are recommended.

Conclusion

A comprehensive, developmentally sensitive framework integrating therapeutic, familial, and educational strategies holds promise for effective management of childhood separation anxiety. Further research with larger, diverse samples is needed to confirm long‐term benefits.

1. Background

Separation anxiety disorder (SAD) is characterised by excessive and developmentally inappropriate distress concerning separation from primary attachment figures, going well beyond the normative anxieties of early childhood and persisting over time [1, 2]. Epidemiological studies indicate that SAD is among the most common childhood anxiety disorders, with point prevalence estimates around 3.9%–5.3% in school‐age children and somewhat lower but still substantial rates in adolescence [2, 3, 4]. SAD frequently co‐occurs with other internalising and externalising problems, including specific phobia, oppositional defiant disorder, and other anxiety disorders, underscoring its complexity and clinical significance [3, 4]. If unaddressed, separation anxiety is linked to impaired emotional, social, and academic functioning, including school refusal, peer difficulties, and disrupted family relationships, and it increases risk for later psychopathology such as panic and depressive disorders into young adulthood [5, 6, 7]. These findings highlight SAD not only as a developmental anxiety problem but also as a potential gateway to broader socio‐emotional difficulties across the life course [2, 8, 9].

Given these consequences, early and effective intervention is considered a public health priority. Untreated anxiety disorders in childhood significantly reduce quality of life and interfere with social, emotional, and academic development into adulthood [10]. A wide range of intervention strategies has emerged, including cognitive‐behavioural therapy (CBT) protocols (e.g., Coping Cat, CAMP, TAFF), parent–child interaction therapy (PCIT), attachment‐based and couples‐focused approaches, schedule‐based paradoxical therapy, and broader parent‐focused programs [8, 11, 12, 13, 14]. CBT based interventions have the strongest empirical base for child anxiety and for SAD specifically, with systematic reviews and meta‐reviews showing short‐ and longerterm efficacy across several specific anxiety dis‐orders [11, 15]. At the same time, parent‐focused and family‐based interventions demonstrate promising effects on children's anxiety and on parent–child relationships, suggesting that targeting the caregiving context may enhance emotional and social outcomes beyond symptom reduction alone [12, 14, 16]. However, existing evidence is fragmented across protocols, age groups, and outcome domains, and important questions remain about which combinations of therapeutic, behavioural, educational, and relational strategies most effectively reduce separation anxiety while promoting emotional regulation, social competence, and relationship quality.

Although narrative and systematic reviews have synthesised psychological treatments for child anxiety and for SAD more broadly, they often emphasise symptom change, focus on CBT, or aggregate across heterogeneous anxiety diagnoses, leaving limited clarity on the comparative effectiveness of diverse interventions and on broader emotional and social well‐being outcomes [11, 15]. Emerging studies of paradoxical, attachment‐based, and parent‐only interventions, alongside evidence that parents commonly use informal strategies that only partially alleviate children's separation distress, further illustrate the variability in practise and the need for a structured evidence map [17, 18]. A scoping review is therefore well suited to this field: it can chart the breadth of available intervention research, describe the range of strategies (child‐focused, parent‐focused, school‐based, and combined), identify the outcome domains assessed, and locate key conceptual and methodological gaps to guide future trials and refinements.

1.1. Study Aim

To systematically map and describe the existing evidence on therapeutic, parental, and educational interventions for childhood separation anxiety.

1.2. Study Objectives

• To map and describe the existing literature on therapeutic, parental, and educational interventions aimed at reducing separation anxiety symptoms in children.

• To identify key factors and characteristics that influence the effectiveness of intervention strategies in alleviating separation anxiety symptoms in children.

• To synthesise and present comprehensive recommendations from the existing literature for reducing separation anxiety in children through therapeutic, family, and educational approaches.

2. Study Design

The review was conducted following the methodological framework established by Arksey and O'Malley, with further refinement by the Joanna Briggs Institute [19, 20]. It also adheres to the PRISMA‐ScR guidelines for scoping review protocols [21]. The review protocol is registered on PROSPERO with the registration number CRD420261423261.

3. Search Strategy

A comprehensive and systematic search was conducted across multiple electronic databases to identify relevant studies evaluating the effectiveness of intervention strategies aimed at reducing separation anxiety and enhancing emotional and social well‐being in children. The databases searched included PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and Google Scholar.

To facilitate efficient management of search results and ensure consistency during screening, references were exported and organised using EndNote X8 software. This tool helped de‐duplicate records, manage citations, and streamline the screening process. The search strategy was developed with the assistance of a health sciences librarian, utilising a combination of controlled vocabulary (such as MeSH terms) and free‐text keywords. These terms were iteratively refined to maximise sensitivity and specificity. Core concepts included separation anxiety and child anxiety, intervention strategies, outcomes related to emotional resilience and social well‐being, and the paediatric population. Structured search strings were created for each database, incorporating Boolean operators, truncation, and database‐specific controlled vocabulary. For example, in PubMed, the search combined terms like ‘separation anxiety,’ ‘child separation anxiety,’ ‘paediatric separation anxiety,’ ‘interventions,’ ‘treatment,’ ‘parent–child relationship,’ ‘attachment,’ ‘emotional resilience,’ and ‘social well‐being.’ Similar tailored strings were adapted for other databases, ensuring consistency and comprehensive coverage. The searches were limited to articles published in English from 2005 to December 2025. To promote transparency and reproducibility, the exact search strings used in each database are documented and available upon request.

