Separation Anxiety Presenting as Severe School Behavioral Dysregulation in an Immigrant Child

Separation anxiety in children may present with behavioral dysregulation, particularly in the context of psychosocial stressors, such as immigration-related trauma. This case describes an 8-year-old Hispanic boy presenting with escalating school refusal and aggressive outbursts, ultimately resulting in juvenile court involvement. Comprehensive evaluation, including validated screening tools, revealed underlying separation anxiety associated with prior traumatic family separation. Treatment with cognitive behavioral therapy and sertraline resulted in symptom remission. This case highlights the importance of trauma-informed, culturally responsive assessment in pediatric behavioral presentations.