Does my child have Separation Anxiety?

Life is full of separations, from birth, to nursery to starting school, leaving home and death. The addition of a pandemic this year may explain why so many parents are contacting me with this concern. To help you cope with the separations here are some suggestions and ideas:

What is Separation Anxiety?

Separation anxiety is a natural development stage. The infant might cry when its mother is out of sight for a few minutes, and the toddler might cling to you or have a temper tantrum when it is time to go to school for the first time. Since children are totally dependent on their carers, it’s natural for them to feel vulnerable when you leave them. While the intensity and timing of separation anxiety can vary tremendously from child to child, it’s important to remember that a little worry over leaving mummy or daddy is completely normal, even when your child gets older.

When does it become a Disorder?

However, some children experience separation anxiety that doesn’t go away, even with a parent’s best efforts. These children experience a continuation or reoccurrence of intense separation anxiety during their junior school years or beyond. They often complain of tummy aches, headaches, or other physical symptoms. The distress prevents them from participating in age-appropriate activities and learning opportunities like joining sports teams or even in some cases attending school. The anxiety often means that they need their parent to constantly present. Therefore, this is often time-consuming and tiring for parents.

If separation anxiety is excessive enough to interfere with normal activities like school and friendships, and is persistent for months, then it may be a sign of a larger problem: separation anxiety disorder. You can check out the by clicking on the link  Diagnostic Criteria for Separation Anxiety Disorder  DSM-V

Symptoms of an Anxiety Disorder

Fear that something terrible will happen to a loved one. The most common fear a child with separation anxiety disorder experiences is the worry that harm will come to a loved one in the child’s absence. For example, the child may constantly worry about a parent becoming sick or getting hurt.

Worry that an unpredicted event will lead to permanent separation. Your child may fear that once separated from you, something will happen to maintain the separation. For example, they may worry about being kidnapped or getting lost.

Refusal to go to school. A child with separation anxiety disorder may have an unreasonable fear of school, and will do almost anything to stay home.

Reluctance to go to sleep. Separation anxiety disorder sometimes creates Sleep onset difficulties, either because of the fear of being alone or due to nightmares about separation

Repeated complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

Risk factors for developing the Disorder may include:

  • Life stresses or loss that result in separation, such as the illness or death of a loved one, loss of a beloved pet, divorce of parents, or moving or going away to school
  • Certain temperaments and sensitive Amygdala’s, which are more prone to anxiety disorders than others are.
  • Family history, including blood relatives who have problems with anxiety or an anxiety disorder, indicating that those traits could be inherited, intergenerational attachment and separation difficulties.
  • Overprotective parenting
  • Environmental issues, such as experiencing some type of disaster that involves separation. For Example Pandemics!

What is the treatment for Separation Anxiety Disorder?

There are very few studies on the treatment of  SAD, most of the research is for generalised anxiety. Most children suffer from Anxiety Disorder prior to the age of 12.  Medication is rarely a treatment option in the UK. Cognitive behaviour therapy (CBT) inclusive of psychoeducation, relaxation, teaching coping self-talk, and exposure therapy are the most common treatments for children with Separation Anxiety. 

CBT works best with children who have a good cognitive capacity to identify negative thoughts. For very young children and those not as able or motivated, Art therapy with parent-child pairs has been found helpful with improving parent child relationships and decreasing anxiety (Plante & Bernache, 2008) and sometimes parent-only interventions work too.

I prefer an Integrative interventions that includes a parent intervention in combination with child. This shape has been found to be more effective than individualised child CBT (Barrett, Dadds, and Rapee, 1996). Integrative models focus on parental thoughts, parenting behaviours, and the parent child attachment. This often includes parental fears of SAD, parental fears of leaving the child, and parental negative cognitions.

How to ease normal Separation Anxiety

Practice separation at home first, small steps help. Leave your child with a caregiver for brief periods and short distances at first. Even helping them to move from downstairs to upstairs on their own can help. Games like hide and seek and peek a boo can help the process along. As your child gets used to separation. you can gradually leave for longer and travel further.

Schedule separations after naps or feedings. Babies are more susceptible to separation anxiety when they’re tired or hungry.

Develop a quick “goodbye” rituals at night time or at other transitions, such as just before school.

Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss.

Identify a safe attachment figure to handover too. It is not helpful if you are anxious to have multiple attachment figures. You can use a simple three step process, hug, goodbye, and handover to a teacher or someone your child feels close to.

Use a transitional object. Something of yours to keep if they are worried about being away from you.

I know it might be strange to leave mummy or not be at home but I know you are going to be fine once you are there. Let’s think of something you can bring in to help you feel safe. What can I do to help you?

This is good for children whose parents separated or if they’ve lost a parent or even grandparent. Examples are a worry stone, something of your to keep, a bracelet or a favourite toy.

Separation anxiety

Name the Worry– even younger children need their feelings named and acknowledged.

Back to school anxiety

If you know a big separation is coming, listen, plan and problem solve with your child. Make a picture book of positive separations in readiness. Talk about previous transitions and think about what worked and what you may do differently this time.

You can use the Ladder of Success to help to work together for goals

Try not to give in. Be positive, setting consistent expectations limits will help your child’s adjustment to separation.

If we give to anxiety, even though it is often from a loving place, it maintains the cycle

In Conclusion

No matter how fretful your child becomes when parted from you, separation anxiety/ disorder is treatable. There are plenty of things you can do to make your child feel safer and ease the anxiety of separation.

Remember: parenting is hard work and you all deserve support. And when it all starts to feel impossible, ask for help. If you need help and support contact me for a consultation or do join my newsletter communityWith Gratitude Catherine 

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Other Related Posts:

Recognising Anxiety in your Child

Does my Child have GAD ( Generalised Anxiety Disorder)

Sleep and Anxiety, 9 Ways to Manage the Worry Monsters at Night

Back to School Anxiety following COVID-19

Back to School Sleep Solutions following the pandemic

Talking to your Child about Anxiety

Understanding and Managing Meltdowns

References:

1.Dr Alexandra Boyd, Exeter University, IAPT Training Separation Anxiety

2.Liesbeth G. E. Telman,1 Francisca J. A. van Steensel,1 Marija Maric,2 and Susan M. Bögels1,What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders,  Pubmed ncbi.nlm.nih.gov/pmc/articles/PMC5945734

3.American Psychiatric Association DSM -5

     

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