The screening process involved two independent reviewers who examined the titles and abstracts of the retrieved articles. Discrepancies were resolved through discussion or consultation with a third reviewer. Articles passing this initial screening were then retrieved in full text for detailed eligibility assessment. Only peer‐reviewed original research articles focusing on intervention strategies for reducing separation anxiety and promoting emotional or social well‐being in children were included.

In addition to database searches, efforts were made to include grey literature to minimise publication bias. Targeted searches were conducted in Google Scholar, focusing on the first 200 records, with an emphasis on highly cited studies, theses, conference proceedings, and reports from relevant organisations. These searches used variations of the core keywords and filters for recent years to align with the database searches. Furthermore, reference lists of included articles and relevant reviews were hand‐searched, and citation tracking was performed using tools such as Google Scholar and Web of Science. These steps aimed to identify additional pertinent studies that might not have been captured through database searches alone. This multi‐pronged, transparent search approach, supported by the use of EndNote for reference management, was designed to ensure a thorough and reproducible identification of the existing evidence on intervention strategies for childhood separation anxiety, thereby strengthening the validity of this scoping review.

4. Study Eligibility

The study selection process was conducted systematically to ensure the inclusion of high‐quality research that specifically examines the effectiveness of intervention strategies for reducing separation anxiety and fostering emotional and social well‐being among children. Prior to the search, clear eligibility criteria were established to guide screening of titles, abstracts, and full‐text articles. These criteria focused on studies that directly investigated therapeutic approaches, parental involvement, or educational strategies aimed at alleviating separation anxiety or enhancing well‐being in children.

Included studies were published from 2005 to December 2025, written in English, and appeared in peer‐reviewed journals, ensuring relevance and quality. The review prioritised original research employing qualitative, quantitative, or mixed‐methods approaches to provide a comprehensive understanding of effective intervention strategies. Special emphasis was placed on studies that explicitly evaluated the impact of specific strategies on reducing separation anxiety and promoting emotional and social resilience. Studies that were reviews, commentaries, or focused solely on other aspects of child well‐being without addressing separation anxiety or intervention efficacy were excluded. Research outside the specified timeframe or lacking a clear focus on intervention effectiveness was also omitted. Further details on the selection process are available in Table 1.

TABLE 1.

Article eligibility criteria.

Criterion	Inclusion	Exclusion
Publication Year	2005—December 2025	Published before 2005 or after December 2025
Language	English	Non‐English
Study distinction	Full articles	Abstracts
Study type	Original peer‐reviewed articles (qualitative, quantitative, mixed methods)	Other types of papers (reviews, commentaries, etc.)
Country	All countries	—
Participants	Children experiencing separation anxiety and relevant caregivers or parents involved in intervention strategies.	Populations not involving children with separation anxiety or unrelated to intervention outcomes.
Focus	Studies evaluating the effectiveness of intervention approaches aimed at reducing separation anxiety and enhancing emotional and social well‐being in children	Studies unrelated to intervention strategies or focusing solely on other aspects of child development without addressing separation anxiety or well‐being
Setting	Settings involving children receiving interventions, including clinical, educational, or community environments	Studies that do not specify the setting or involve populations outside of children or intervention contexts.

5. Data Extraction

Two reviewers, M.Q. and M.H., independently collected and extracted relevant data from the chosen studies. This information covered multiple aspects, including study features, research approaches, participant details, main findings, noted limitations, and possible practical applications. To enable thorough analysis and integration, the extracted data were systematically arranged into a structured matrix.

6. Data Synthesis

The data were synthesised using a systematic thematic analysis following the five‐step framework [22]. This approach aimed to identify and categorise key themes related to the effectiveness of various intervention strategies in reducing separation anxiety and promoting emotional and social well‐being in children. Each theme was supported by evidence from the included studies, ensuring the synthesis was grounded in current research. This method facilitated a comprehensive understanding of how different therapeutic, parental, and educational strategies impact children's emotional resilience and social well‐being across diverse settings and populations.

7. Result

An initial search of the designated databases resulted in 351 records. These records, along with their abstracts, were exported using EndNote X8 and compiled into a Microsoft Word document. After removing duplicates, 334 abstracts remained for further screening. Based on the established eligibility criteria, 117 abstracts were selected for full‐text review. Of these, 18 studies met the inclusion criteria and were included in the final analysis. The article selection process is illustrated in Figure 1, following the PRISMA‐ScR (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines.

