Separation anxiety in children occurs when a child fears separation from their parents or guardians.
It is natural for a young child to feel anxious when they are separated from their parents and is a normal stage of development. Separation anxiety usually starts at about 6 to 8 months of age and can last until about 2 and a half to 4 years of age.
If fear and anxiety intensifies or become persistent enough to interfere with school, friendships and other activities, your child may have separation anxiety disorder.
What is Separation Anxiety Disorder?
Separation anxiety disorder occurs in approximately 3-4% of children and is characterised by developmentally inappropriate and excessive anxiety concerning separation from home or from loved ones.
In younger children, separation anxiety usually involves crying, clinging to a parent, throwing tantrums and refusing to participate in activities that require separation from the attachment figure, and difficulty sleeping without the attachment figure present.
Adolescents can also experience separation anxiety disorder which is characterised by their limited independent activities and reluctance to leave home. They may also make complaints about somatic symptoms such as stomach aches and headaches before or during separation.
When to Get Help
Separation anxiety disorder in children might be diagnosed if a child displays 3 or more of the following behaviours for a duration of at least 4 weeks, and the disturbance causes significant distress or impairment in social, academic or other important areas of functioning:
- Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated;
- Persistent and excessive worry about losing or about possible harm happening to major attachment figures;
- Persistent and excessive worry that an unpleasant event will lead to separation from a major attachment figure (for example getting lost or being kidnapped);
- Persistent reluctance or refusal to go to school or elsewhere because of fearing separation;
- Persistent and excessive fear or reluctance to be alone or without major attachment figures at home, or without significant adults in other settings;
- Persistent reluctance or refusal to go to sleep without being near an attachment figure, or reluctance or refusal to sleep away from home;
- Recurrent nightmares involving the theme of separation;
- Repeated complaints of physical symptoms such as headaches, stomach aches, nausea or vomiting when separation from attachment figures occurs or is anticipated.
Treatment for Separation Anxiety Disorder in Children
Treatment generally involves exposure-based Cognitive Behaviour Therapy. This strategy requires children to gradually face situations in a hierarchical fashion, allowing anxiety to decrease over time.
Psychoeducation is an important part of Separation Anxiety Disorder treatment, as it teaches children to identify and better understand the physiological, behavioural and cognitive signs of anxiety. Relaxation techniques such as deep breathing, counting to ten, and visualising a comforting place, can also help children to improve symptoms and create a sense of control over their body.
Helpful hints you can implement at home or school:
- Create a step ladder with increasing lengths of time away from your child. For example, you could start with leaving your child in their room to play without you; then you could increase it to leaving the child with the other parent, while you have a coffee at the neighbour’s house.
- Do not avoid separation with your child as this will exacerbate the problem.
- Tell your child when you are leaving and when you will be back.
- Make the goodbye brief and don’t drag it out.
- Say to your child, “I will come back after lunch. You will be okay” or help them come up with a phrase that they can say to themselves such as: “I can be brave. Mum will come back.”
- Keep a calm/happy expression on your face.
- Settle your child in an enjoyable activity before leaving.
- Allow your child to take a loved object from home with them eg their favourite teddy bear.
- When your child becomes upset, gently remind them of the plan you have decided on, and what happened last time you left.
- Firmly and consistently set limits. For example: “I know you would like to come with me and that this is very hard for you. I have to go to the shops now and I will see you in 30 minutes. I know that you can do this and that you are very brave. When I get home, how about we watch a movie?”
- Reward your child’s efforts with praise.
If separation anxiety is interfering with your child’s daily activities it might be time to book an appointment to explore your options, and learn how to help your child overcome their fears.
- Choate, M., L., Pincus, D. B., Eyberg, S. M., & Barlow, D. H. (2005). Parent-Child Interaction Therapy for Treatment of Separation Anxiety Disorder in Young Children: A Pilot Study.Cognitive & Bahavioral Pactice, 12. 126-135. DOI: 1077-7229/05/126–135$1.00/0
- Hanna, G. L., Fischer, D. J., & Fluent, T. E. (2006). Separation Anxiety Disorder and School Refusal in Children and Adolescents. Pediatrics in Review, 27 (56). DOI: 10.1542/pir.27-2-56