Separation Anxiety

What is Separation Anxiety?

Separation anxiety is excessive anxiety or worry about separation from the home or from a person whom the child is attached. Typically the attached person is a parent or caregiver but the attached person(s) can also include siblings, other family members or other significant individuals in the child’s life.

For a child who has separation anxiety, he/she may often need to know the whereabouts of this caregiver(s), or to stay in touch with him/her (e.g. through phone calls) to stay calm. Children may also become preoccupied with fears that he/she will become lost and never reunite with their caregiver or that an accident may befall the caregiver.

Is it normal?

Some separation anxiety is normal and expected in children. Normal distress about separation can start as early as one year old and it’s typical to observe this distress when children are 3-5 years old. Anxiety about separation from caregivers typically subsides around ages 7-8 years.

What causes separation anxiety?

Separation anxiety can result from a number of different factors and it’s different for each individual. Some factors that may make it more likely for a child to develop more severe separation anxiety are: a history of illnesses or hospitalizations, heredity/temperament (e.g. if parents had separation anxiety when they were children), frequent moves/ relocations of the family home, death of close relatives or family pets, or abuse (emotional, physical or sexual).

How do I know if my child has “excessive anxiety”?

Only a qualified professional (for example,  a psychologist) can make a diagnosis of Separation Anxiety Disorder  and help  evaluate if your child displays some of the following symptoms:

1. Repeated tantrums or emotional outbursts when separating (or anticipating a separation) from their home or their caregiver(s)
2. Prolonged worry about possible harm befalling their caregiver(s)
3. Repeated reluctance or refusal to go to school because of their fear of separation
4. Repeated reluctance or refusal to go to sleep without being near a caregiver
5. Reluctance or refusal to go to sleepovers due to their fear
6. Repeated nightmares about separation
7. Ongoing complaints of physical symptoms (e.g. headaches, stomachaches, nausea) when the child has to separate (or anticipates separating) from their caregiver.

How will a psychologist assess those symptoms?

The psychologist will want to collect information about a number of different areas of your child’s life and from a number of different sources. They will want to do this a number of different ways:

• They will want to interview you, your child and possibly other informed persons (e.g. your child’s teacher, another close relative with whom your child spends a lot of time).
• The psychologist will  give you some questionnaires to fill out. Similar questionnaires may also be given to your child (if s/he is old enough) and the other informed person. These questionnaires will ask you about your child’s behavior in a wide range of situations. For example, you may be asked questions about how your child behaves at home (e.g. does s/he always follow your instructions), with his/her peers (e.g. does s/he interrupt others), and in general (e.g. does s/he often get sick or have head or stomach aches).

Often children with separation anxiety report somatic, or bodily, complaints like nausea, stomach aches, head aches, etc. If this is true for your child it is important that they have a full physical exam by your family doctor or pediatrician to rule out any other physical problems (e.g. ulcers).

In addition to an interview, questionnaires and a possible physical exam the psychologist  may want to review your child’s school records, ask you or him/her to record and monitor certain behaviors (e.g. not going to school/ temper tantrums) or observe you and your child interacting or how your child behaves at school. All these different assessment measures are important to giving an appropriate diagnosis to your child.

How is separation anxiety treated?

There are a number of supported treatments for separation anxiety. A “supported” treatment means that research studies with children who have anxiety have indicated that the treatment is effective at reducing the child’s anxiety. Often a psychologist will use a number of these to best help your child. They will take into account your child’s age, their specific symptoms and your preferences to best treat your child. These supported treatments are:

• Cognitive Behavioral Therapy (CBT)- CBT involves changing the way we think about situations, such as replacing worrisome thoughts with more realistic and supportive ones.
• Relaxation Training- this involves teaching your child physical relaxation techniques like deep breathing
• Modelling- this involves demonstrating a way of coping with worry or a fear to your child and then having your child practice and use this strategy in their day to day life
• In vivo exposure- this involves slowly getting your child used to separation from his/her caregiver in a step by step fashion so that they are able to adjust and cope with separation when it occurs
• Reinforced practice- this involves rewarding a child for practicing a technique described above or achieving a goal for a certain step during in vivo exposure
• Family Anxiety Management- this involves the therapist working with the whole family to find a plan to help the child overcome their fears

Is there anything I can do to help my child?

There are a number things that parents can do to help their children with separation anxiety. While a psychologist can best help you with this there are some general parenting tips:

• DO establish a routine- Routines help ground children and are reassuring; they thrive of predictability. Setting up a routine for saying good bye and reuniting afterwards can help your child know what to expect
• DO help your child prepare if there is any major change coming in their life (e.g. starting school, moving) by practicing the new routines, and introducing fun aspects into the change (e.g. shopping for school supplies, making some tasks into a game).
• DO model the behavior you want to see in your child. If a parent acts overly nervous and concerned about a separation this can cause the child to become overly anxious as well. Model being brave and confident with your child and try to avoid long emotional goodbyes.
• DO encourage physical exercise- this is important to relieve stress and worry

DO NOT, when separating from your child, sneak away while they are playing, or when their attention is on something else to avoid causing them anxiety or provoking a tantrum. This can make a child feel even more anxious. Establish a quick but attentive routine of saying goodbye (see above) to help build your child’s confidence.

There are many other good pamphlets and sources of information on separation anxiety. A good website to look is: Anxiety BC’s website on separation anxiety