FIGURE 1.

Identification and screening of relevant studies: A PRISMA‐ScR flow diagram.

7.1. Characteristics of Included Studies

Table 2 offers a comprehensive overview of the eight studies included in the review, detailing their key features such as research design, sample size, country of origin, primary objectives, and main findings related to separation anxiety in children. The selected studies encompass a diverse range of countries within the region, with Iran representing the majority at 72.22% (n = 13), followed by Indonesia with 11.11%, and one study each from Germany, Norway, and the United States, each accounting for 5.55%.

TABLE 2.

Summary of studies on interventions and factors influencing separation anxiety in children.

Study	Aim	Design, sample, Country	Main result	Recommendation
[23]	To examine the effectiveness of child‐centred group play therapy (CCGPT), narrative therapy, and their combination in reducing separation anxiety disorder (SAD) and improving social–emotional behaviours in preschool children.	Design: Randomised controlled trial	Children in the CCGPT and combined therapy groups showed significantly lower separation anxiety symptoms after the intervention compared to the control group (p = 0.005 and p < 0.000, respectively).	Combining CCGPT and narrative therapy can be an effective approach to reduce separation anxiety and promote social–emotional development in preschool children.
		Sample: 48 children	The narrative therapy group did not show a significant reduction in separation anxiety compared to the control group.	Implementing these group therapies in preschool settings can help prevent long‐term anxiety issues and support healthy social development.
		Country: Iran	All three intervention groups showed a significant reduction in social–emotional difficulties (as measured by the SDQ) compared with controls (p < 0.01).	Future research should include larger sample sizes and follow‐up assessments to evaluate long‐term effects and generalizability.
			Prosocial behaviours increased significantly in all intervention groups after treatment (p < 0.01), with the greatest effect observed in the combined group.
[24]	To compare the effectiveness of attachment‐based play therapy and play therapy based on the parent–child relationship on the psychological well‐being of children with separation anxiety disorder.	Design: Quasi‐experimental	Both attachment‐based play therapy and parent–child relationship play therapy significantly improved children's psychological well‐being (p < 0.05).	Implement both attachment‐based play therapy and parent–child relationship play therapy as effective interventions to reduce psychological distress in children with separation anxiety.
		Sample: 40	No significant difference was found between the two therapies in post‐test and follow‐up stages (p > 0.05).	Use these evidence‐based approaches in clinical and educational settings to improve emotional and psychological outcomes.
		Country: Iran	The therapies increased self‐concept, life satisfaction, and resilience, and these improvements persisted at follow‐up.	Conduct larger‐scale studies with longer follow‐up periods to confirm the durability of effects and explore the impact on other emotional and behavioural outcomes.
			Effect sizes indicated that about 40% of the variance in psychological well‐being was explained by the interventions.
[25]	To examine the effect of art therapy (drawing therapy) on improving problem‐solving skills, self‐concept, and interpersonal relationships in children with Separation Anxiety Disorder (SAD) in Tehran.	Design: Quasi‐experimental	Art therapy significantly improved problem‐solving skills, self‐concept, and interpersonal relationships in children with SAD (p < 0.01).	Art therapy can be an effective intervention for enhancing cognitive and social skills in children with SAD.
		Sample: 30	The experimental group showed notable improvements compared to the control group in all three variables at post‐test.	Implement structured drawing therapy programs in clinical and educational settings to support emotional and interpersonal development.
		Country: Iran	Effect sizes indicated substantial clinical significance, with improvements maintained at follow‐up.	Further research with larger samples and diverse age groups is recommended to confirm and expand upon these findings.
[26]	To evaluate the effectiveness of storytelling therapy in enhancing creativity and emotional intelligence in children with Separation Anxiety Disorder (SAD).	Design: Quasi‐experimental	Storytelling therapy significantly improved creativity, with increases observed in fluency, originality, flexibility, and elaboration (p < 0.01).	Incorporate storytelling therapy into clinical and educational programs for children with SAD to foster creativity and emotional skills.
		Sample: 30 children	Emotional intelligence also significantly increased across multiple subdomains, including adaptability, emotional readiness, regulation, peer relations, self‐esteem, and motivation (p < 0.01).	Conduct further research with larger samples and diverse settings to validate and expand upon these findings.
		Country: Iran	These improvements were maintained at post‐test, indicating the effectiveness of storytelling therapy in this population.	Train parents and teachers on storytelling techniques to support child development in emotional and creative domains.
[27]	To evaluate the effects of laughter yoga on reducing separation anxiety disorder (SAD) symptoms in kindergarten children in Rafsanjan, Iran.	Design: Quasi‐experimental	The prevalence of SAD among the sampled children was 25.33%.	Incorporate laughter yoga into routine activities in kindergartens as a complementary method to alleviate SAD symptoms.
		Sample: 56 children	Children in the laughter yoga group exhibited a significant decrease in SAD scores after the intervention (p = 0.000).	While not a complete replacement for psychological therapies, laughter yoga can serve as an effective supplementary approach to reduce anxiety symptoms in young children.
		Country: Iran	Laughter yoga was effective in reducing the severity of separation anxiety symptoms in preschool children.	Further research is recommended to examine the long‐term effects and compare laughter yoga with other therapeutic interventions.
