William was adopted from an orphanage at 18 months and shows clinging behavior and insomnia at age five. His likely diagnosis is what?

• A. Separation anxiety disorder
• B. Reactive attachment disorder
• C. Generalized anxiety disorder
• D. Oppositional defiant disorder

Answer: (A)

Separation anxiety disorder shows up when a child experiences excessive fear or distress at the idea of being apart from the primary caregiver, often leading to clinginess and sleep problems. In this case, William was adopted after living in an orphanage, which can create heightened sensitivity to separation. At age five, his persistent clinging and insomnia around separation from his caregiver fit this pattern well—he’s distressed at the thought of being apart and seeks constant closeness for reassurance.

Reactive attachment disorder would more likely present as withdrawal or indiscriminate sociability toward strangers rather than clear clinginess toward a specific caregiver. Generalized anxiety disorder would involve pervasive worry across many domains, not just separation-related distress. Oppositional defiant disorder would show a pattern of defiant, oppositional behavior rather than anxiety-centered responses to separation.