It is natural for young children to become upset or worry when they separate from their parent(s) or caregiver, particularly when faced with a new setting or situation with unfamiliar people (e.g., starting childcare or going to a new school). This initial worry generally passes with time and as the child grows older.
For children with Separation Anxiety Disorder, the worry and distress at the time of separation is well above what would be expected of the child’s age and developmental level, and is consistently present for at least four weeks. In this case, the child has an overwhelming fear that they will be lost from their family or that something bad will happen to their loved ones when they are separated. As a result, they can become very distressed when they have to separate or are even thinking about separating from their loved ones.
Children with Separation Anxiety Disorder might avoid activities that require separation and try to ease their anxiety by frequently calling for their loved ones or through seeking reassurance that they and their family will be safe. This worry and distress continues despite warm-up periods and repeated experiences in the setting, and despite parents’ attempts to reassure and talk with their child.
The persistent anxiety and distress experienced by children with Separation Anxiety Disorder significantly impacts their ability to engage in everyday activities, daily routines and developmental tasks. It can also lead to physical pain such as stomachs and headaches caused by the thought of being separated.
Common worries/fears in Separation Anxiety include:
- That they might not see their loved one again.
- That they might be kidnapped, hurt or killed AND/OR that this may happen to their loved one.
- That they could get lost.
- Their parents might disappear or not return home.
- Their parents might forget about them or not love them any more.
Common physical symptoms or complaints at separation or when separation is anticipated include:
- Tearfulness
- Headaches
- Stomach aches
- Nausea or vomiting
- Dizziness or fainting
- Muscle tension or body ‘freezing’
- Cramps or muscles aches
- Heart racing/palpitations and associated over-breathing, sweatiness, over-heating (e.g., hot flushes, red face/cheeks, clammy hands)
Children with separation anxiety also commonly experience:
- Dreams or nightmares about separation (especially young children).
- Difficulties settling to sleep or staying in their own room/bed.
- Avoidance of and refusal to go into situations that require separation such as the following:
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- Going to childcare, preschool, or school
- Going to sleepovers
- Going on camps
- Going on public transport
- Going to bed
- Being in a separate room of the house
- Visiting friends or relatives
- Staying home when a parent goes out
- Being left with a babysitter
- Moving house or changing daycare, preschool, or school
Treatment for Separation Anxiety
Research shows that Behaviour Therapy and Cognitive Behaviour Therapy (CBT) are the most effective treatments for Anxiety Disorders, including Separation Anxiety.
These therapies involve teaching the following strategies to the child and parent(s):
- Education about anxiety, separation anxiety, things that trigger the anxiety, and things which are maintaining the child’s worries and fears.
- Emotion discussions: Talking openly about anxiety and other feelings, and up-skilling parents or caregivers to do this effectively through listening, validation and problem- solving.
- Behaviour management: Relaxation (e.g., deep breathing) and coping strategies; anticipating and planning how to manage future changes and transitions (i.e., predictability reduces anxiety); parenting in a consistent way; putting regular routines into place; modelling coping behaviours; problem solving; use of rewards and behaviour charts to encourage coping and brave behaviour.
- Gradual Exposure to Separations: This involves helping children to gradually face their fear of separations using a step by step approach where they face situations which cause them to feel anxious. When small, realistic and achievable goals are set, alongside a motivating reward system, children learn to sit with their anxiety and cope with it, and also learn that their fears often do not come true or that they were not as bad as they had thought they were. Each step is practised frequently and mastered before moving on to a more difficult step. The use of reward charts can be very helpful and involving children in choosing their goals and rewards is helpful for boosting their motivation.
If you would like to find out more about our treatment for Separation Anxiety, or to book an appointment with one of our child clinical psychologists who provides treatment for this condition, please email or call the clinic on 02 9438 2511.