[28]	To evaluate the effectiveness of schedule‐based paradoxical therapy in reducing separation anxiety symptoms and improving mother–child relationship functioning in children aged 6 to 9 years.	Design: Quasi‐experimental	The schedule‐based paradoxical therapy significantly reduced separation anxiety symptoms (F = 6.91, p = 0.016, η 2 = 0.26).	Implement schedule‐based paradoxical therapy as a culturally adaptable and time‐efficient intervention for children with separation anxiety.
		Sample: 20 children	The therapy also significantly improved mother–child relationship scores (F = 14.97, p = 0.001, η 2 = 0.42).	Use this approach alongside other therapeutic methods to enhance its effectiveness.
		Country: Iran	Post‐intervention, the experimental group showed a notable decrease in separation anxiety and a significant increase in mother–childrelationship quality compared to the control group.	Further research with larger samples and diverse populations is recommended to validate these findings and explore long‐term effects.
[29]	To examine the influence of parental attachment on early childhood children's separation anxiety, specifically how the quality of child–parent attachment affects the level of separation anxiety in children aged 5–6 years.	Design: Cross‐sectional	The regression analysis showed a significant negative relationship between parental attachment and children's separation anxiety (F = 15.26, p < 0.05).	Parents should foster a positive, secure attachment with their children to reduce separation anxiety.
		Sample: 185 children	High parental attachment was associated with lower levels of separation anxiety in children.	Parental behaviours that promote trust, open communication, and emotional bonding should be encouraged.
		Country: Indonesia	The statistical test indicated that parental attachment explains approximately 8.1% of the variance in children's separation anxiety (R 2 = 0.081).	Early intervention programs aimed at strengthening parent–child attachment could help alleviate separation anxiety in preschool children.
				Further research could explore additional factors influencing separation anxiety and the long‐term effects of parental attachment.
[30]	To explore the forms, contributing factors, and practical mentoring approaches related to separation anxiety in a 4‐year‐old child who refused to go to school.	Design: Qualitative	The child's separation anxiety manifested through crying, clinging behaviour, verbal refusal, and expressions of fear during separation from the mother.	Educators and parents should collaborate to provide emotionally supportive, developmentally appropriate transition strategies for young children entering school.
		Sample: 2 young children	The anxiety gradually subsided after engaging in play and feeling secure in the classroom.	Implement play‐based, empathetic approaches to help children manage separation anxiety.
		Country: Indonesia	Contributing factors included a strong attachment to the mother, overprotective parenting, limited prior social experience, parental anxiety, and early caregiving trauma.	Recognise that separation anxiety at this age is normal and temporary, but early support can facilitate smoother adaptation.
			The anxiety was identified as situational, adaptive, and temporary rather than a clinical disorder.	Training teachers and parents to use consistent, nurturing, and responsive methods during initial school transitions.
[31]	To evaluate the short‐term efficacy of a disorder‐specific cognitive‐behavioural therapy (CBT) program, including parent training, in treating children aged 5–7 years with separation anxiety disorder (SAD).	Design: Randomised controlled trial	76.19% of children in the treatment group no longer met DSM‐IV criteria for SAD at follow‐up, compared to 13.64% in the waiting list group.	The study supports the short‐term efficacy of a disorder‐specific CBT approach for young children with SAD and suggests that such programs are effective. Future research should explore long‐term outcomes, larger sample sizes, and the application of similar approaches across diverse populations.
		Sample: 43 children	Between 91% and 100% of children were rated as very much or much improved immediately after treatment by themselves, their parents, or therapists.
		Country: Germany
[14]	To investigate the effect of parent–child interaction therapy (PCIT) on reducing symptoms of separation anxiety disorder in children aged 3–6 years of nurses working in educational hospitals in Qazvin.	Design: Pre‐test/post‐test	The intervention significantly reduced separation anxiety symptoms, with the mean score decreasing from 10.82 ± 0.62 before intervention to 7.69 ± 0.52 after intervention (p = 0.0006).	Parent–child interaction therapy is effective in reducing separation anxiety symptoms among preschool children. It can be used as a valuable treatment plan, especially in populations where early intervention is critical. Further studies should explore long‐term effects and broader populations.
		Sample: 67 children
		Country: Iran
[32]	To evaluate the effectiveness of child–parent relationship therapy (CPRT) in reducing the severity of separation anxiety disorder (SAD) symptoms in children aged 6–7 years, and its impact on maternal stress, self‐efficacy, and mother–child relationship.	Design: Quasi‐experimental	The severity of separation anxiety symptoms decreased significantly in the intervention group from a mean score of 13.2 ± 3.4 pre‐intervention to 10.1 ± 3.9 post‐intervention (effect size: Hedge's g = 0.85).	Child–parent relationship therapy is effective in reducing separation anxiety symptoms, maternal stress, and improving mother–child relationships. It is recommended to use CPRT as a therapeutic intervention for children with SAD and to conduct further studies with larger sample sizes to confirm and generalise the findings.
		Sample: 24 mothers of children diagnosed with separation anxiety disorder	The intervention also significantly reduced maternal stress (effect size: Hedge's g = 2.20), increased maternal self‐efficacy (effect size: Hedge's g = −1.14), and improved parent–child relationship measures such as acceptance and reduced overprotection, indulgence, and rejection.
