Separation Anxiety

Anxiety manifests in a multitude of ways depending on the unique experiences of an individual.

We can expect for younger children (typically under 4) to feel nervous or more scared facing new experiences without their caretakers beside them. But, children with an insecure attachment often have more difficulty with their confidence in experiencing new situations. This can come from a number of negative experiences, but also from positive ones. For instance, due to COVID-19, many children have not been required to build upon their confidences in being separated from their caretakers. Children may have a tendency to be more dependent on their caregivers, simply because they have not been required to practice their independence. 

The following are the criteria for a child (or adult) to have Separation Anxiety Disorder based on the Diagnostics Statistics Manual V. 

Diagnostic Criteria for Separation and Anxiety Disorder

The criteria for diagnosis of separation and anxiety disorder include the following:

1. Developing inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

• Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
• Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters or death.
• Persistent and excessive worry about experiencing an untoward event (eg. Getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
• Persistent reluctance or refusal to go out, be away from home, go to school, go to work, or elsewhere because of fear of separation.
• Persistent and excessive fear or reluctance about being alone or without major attachment figures at home or In other settings.
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
• Repeated nightmares involving the theme of separation.
• Repeated complaints of physical symptoms (eg.headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

2. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
3. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
4. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

Luckily, there are some very simple ways to treat separation anxiety and increase independence and confidence. 

Therapy is often the first stop, although not always necessary. A therapist will likely use CBT and exposure therapy to help your child learn to manage their feelings and distress by identifying the irrational thoughts and replacing with real true thoughts based on their experiences. Exposure therapy involves gradually increasing times of separation so that the child can tolerate more and more distance and time from the person they are attached to. 

5 Ways to help your child with their Separation Anxiety without the use of Therapy or Medication

1. Make and Practice a Goodbye Ritual: The practice part is the most important here. Without helping to rewire the brain when a person is calm, there is little likelihood that the person could access that coping skill when they are anxious. The ritual should be brief and can include things like a giant hug, a couple kisses, and a phrase (Love you lots, goodbye and see you later etc). Stick to it and practice at every opportunity presented. 
2. Intentional Practice: When you know there will be a less usual time to say goodbye, practice the entire event first. This could include going to the school, dropping off at a friends house, or even a grandparents’ or babysitters. If you’re able, drive to the location and practice your goodbye ritual. The more familiar with the events, the better!
3. Use a Transitional Object: This is something that is used to instill feelings of safety and comfort like a blanket, or a picture. Bring it out and make it a part of the goodbye ritual to initiate feelings of security and to feel loved and connected even though you are apart. 
4. Validate Feelings and Get Excited: When you notice that your child is anxious by means of being clingy, crying, or avoiding, validate that you know that is how they are feeling, rather than immediately jumping to words of encouragement. When your child is able to successfully say goodbye for any length of time (30 seconds or 10 minutes), make sure to give plenty of positive praise and reinforcement in the way of excitement and happiness. 

5. Model a Positive Goodbye: It can be very helpful to make the goodbye ritual universal for a time so that the child who is anxious can see that it is expected for all family members, or those that are in the home. Seeing how another person says goodbye can encourage a child to be successful and replicate the same thing. 

Be patient. The harder a child is pushed, the more difficult the process can be. It may take longer than ideal, but it is well worth it in the end for you and your child.