miketrue.net/separation anxiety

Separation Anxiety in Children

Written by: Michael S. True, M.Ed

This article is copy protected and should only be reproduced by permission of the author. For information contact me at: mstrue1@hotmail.com.

Recently a parent asked me if I knew what could be done concerning his child's "separation anxiety". I have some advice I would like to pass along.

First let me begin by saying that anxiety during the separation of children from their parents for the first time may normally occur. This, in and of itself is not a cause for major concern. However, if this behavior, (see definition), occurs frequently or doesn't seem to get resolved, you may need to examine the situation more closely.

The following is an excerpt defining separation anxiety disorder:

Diagnostic Criteria: (as noted on the International Mental Health website: www.mentalhealth.com)

I... Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

1.. recurrent, excessive distress when separation from home or major attachment figures occurs or is anticipated

2.. persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

3.. persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)

4.. persistent reluctance or refusal to go to school or elsewhere because of fear of separation

5.. persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

6.. persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home

7.. repeated nightmares involving the theme of separation

8.. repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

II... The duration of the disturbance is at least 4 weeks.

III... The onset is before age 18 years.

IV... The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

V... The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia.

I have seen parents, with the best of intentions attempt to control a child's anxiety behavior by staying with the child whenever there is any chance of a behavioral outburst. Through their experiences, they have come to "predict" potentially "traumatizing" settings and circumstances.

Occasionally, in the home or other familiar setting, the child seems perfectly content to separate him or herself from a parent, if the parent is still within sight. When going out into the community, however, hand-in-hand connection often offers the only apparent solution to calming the child's fears.

In many cases, the child has spent the majority of his or her lifetime being closely watched over by one or both parents. Sometimes a "nanny" acts in a substitute role if there has been a strong, comfortable bond between the nanny and the parents. (This transference can serve as an indicator that the child may adapt to changing events.)

However, if the child seems to desperately need at least one person to be physically present at all times, this is a cause for some concern. The child may believe that something "bad" will happen to the parent if he or she leaves. This level of anxiety will often interfere with many aspects of the child's routine.

Ordinarily, children will begin to move toward autonomy as early as their second year of life. Parents, or those who give care, provide a strong element of security in their lives. Generally, if their environment is free of danger and nurturing, they will quickly learn to explore in an ever-widening circle. At that point, the parent must set boundaries, but provide outlets for the toddler to learn how to become more self-reliant. Parenting then becomes a serious occupation. Unfortunately, kids don't come with a user's manual. Fortunately, every library and bookstore has at least 20 books on the subject!

If an infant is often, (and here's a technical term I use a great deal), "fussy", most parents will hold or rock the infant frequently or continually, in an effort to calm her or him. If a youngster has a history of illness or some medical distress, the people closest to the child will often be drawn even closer. Occasionally, this may cause some anxiety in the boy or girl as they overcome their illness or adapt to their physical condition. Commonly, when the parent or care provider decide it is time to encourage the child to become more independent, behavior begins to change in a relatively short period of time.

Attention is usually given on varying levels as the child grows older. The more attention that is given, the more it will come to be expected. Doing too much for a pre-school child can result in unusually strong dependencies. The dependencies created may include the parent having to do many routine daily functions for the child, instead of the child performing those tasks independently. Some examples include: sleeping alone, eating, bathing, washing hands and face, brushing teeth, dressing, or toileting.

My advice on things to do or try:

Let me underline here that there is no reasonable fault on the part of you, the parent, (or caregiver), who wishes to protect your child from these episodes. Your youngster may be in risk of endangering him or herself or others. You may be feeling pressured by others to calm your child, especially in public places. Your child may display symptoms of physical discomfort, complaining of headaches, nausea, actually vomiting, and usually crying without stopping for very long periods of time. You may truly feel that your child needs you to give comfort.

Every person is different, unique. Children learn at different speeds. The way we, as people, live and grow is by learning and adapting, learning and adapting. It is an ongoing process. This is the essence of our survival. However, if we are alive we are learning and as we learn we gain the skills that are needed for us to succeed on our own. I'm told, "that's a good thing."

Once this is understood, then the "detective work" begins. Can your child be taught to become more able to adapt to changes in his or her environment? Will you need help in making this happen? Where do you begin?

Step one:

At any time, when you, as a parent, feel that there is a significant concern about your child's emotional or mental health, a routine check-up with your local family physician is in order. This advice is especially directed at young or less-experienced parents. It is always important to "rule out" the possibility that a medical or physical condition may be contributing to the child's feelings of anxiousness. By doing this one simple step, you can begin to make informed decisions on how to deal with your child’s needs.