		Country: Iran
[16]	To compare the effectiveness of cognitive‐behavioural therapy (CBT) and parent–child interaction therapy (PCIT) on improving parent–child interaction in children diagnosed with separation anxiety disorder (SAD).	Design: Quasi‐experimental	There was a significant difference between the two intervention groups (CBT and PCIT) in parent–child interaction (F = 14.09; p < 0.001).	CBT can be an effective treatment for enhancing parent–child interactions in children with SAD. The findings support implementing CBT as a therapeutic approach, but further research with larger samples and long‐term follow‐up is recommended to confirm these results.
		Sample: 30 children	CBT had a greater effect on improving parent–child interaction than PCIT (p < 0.001).
		Country: Iran	Both interventions significantly improved parent–child interaction compared to the control group.
[33]	To evaluate the long‐term effectiveness of cognitive‐behavioural therapy (CBT) in youth with anxiety disorders, specifically assessing whether treatment gains are maintained or improved approximately 4 years after treatment in community clinics.	Design: Prospective	Approximately 53% of participants no longer met criteria for any anxiety diagnosis at long‐term follow‐up.	CBT shows durable long‐term benefits for youth with anxiety disorders in community settings, with similar outcomes for individual and group formats. The findings support wider implementation of CBT in community clinics, but further research is needed to optimise treatment for youth with SOP and to identify predictors of long‐term success.
		Sample: 139 children	About 63% had lost their principal anxiety diagnosis.
		Country: Norway	Significant reductions in anxiety symptoms were observed, with no significant differences between ICBT and GCBT.
			Youth with a principal diagnosis of social anxiety disorder (SOP) had lower odds of recovery compared to those with separation anxiety disorder (SAD) or generalised anxiety disorder (GAD).
[34]	To evaluate the feasibility and preliminary effectiveness of a dismantled, exposure‐focused CBT protocol for childhood anxiety disorders, comparing it to traditional CBT components in a small sample.	Design: Randomised controlled trial	Both groups showed significant improvement, with large effect sizes.	The findings support further development and a fully powered randomised controlled trial to confirm whether early exposure without prior anxiety management strategies can improve treatment efficacy and efficiency for childhood anxiety disorders.
		Sample: 14 children	The exposure‐focused protocol (parent‐coached exposure) was more effective and efficient, with greater symptom reduction and fewer treatment sessions needed.
		Country: United States	The early exposure protocol was safe, tolerable, and distinguishable from standard CBT.
[35]	To compare the effectiveness of maternal training based on attachment‐based intervention versus cognitive‐behavioural intervention in reducing multiple dimensions of anxiety in children with separation anxiety disorder.	Design: Quasi‐experimental	Both attachment‐based and cognitive‐behavioural interventions significantly reduced multiple dimensions of children's anxiety, with statistical significance (F = 4.207, p = 0.0001). The effects were maintained at follow‐up, showing both methods are effective, and no significant difference was found between the two interventions in their long‐term effects.	Both attachment‐based intervention and cognitive‐behavioural intervention are effective for reducing anxiety in children with separation anxiety disorder. It is recommended to use either method depending on the specific circumstances and needs of the child and family.
		Sample: 45 mothers
		Country: Iran
[36]	To evaluate the effectiveness of problem‐solving story therapy (PSST) in reducing separation anxiety disorder (SAD) and improving bilateral attachment in primary school children.	Design: Quasi‐experimental	Implementation of PSST significantly improved SAD symptoms and bilateral attachment components, with statistical significance (p < 0.01). The results showed notable reductions in separation distress and anxiety components, and improvements in attachment behaviours, sustained at follow‐up.	PSST is an effective non‐pharmacological method for treating SAD and enhancing bilateral attachment in primary school children. It is suggested that psychologists, counsellors, and parents incorporate storytelling therapy in interventions for children with SAD.
		Sample: 30 children
		Country: Iran
[37]	To evaluate the effectiveness of attachment‐based psycho‐educational interventions in reducing symptoms of separation anxiety disorder (SAD) in preschool children and improving their mothers' parenting practises in Tehran.	Design: Quasi‐experimental	The attachment‐based psycho‐educational package significantly reduced the severity and symptoms of separation anxiety disorder in children, with effects persisting at follow‐up (exact numbers are not provided but statistically significant). Additionally, the intervention improved maternal parenting practises, increasing positive involvement and monitoring, and decreasing poor supervision and inconsistency (all with P < 0.01).	Implement attachment‐based psycho‐educational programs for mothers to effectively reduce separation anxiety symptoms in preschool children and enhance parenting skills. Such programs can be delivered via workshops or training sessions, especially targeting mothers of children with attachment and anxiety issues.
		Sample: 24 children
		Country: Iran
[38]	To examine the effectiveness of sandplay therapy in reducing symptoms of separation anxiety disorder in children aged 5–7 years.	Design: Quasi‐experimental	Sandplay therapy significantly reduced symptoms of separation anxiety disorder in children, as indicated by covariance analysis. The therapy was effective in decreasing separation anxiety symptoms after the treatment sessions.	Sandplay therapy can be considered an effective therapeutic approach for reducing separation anxiety symptoms in young children, and it should be integrated into clinical practise for children with this disorder.
		Sample: 30 children
		Country: Iran

