Dealing with Childhood Separation Anxiety
By: Tara Cuskley
Aside from cereal and showers, are crying, tantrums, stomachaches, or headaches a normal part of your child’s routine before leaving for school in the morning? If so, it could be an indication of a clinical Separation Anxiety Disorder. But how do you distinguish normal, age appropriate fears of separation from a clinical disorder?
Normal separation anxiety from primary caregivers generally starts to develop around one-year of age and can last on and off up until about four years of age. Tantrums, crying, or clinginess may be a normal feature of separations during this stage of development (Pendley, 2012). However, if anxiety symptoms persist past this stage of development or are impairing your child’s everyday functioning, it may be a sign of Separation Anxiety Disorder (SAD). Children with this disorder may believe that something bad will happen during the separation such as getting kidnapped or getting lost without the caregiver, or they may believe that some disastrous harm will befall their parent, preventing their return (American Psychiatric Association, 2013). This may manifest as physical symptoms of anxiety such as nausea, vomiting, shortness of breath, or panic attacks before a separation or before leaving for school. Children with the disorder may refuse to go to school or other places with out their primary caregivers, throwing tantrums or physically clinging on to parents in order to prevent the separation. Difficulty sleeping without the caregiver at night or nightmares of separation are also common features of the disorder (American Psychiatric Association, 2013). Normal fears of separation may present as some mild clinginess or anxiety and fade as the elementary years progress. If your child’s separation fears intensify with age or do not fade, it is important to seek advice or treatment from a medical professional.
SAD is a relatively common childhood anxiety disorder, affecting 3.2% to 4.1% of children (Hanna, Fischer, & Fluent, 2006), and can have a number of causes or triggers. It may be a heritable disorder and symptoms may be triggered by a change in environment, such as school, home, or family situation, or stressful or traumatic event, such as the loss of a loved one (American Psychiatric Association, 2013). In some cases, an over-protective parenting style may also contribute to the anxieties of a child. If this is something you are dealing with in your family, it is important to first educate yourself about the disorder and to provide a supportive, empathetic environment for your child to speak about his or her fears. Identify and anticipate your child’s triggers and attempt to set up a consistent routine surrounding separation. If the child separates more easily from one parent, use that parent for school drop-offs. Keep calm during the separation, and offer choices surrounding the separation routine to give your child more control over the process. It’s important, though, to set firm limits around rules in the home and necessity of attending school or other activities. Provide gentle encouragement and praise for the positive efforts on the part of your child. Getting your child’s school involved may also be necessary. Often, there are support persons within the school, such as a school psychologist or social worker who will be skilled at working with children with anxiety. They may be able to act as a safe place for your child within school or even become involved in developing a separation plan when your child arrives at school.
If your child is still experiencing severe separation anxiety with these measures in place, you may with to seek out professional treatment for your child. Cognitive-behavioral therapy has been identified as the primary treatment for clinical separation anxiety disorder. The treatment aims to allow children to separate anxious feelings and thoughts from physical sensations, as well as identify a coping plan for separation and extreme feelings of anxiety (Ponton, 2006). Behavioral strategies such as modeling, progressive relaxation, role-playing, self-monitoring and reinforced practice may be utilized, and usually, children are gradually exposed to their feared separation scenarios, starting slowing and progressing to more challenging situations (Hanna, Fischer, & Fluent, 2006). Often, parent involvement is a key component of treatment. There is hope and recovery from this disorder with the right structure and treatment in place. For additional information on treatment, consult with your local healthcare provider or contact Bio Behavioral Institute.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5thed.). Washington, DC: American Psychiatric Publishing.
Hanna, G. L., Fischer, D. L., and Fluent, T. E. (2006). Separation Anxiety Disorder and School Refusal in Children and Adolescents. Pediatrics in Review, 27, 56-63.
Pendley, J. S. (2012). Separation Anxiety. Retrieved on September 21, 2014 from http://kidshealth.org/parent/emotions/feelings/sep_anxiety.html#
Ponton, L. (2006). Treatment of Separation Anxiety Disorder. Psych Central. Retrieved on September 21, 2014, from http://psychcentral.com/lib/treatment-of-separation-anxiety-disorder/000131