Of course, if there is some physical need to be dealt with, that must occur first. It is very important for you to understand that your child will become accustomed to the constant attention being given. There is a natural tendency in all human beings to repeat actions that get us what we believe we need. A child will often pretend to be sick or upset if he or she is not getting the amount of attention that once occurred. In cases of short-term illnesses, this may not happen because the child is relieved from the discomfort of the illness and wants to get back to a normal routine. However, if your child, has had a long term illness, or has a disabling condition that requires your attention on a frequent basis, this could lead to a dependency behavior.

Step Two:

If the doctor has ruled out any physical ailment or condition, you are free to deal with the behavior on a different level. In essence, the child must be taught how to become more independent. Learning is a simple process but requires the understanding of two basic elements: In behavioral terms, “successive approximation” and “reinforcement” are key words.

The first, successive approximation, speaks to moving slowly toward or away from one behavior and replacing it with another. This is often spoken of in terms of steps or stages. The steps may begin very small and increasingly be expanded as the child becomes comfortable with the previous step. In the case of assertiveness training, you will want to give your child many little opportunities to do things for him or herself.

Reinforcement is the act of providing something to the child that encourages the changes being sought after. Encouraging words from you, the parent, are perhaps the most effective reinforcement that can be given. Other direct sources of reinforcement may include: favorite foods, special activities, favorite toys, time to be spent with significant others, TV time, playtime, etc. These would be supplied only after the desired behavior has occurred, even if for only a brief period of time.

In my experience, the starting place must include giving the child an opportunity to tell you why they are so upset at the prospect of your leaving. By simply asking your son or daughter, what do you think is going to happen when I am “gone”, you may gain a good deal of insight into what their belief is. However, it does not help to say, “No, that will never happen.”

Instead, a better idea is to pick times when you are able to “move away” from your child in a comfortable setting, (such as around your home or in the home of a familiar relative), for brief periods of time and then make a point of telling your child that she or he did a “great job” of spending time on his or her own. If the period when you are out of sight exceeds five or more minutes, in the early stages, return with a special treat but always remember to remind your child how they did very well, “on their own”. This will build self-confidence.

Step Three:

Allow them the chance to do as many self-care tasks as possible and give lots of encouragement for this as well. If a child believes that they will not be able to do basic routines such as feeding themselves, toileting, or sleeping on their own, the need for you to be there greatly increases.

For younger children there are many stories in children’s literature where other children overcome their fears and learn to do things for themselves. Read these books to your child or tell them about events in your life where you had to “go it alone”, but be sure it has a very positive outcome.

Step Four:

When separation must occur overnight or in the community, provide your child with a security item. This may be a favorite stuffed animal, toy, picture, or even the old blanket, (cut a square of the material that can be carried as the dependency on it decreases).

In the beginning, before the separation, explain the need for you to leave. You may say, “I must run out to the car to get something while you stay here”. Make the initial separation short and don’t forget to praise your son or daughter for their ability to stay there for that short period of time when you return.

If you want your child to sleep alone, start by staying in the child’s own room until they fall asleep. Reassure them that you will be nearby if they should need you during the night. Once your son or daughter has gone to sleep, leave. In the morning or if he or she wakes during the night, respond to them as needed but always remind them how well they did while you were out of the room. Repeat the process until the separation occurs naturally. (You may also consider background noise tapes, music, etc., to calm your child.)

Be wary of falling into the habit of giving into tantrums or fits of crying. Although this may be difficult for you as a parent, saying you are leaving and then not doing so will cause more harm than good. If you know that your child will be disruptive, make sure the person who stays with him or her is able to tolerate the commotion. They must also give encouragement for appropriate behaviors while you are away. Special treats and familiar toys will help.

If this is successful, increase the length of time that you are away by relatively small amounts, five minutes, then ten, then fifteen. If your child is interacting in a positive way when you return, hang back for a short period to maximize the experience. Also it is helpful if, upon your return, you encourage your son or daughter to continue in the activity in which they may be engaging, while you stay “nearby”. Do not hold the child at this time unless you are going to be leaving. You do not want them to expect you to be a part of this new activity on a regular basis.

If a specific fear has been voiced, such as, “ you might get killed or go away forever”, frequently remind your child how that has not happened.

Finally, if you feel the need to work with a professional on this matter, please do. In extreme cases medications can be used to reduce anxiety and feedback from a specialist can give you the direction and support you, as a parent, need to push through this difficult time.

I cannot emphasize enough how important it is that you see yourself as teaching your youngster to become more self-reliant. As I always say, “each of us should take pride in our independence”. This is the goal of the human spirit. Allow your child to experience it firsthand.