In terms of research methodologies, most studies used a quasi‐experimental design (61.11%, n = 11), while the remaining studies included three randomised controlled trials (16.66%), one cross‐sectional study (5.55%), one prospective quantitative study (5.55%), one pre‐test/post‐test study (5.55%), and one qualitative study (5.55%).

7.2. Thematic Analysis

Thematic analysis is a qualitative approach used to systematically identify, analyse, and interpret meaningful patterns within textual data [39]. In this study, researchers conducted a manual thematic analysis to examine the effectiveness of various intervention strategies for reducing separation anxiety and promoting emotional and social well‐being in children. Two independent reviewers meticulously coded relevant research articles to identify key concepts, therapeutic approaches, parental strategies, and educational methods. These initial codes were then grouped into broader thematic categories based on shared patterns and underlying themes, such as the impact of therapeutic interventions, parental attachment, and support strategies. To enhance the credibility and validity of the findings, peer debriefing with child development specialists and independent coding by experienced researchers were employed. These measures ensured a rigorous, comprehensive synthesis of existing evidence on how different intervention approaches can improve children's emotional resilience and reduce separation anxiety across diverse settings. The reviewers identified two main themes: (1) Comprehensive review of therapeutic approaches and factors influencing separation anxiety in children, and (2) Comprehensive recommendations for reducing separation anxiety in children: therapeutic, family, and educational approaches.

7.2.1. Comprehensive Review of Therapeutic Approaches and Factors Influencing Separation Anxiety in Children

7.2.1.1. Effectiveness of Group and Combined Therapies in Reducing Separation Anxiety

Children receiving Child‐Centered Group Play Therapy (CCGPT) and combined therapy showed significant reductions in separation anxiety symptoms compared to controls [23]. Narrative therapy alone did not yield significant effects. All three intervention groups experienced improvements in social–emotional skills, with prosocial behaviours increasing most notably in the combined group. These findings suggest that combining therapies may enhance efficacy in alleviating separation anxiety and promoting social–emotional development.

7.2.1.2. Impact of Attachment and Parent–Child Relationship on Play Therapy

Both attachment‐based and parent–child relationship play therapies significantly enhanced children's psychological well‐being, including self‐concept, resilience, and life satisfaction, with effects sustained over time [24]. No significant difference was found between these approaches, indicating their comparable effectiveness. These interventions accounted for approximately 40% of the variance in well‐being, emphasising the importance of secure attachment in reducing anxiety.

7.2.1.3. Art Therapy's Role in Cognitive and Social Skill Development

Art therapy (drawing) substantially improved problem‐solving skills, self‐concept, and interpersonal relationships among children with SAD, with effects maintained at follow‐up assessments [25]. The significant improvements highlight art therapy as a valuable modality for enhancing cognitive and social functioning in anxious children, supporting its integration into clinical and educational settings.

7.2.1.4. Enhancement of Creativity and Emotional Intelligence via Storytelling

Storytelling therapy effectively increased creativity—measured through fluency, originality, flexibility, and elaboration—and enhanced emotional intelligence across multiple domains, including regulation, peer relations, and motivation [26]. These benefits persisted after the intervention, indicating storytelling's potential to foster emotional and creative development in children with SAD.

7.2.1.5. Laughter Yoga as a Complementary Anxiety Reduction Technique

Laughter yoga significantly decreased separation anxiety symptoms among preschool children, with a prevalence rate of 25.33% in the sample [27]. The intervention proved effective in reducing anxiety severity, suggesting its utility as a fun, non‐invasive supplementary approach in early childhood settings to alleviate separation‐related distress.

7.2.1.6. Paradoxical and Parental Attachment‐Based Interventions

Schedule‐based paradoxical therapy significantly reduced separation anxiety and improved mother–child relationships, with notable effect sizes [28]. Additionally, a strong negative correlation between parental attachment and children's separation anxiety was identified, indicating that secure attachment is protective against anxiety [29]. These findings underscore the importance of parental involvement and tailored therapeutic approaches.

