Separation anxiety in children
It is normal for young children not to want to stray too far from us. After all, we are animals, and survival instincts tell our young that too much time or distance between them and us is a risky thing to do. For this reason, the normal developmental ‘separation anxiety’ and ‘stranger anxiety’ experienced by infants and young children are thought to be programmed. That said, the intensity of this ‘normal anxiety’ differs depending on the child’s temperament and how responsive their caregivers have been to their need for reassurance and closeness.
separation anxiety disorder
Separation anxiety disorder is different. It often occurs later, causes more distress, and affects the child’s functioning. The anxiety is simply too much, so instead of serving to protect the child, it upsets and annoys the child and is therefore considered a disorder.
According to the DSMIV* (one of the diagnostic classification systems used by psychiatrists), separation anxiety disorder is defined as excessive and developmentally inappropriate anxiety related to separation from home or work. the primary caregivers, with three or more from this list occurring:
- recurrent excessive distress when separation from home or primary caregivers is anticipated
- Persistent and excessive worry about losing or possible harm to primary caregivers.
- persistent and excessive worry that an adverse event will lead to separation from a primary caregiver (for example, getting lost or being kidnapped)
- persistent reluctance or refusal to go to school or elsewhere due to these fears of separation
- persistent and excessively fearful or reluctant to be alone or without primary caregivers at home or in other settings
- persistent reluctance or refusal to go to sleep without being near a primary caregiver or to sleep away from home
- repeated nightmares involving separation issues
- repeated complaints of physical symptoms such as headaches, stomach aches, nausea, vomiting, etc. when separation from a primary caregiver occurs or is anticipated
These symptoms must last four weeks or more in a child or young adolescent and cause significant distress and impaired functioning to be considered a disorder.
Separation anxiety disorder is common, occurring in about 4% of children and affecting girls and boys equally. Although it may have an earlier onset, it seems to be more common in children 7 to 8 years of age.
So why are some children affected by separation anxiety disorder? Like most mental health problems, the causes are many and varied, and it is often the contribution of several that is responsible. Genetic vulnerability to anxiety, a shy and inhibited temperament, a recent death in the family, parental divorce, or illness of a parent or child are all contributing factors. Children are also very good at picking up on their parents’ cues. As a result, a child sometimes perceives (rightly or wrongly) that her parents need them to stay close. This may be due to the parent’s own anxiety, due to their desire for the child’s company or help, or due to the parent’s “need to be needed”.
Just as the causes vary, so does the presentation of separation anxiety disorder. Refusal to go to school, reluctance to go to school camps or friends’ houses without a parent, nightmares, insistence on sharing a bed with parents or following family members around the house are examples. How separation anxiety disorder can present. Some children will cry when separated from their parents, others will have tantrums, become distracted, nervous, or aggressive. Parents can often feel frustrated and exhausted. It can be difficult to strike the right balance between providing comfort and closeness while promoting independence and a sense of competence.
What’s next? The good news is that separation anxiety disorder treatment is readily available. As with any mental health problem, the earlier intervention is sought, the faster recovery is likely to occur. In the first instance, seek an evaluation from your child’s Family Doctor, who can then refer you to a Psychiatrist or Child Psychologist, depending on your child’s needs. Treatment will then depend on your child’s age and the severity of her symptoms. Education about anxiety and its contributors, relaxation strategies, cognitive behavioral therapy (CBT), liaison with school teachers, and guidance officers are considered useful treatment strategies. It is important to make sure that everyone in your family and the treatment team have the same goals to help your child work through her anxieties. In some severe or long-term cases, medication (often with a selective serotonin reuptake inhibitor ‘SSRI’) in addition to the treatment approaches mentioned above may also be helpful.
*American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Revised Text. American Psychiatric Press; 2000