Learning to cope with the separation from a loved one is a natural growth and developmental process for children. Children cry when a parent leaves them alone, even for an hour or sometimes even when there are other caring adults present. A natural attachment to primary caregivers develops from infancy, and separation can be stressful for both caregiver and child. Separation anxiety can lead to a form of posttraumatic stress, PTSD, toxic stress and anxiety that is a result of ongoing, prolonged or abrupt and traumatic separation events. Separation anxiety is not only experienced by children, though when speaking about this condition, we are usually referring to children. People rarely stop to think about the impact that separation anxiety has on adults. Moreover, we assume that it is limited to children.
Separation anxiety is a disorder that is often considered as beginning in childhood, only to be diagnosed in adulthood ‘if onset is before 18’. Most anxiety disorders, in general, share features of excessive fear and anxiety including related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors.
In children, the essential feature of excessive anxiety concerns separation from the home or from those to whom they are attached. The anxiety is expressed beyond the developmental level, lasting at least 4 weeks in children and adolescents and 6 months in adults on average. Children with separation anxiety disorder usually come from tightly knit families, and when separated, they may exhibit apathy, sadness, and social withdrawal.
Depending on their age, some children may fear animals, car accidents, airplane travel, burglars, and fear of the dark. Death and dying are often concerns, while some children may say that no one loves or cares for them.. They may become extremely upset showing anger or aggression towards someone who is forcing their separation. When children are alone, they may report seeing frightening people in their bedroom or images reaching for them or feel eyes staring at them-all signs of the anxiety disorder.
In light of recent family separations at our nation’s southern borders, there are chances that many of the children and the adults, who’ve been separated because of their immigration status, will exhibit and experience symptoms of anxiety disorders. As a result of the related toxic stress and potentially trauma-inducing experiences, adults and children may both present with signs and symptoms of separation anxiety disorders.
Specific Symptoms of Separation Anxiety Disorder
Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:
- 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 befalling, major attachment figures
- persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
- persistent reluctance or refusal to go to school or elsewhere because of fear of separation
- persistently and excessively fearful or reluctant 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 a major attachment figure or to sleep away from home
- repeated nightmares involving the theme of separation
- repeated complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated
There are a number of commonly used treatments for separation anxiety disorders, most of which focus on psychotherapeutic modalities. It’s extremely important to seek professional help to properly diagnose and treat this condition. The earlier the intervention, the better chances for successful management of symptoms.
Cognitive-behavioral therapy[CBT] is the primary type of treatment used for separation anxiety disorder. It focuses on teaching children skills like recognizing feelings about separation and identifying their body’s reactions to those feelings of anxiety. They are also taught to identify their thoughts and develop plans to cope in separation situations. Strategies such as modeling, role-playing, relaxation training, and reinforced practice are used additionally.
Research shows that incorporating parents into treatment with children can be very helpful in reducing anxiety and anxious behaviors. Parents learn new ways to interact with their child to avoid reinforcement of fears, and they learn to give praise and positive reinforcement for brave behaviors. Play therapy may be used for younger children unable to identify their feelings and thoughts. Feelings are validated and children are helped to understand the reasons behind their feelings.
Family therapy is sometimes appropriate to help weed out any underlying family issues which may contribute to anxiety. This helps the entire family to recognize the effect on the entire unit, and can foster a sense of teamwork. This way, there is less ideology that it’s the ‘child’s problem’ alone in isolation of all other family members.
Parenting Strategies to Help a Child With Separation Anxiety
If you suspect that your child may suffer from this disorder, there are also strategies you may use to help. These include:
- allow your child to stay home when he or she doesn’t want to go to school, day care, etc…
- surprise your child with sudden changes in plans or activities.
- let your child focus on the unlikely bad things that can happen.
- punish your child for behaviors that are a result of separation anxiety or his/her fears.
- focus on fun activities at school, day care, etc.
- help your child get settled at school or daycare, first, and then leave.
- let your child know you will return to pick him/her up from school, day care, etc.
- compliment your child when he/she acts and responds appropriately.
- remind him how you have returned for him/her in the past.
- help him think of ways a favorite superhero might handle the situation.
- reward targeted and desired behaviors.
- reward behaviors as they become more appropriate and less controlled by fears.