7.2.1.7. Nature and Situational Factors of Separation Anxiety

In a qualitative case, separation anxiety was characterised by typical adaptive behaviours such as crying and clinging, primarily influenced by attachment to caregivers, overprotective parenting, and limited social exposure [30]. The behaviour was deemed temporary and situational, not a clinical disorder, emphasising the need for supportive, empathetic strategies during early school transitions.

7.2.2. Comprehensive Recommendations for Reducing Separation Anxiety in Children: Therapeutic, Family, and Educational Approaches

7.2.2.1. Therapeutic Interventions in Preschool and Clinical Settings

Implementing combined and targeted therapies, such as Child‐Centered Group Play Therapy (CCGPT) and narrative therapy, can effectively reduce separation anxiety and promote social–emotional development in preschool children [23]. Art therapy and storytelling techniques are also beneficial for enhancing cognitive, social, and emotional skills, supporting children's overall development [25, 26]. Incorporating these evidence‐based practises into routine educational and clinical programs can foster emotional resilience and social competence [25, 26].

7.2.2.2. Parent–Child Relationship and Attachment‐Based Strategies

Strengthening parent–child attachment through attachment‐based play therapy and parent–child relationship play therapy significantly improves children's psychological well‐being and reduces separation anxiety [24]. Parental behaviours that promote trust, emotional bonding, and open communication are crucial, and early intervention programs can support secure attachments, thereby alleviating anxiety (Astuti et al. [29]). Encouraging collaborative efforts between parents and educators can create a supportive environment for children navigating separation [24, 29].

7.2.2.3. Creative and Relaxation Activities for Anxiety Reduction

Activities such as laughter yoga, storytelling, and art therapy are effective complementary approaches for reducing anxiety symptoms and fostering emotional and social skills [24, 26, 27]. Laughter yoga, in particular, can be incorporated into preschool routines as a fun, non‐invasive method to ease separation distress, while art and storytelling encourage creativity and emotional regulation [26, 27]. Further research is needed to explore their long‐term impacts and comparative effectiveness.

7.2.2.4. School Transition and Supportive Strategies

Educators and parents should collaborate to implement developmentally appropriate, empathetic transition strategies for young children entering school, recognising that separation anxiety is often temporary and adaptive [30]. Play‐based, nurturing approaches and consistent routines help children manage separation and build resilience during early school experiences [30]. Training for teachers and parents in responsive support techniques can facilitate smoother adaptation and reduce anxiety [30].

7.2.2.5. Need for Further Research and Larger‐Scale Studies

While current evidence supports various interventions, future research should focus on larger sample sizes, diverse populations, and long‐term follow‐up assessments to confirm the durability and generalizability of these findings [23, 24, 25]. This will help optimise intervention strategies, identify mediating factors, and develop comprehensive programs tailored to different developmental and cultural contexts [23, 25, 27, 28].

8. Discussion

The reviewed interventions collectively indicate that separation anxiety in children can be effectively reduced through developmentally sensitive, relationship‐focused, and multimodal strategies that simultaneously target symptoms and broader social–emotional functioning [23, 24, 25, 26, 27, 28, 29]. Evidence that child‐centred group play and combined therapies outperform narrative therapy alone, and that attachment‐based, parent–child relationship play, art, storytelling, laughter yoga, and paradoxical, schedule‐based approaches enhance self‐concept, resilience, emotional regulation, and prosocial behaviour, aligns with broader paediatric anxiety literature showing that interventions integrating cognitive, emotional, and relational components (e.g., CBT with family involvement) yield superior outcomes to child‐only or purely didactic formats in generalised and social anxiety disorders [40]. Similar to findings in youth social anxiety and generalised anxiety, where group CBT and combined family‐based formats enhance peer functioning and reduce internalising symptoms, the current separation‐anxiety studies highlight that gains often extend beyond symptom relief to creativity, emotional intelligence, and mother–child relationship quality, reinforcing the value of systemic, skills‐focused care across childhood anxiety presentations [41, 42].

At the same time, these results parallel and extend evidence from other youth anxiety disorders, indicating that modality tailoring and context sensitivity are crucial determinants of efficacy. The stronger effects of combined or play‐based formats relative to narrative therapy echo meta‐analytic findings that child‐appropriate, experiential techniques (e.g., exposure‐based group CBT, play‐informed CBT, and parent‐training) are more acceptable and effective than insight‐oriented or purely verbal therapies for younger children with specific phobias or school refusal [43, 44]. The emphasis on parental attachment, overprotective parenting, and limited social exposure as key situational drivers of separation anxiety converges with longitudinal work in other childhood anxiety disorders, where parental control and modelling of threat maintain generalised, social, and panic symptoms [45]. Moreover, the promising role of adjunctive, low‐stigma approaches such as art therapy, storytelling, and laughter‐based interventions mirrors findings in youth with generalised and test anxiety, in whom expressive arts and mindfulness‐play programs reduce distress and improve school adjustment, suggesting that integrating such modalities into stepped‐care models may boost engagement and outcomes across the spectrum of child and adolescent anxiety [46, 47].

