When Separation Anxiety Becomes More Than Just a Worry
Written by Dr Kaylene Henderson, Little Children Big Dreams
Separation Anxiety in Children
It's normal for young children to not want to stray too far from us. We are animals after all and survival instincts tell our young that too much time or distance between them and us is a risky thing. For this reason, the developmentally normal 'separation anxiety' and 'stranger anxiety' that infants and young children experience is thought to be hard-wired. That said, the intensity of this 'normal anxiety' differs depending on the child's temperament and on how responsive their caregivers have been to their need for and closeness and comfort.
Separation Anxiety Disorder
Separation Anxiety Disorder is different. It often occurs when children are older, causes more distress and impacts upon the child's functioning. The anxiety is simply too much, so that instead of serving to protect the child, it upsets and impairs 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 developmentally inappropriate and excessive anxiety concerning separation from home or from main caregivers, with three or more of this list occurring:
- recurrent excessive distress when separation from home or main caregivers is anticipated
- persistent and excessive worry about losing, or about possible harm coming to, main caregivers
- persistent and excessive worry that an untoward event will lead to separation from a main caregiver (eg getting lost or being kidnapped)
- persistent reluctance or refusal to go to school or elsewhere because of these fears of separation
- persistently and excessively fearful or reluctant to be alone or without major caregivers at home or in other settings
- persistent reluctance or refusal to go to sleep without being near a main caregiver or to sleep away from home
- repeated nightmares involving separation themes
- repeated complaints of physical symptoms such as headaches, stomach aches, nausea, vomiting etc when separation from a main caregiver occurs or is anticipated
These symptoms need to last for at least four weeks in a child or young adolescent and cause significant distress and impairment of functioning to be considered a disorder.
Separation anxiety disorder is common, occurring in approximately 4% of children, affecting boys and girls equally. While it can have its onset earlier, it seems to be most common in 7-8 year olds.
So why are some kids affected by Separation Anxiety Disorder? Like most mental health issues, the causes are many and varied and often it's the contribution of several of these that's responsible. Genetic vulnerability to anxiety, shy inhibited temperament, a recent death in the family, parental divorce, or illness in either parent or child are all factors which might contribute. Children are also very good at picking up on their parent's cues. As a result, sometimes a child perceives (rightly or wrongly) that their parent needs them to stay close. This might be due to the parent's own anxiety, or due to their desire for the child's company or assistance.
Just as the causes vary, so does the presentation of separation anxiety disorder. School refusal, reluctance to go to school camps or to friends' houses without a parent, insisting on sharing their parent's bed, nightmares, or following family members around the house are all examples of how Separation Anxiety Disorder might present. Some children will become tearful when separated from their parent, others will tantrum, become nervous, distracted or aggressive. Parents can often feel frustrated and burnt out. It can feel hard to get the balance right between providing comfort while also promoting independence and a sense of competence.
So what's next? The good news is that treatment for Separation Anxiety Disorder is readily available. As with any mental health issue, the earlier that intervention is sought, the quicker recovery is likely to occur. In the first instance, seek an assessment from your child's General Practitioner (GP) who can then refer to a Child Psychiatrist or Psychologist, depending on your child's needs. Treatment will then depend on the age of your child and the severity of their symptoms. Education about anxiety and its contributors, relaxation strategies, cognitive behavioural therapy (CBT), liaison with school teachers and guidance officers are all considered useful treatment strategies. In some severe or prolonged cases, medication (often with a Selective Serotonin Reuptake Inhibitor 'SSRI') in addition to the previously mentioned treatment approaches might also be useful.
*American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. American Psychiatric Press; 2000
Dr Kaylene Henderson
MBBS FRANZCP Cert C&A Psych
Dr Kaylene Henderson is a Child & Adolescent Psychiatrist and Founder of Little Children Big Dreams which provides online help for children who are afraid of the dark or scared of monsters - http://www.littlechildrenbigdreams.com/
Little Children Big Dreams offers personalized printable stories and parent guides to help children beat their fears of monsters or fears of the dark and sleep better at night. Parents are also invited to read Dr Kaylene Henderson's blog on the Little Children Big Dreams website or to visit the Little Children Big Dreams Facebook page for parenting tips and Child Psychiatry information - http://www.littlechildrenbigdreams.com/.