Integrating therapeutic, family, and educational approaches offers a developmentally sensitive framework for reducing separation anxiety in young children by addressing both intrapersonal regulation and interpersonal security. At the individual level, developmentally appropriate interventions such as Child‐Centered Group Play Therapy (CCGPT), narrative therapy, and art‐based modalities directly target preschoolers' emerging emotion‐regulation and social‐cognitive capacities, thereby decreasing anxiety while supporting social–emotional development [23]. These gains are reinforced within the attachment system when parent–child relationship and attachment‐based play therapies strengthen secure bonds, enhance parents' emotional responsiveness, and promote open communication, which are central protective factors in anxiety trajectories during early childhood [24]. Building on this secure relational base, creative and relaxation‐oriented activities—such as laughter yoga, storytelling, and art—provide children with concrete, play‐based opportunities to practise self‐soothing, symbolic expression, and emotional competence in everyday contexts, fostering resilience and adaptive coping with separation demands [27]. Within the educational environment, coordinated school transition strategies that emphasise predictable routines, nurturing teacher–child relationships, and collaborative parent–educator partnerships help children generalise these regulatory and attachment capacities to novel settings, reducing distress during school entry and supporting functional adaptation [30]. Nonetheless, to fully embed these multi‐level strategies into practise and ensure they are culturally and contextually responsive, larger and more diverse longitudinal studies are needed to clarify mechanisms of change, sustainment of benefits, and optimal combinations of interventions across different developmental stages and sociocultural backgrounds [25].

8.1. Implications for Practise and Policymakers

Implications for practise and policymakers emphasise the need to adopt a comprehensive, multimodal approach to reducing separation anxiety in children. Clinicians and educators should incorporate evidence‐based interventions such as Child‐Centered Group Play Therapy, attachment‐based play, art therapy, and storytelling to support social–emotional development [23, 24, 26]. Parental involvement and strengthening parent–child relationships are crucial, and programs that promote secure attachments have a lasting impact [24, 29]. Policymakers should prioritise training for teachers and caregivers in responsive, developmentally appropriate strategies to facilitate smooth school transitions [30]. Integrating playful, expressive, and relaxation activities into early childhood programs can enhance engagement and resilience [27]. Funding for larger, long‐term research is essential to develop culturally responsive, scalable interventions that ensure equitable access and sustained benefits for diverse populations [25].

8.2. Limitations and Recommendations

The limitations of this scoping review primarily stem from the inclusion of only 8 studies, which limits the generalizability of the findings and may not fully capture the breadth of available evidence. Additionally, the heterogeneity in study designs, sample sizes, intervention modalities, and outcome measures restricts the ability to draw definitive conclusions about long‐term effectiveness. The reliance on published peer‐reviewed articles in English introduces potential publication bias and excludes relevant research from non‐English sources and grey literature, which is often not reported or acknowledged. Our methodology, covering a broad time frame from 2005 to 2025, may overlook emerging innovative approaches not yet extensively studied. Future research should focus on larger, more diverse samples using standardised outcome measures and rigorous experimental designs such as randomised controlled trials. Longitudinal studies are needed to assess the durability of intervention effects over time. Incorporating qualitative data can provide deeper insights into contextual factors influencing intervention success. Expanding searches to include grey literature and non‐English publications would enhance the comprehensiveness of the evidence base.

9. Conclusions

In conclusion, the evidence underscores the effectiveness of diverse therapeutic, parental, and educational strategies in reducing separation anxiety and enhancing children's emotional and social well‐being. Combining therapies, strengthening parent–child attachment, and incorporating expressive modalities like art, storytelling, and laughter yoga appear particularly beneficial. These interventions not only alleviate anxiety symptoms but also promote broader social–emotional development, resilience, and positive family dynamics. The findings highlight the importance of a developmentally sensitive, multimodal approach that integrates individual, relational, and environmental factors. Future research should focus on larger, long‐term studies to determine optimal intervention combinations and ensure cultural adaptability. Overall, a systemic, child‐centred framework holds promise for fostering healthier emotional trajectories during early childhood.

Author Contributions

Mohammed Qutishat, Majdi Al‐Hadidi, Koukab Al Gharibi, Eilean Lazarus: conceptualization. Mohammed Qutishat, Majdi Al‐Hadidi, Koukab Al Gharibi, Eilean Lazarus: acquisition, analysis, interpretation of data. Mohammed Qutishat, Majdi Al‐Hadidi, Koukab Al Gharibi, Eilean Lazarus: drafting the article. Mohammed Qutishat: final approval of the version to be published. Mohammed Qutishat, Majdi Al‐Hadidi: accountability for all aspects of the work.

Funding

The authors have nothing to report.

Disclosure

The content of this paper has not been presented or published elsewhere. The data, observations, and interpretations offered here are entirely original and have not been previously shared in any way.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Prisma checklist.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.