My child won’t go anywhere without me. Is it Separation Anxiety?
When your child demonstrates fear of being away from you, their parent, or another caregiver, and it seems out of the ordinary for a child their age (they are older than 3), the child may be struggling with Separation anxiety.
I say they may be struggling because simply demonstrating fear about being away from a parent or caregiver doesn’t indicate separation anxiety on its own. Many children struggle occasionally with anxious feelings about being away from home or a parent.
Your child’s fear of separation can’t be because of another issue. Children with Autism may demonstrate a refusal to do many things. For other children, the anxiety may be due to Generalized Anxiety Disorder or another anxiety disorder.
However, if the separation is causing enough anxiety to impair your child in important areas of functioning, like with their occupation (student), participation in learning new skills, and being a kid, then it’s considered significant. Significantly enough, you may need to get help from a therapist.
What is Separation Anxiety in Children?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), separation anxiety disorder is diagnosed when symptoms persist for at least four weeks and cause significant impairment. [American Psychiatric Association, 2013]
Questions to consider before you call a child therapist:
Has your child’s fear of separation from you, another parent, or caregiver been continual for at least 4 weeks?
How has your child’s fear of separation from you, another parent, or a caregiver interfered with their ability to go to school and stay at school?
How has your child’s fear of separation from you, another parent, or caregiver interfered with their ability to do fun things with friends away from home, and away from you?
More signs of separation anxiety
If you answered yes to the above questions, determine if your child meets at least three or more of the following eight signs outlined by the DSM-5 for Separation Anxiety Disorder.
A repeated pattern of big upset whenever your child knows they will be leaving home or leaving you, or someone they are closely attached to.
These next two points are all about unshakable, EXTREMELY WORRIED THOUGHTS that your child has about the potential to become separated from you or another attachment figure because:
They’re afraid something bad is going to happen to you.
You’ll be harmed in some way, get sick, injured, or die.
The fear is that this event will separate them from you.
They’re afraid something bad is going to happen to them.
Become sick or lost, kidnapped, or be involved in an accident.
The fear is that this event will separate them from you.
These next three points are all about AVOIDANCE. Your child avoids any potential separation from you because when they are apart from you, that’s when something bad may happen to you or them.
They’re extremely unwilling or flat-out refuse to leave home, go to school, or go anywhere because they don’t want to be apart from you.
They’re intensely afraid to be alone or without you at home or in other places.
They’re extremely unwilling or flat-out refuse to sleep on their own if they can’t be near you.
These next points are about involuntary things that happen.
Your child has recurring nightmares about separation from you.
Your child has headaches, stomachaches, and nausea that recur.
“Why do kids have Separation Anxiety”?
There are different theories as to why certain mental health issues, like anxiety, exist. It can be a complex mix of internal and external factors. Some children are more prone to struggle with anxiety due to their biology and how their brain is wired. Some kids are just more sensitive. There is also how a child thinks about or overthinks about things.
In my experience, several events in a child’s life may increase their anxiety around separation from a parent or caretaker to whom they are attached.
A parent was or is critically ill.
A parent has experienced a life-threatening accident.
The child has experienced the death of one parent.
The child has experienced multiple losses, including a death in the family.
One parent is verbally and/or physically violent to the other parent.
The child has experienced a lengthy separation from a parent, perhaps due to a deployment or one parent moving after a divorce.
The child has experienced a natural disaster.
In all these events, something real and scary happened. That scary thing can cause kids (adults, too) to feel afraid. We feel it in our body when our brain senses an immediate threat. This is natural and normal. It’s what bodies do. After something real and threatening happens, the body and mind remember.
If something bad has happened in the past, it can put your body in a high alert state, referred to as hyperarousal. In that state, you scan your environment for bad things or any hint of a threat. If your child is in a state of high alert, you may notice they have difficulty falling asleep, concentrating, regulating their emotions, and being generally irritable and angry.
Additionally, when something bad has happened, your child’s brain is involved. The brain thinks of the possibility of something bad happening again. It replays the past and rehearses for something else to happen in the future. These thoughts fuel anxious feelings in the body.
When Do Children Commonly Show Separation Anxiety?
Here are a few common times when kids with separation anxiety struggle to be away from their parents. Families are unique, so other times may also be difficult for your child.
First day of kindergarten
First day of a new school year
Bedtime
Parents are going out in the evening
A parent leaving home to go to the store
Returning to school after a vacation or break
Returning to school after an illness
Going to day camp
Going to summer camp
How Parents Can Help Kids with Separation Anxiety
If you recognize that your child is struggling with separation, here are some actions to take before you reach out to a mental health provider who provides child therapy.
Avoid arguing with your child’s anxiety. Work on responding calmly to your child.
It is important to be supportive and firm in believing they can move forward while expressing kind empathy for their real feelings.
Read credible pediatric sources to learn more about separation anxiety disorder.
If your child is having stomachaches and headaches, check things out with your child’s pediatrician to have them rule out other causes of the physical symptoms.
Notice and note things that seem to help your child feel calmer.
Deal with your anxiety and worries about your child’s anxious reactions. It’s not uncommon that a child’s anxiety about separation can cause tension in the home between family members.
Practice being apart, little by little.
Rehearse going to school or camp for drop-off. Get in the car and drive there.
How is Separation Anxiety Treated?
One way that Separation Anxiety is treated is with Cognitive Behavioral Therapy (CBT). For children, CBT uses techniques to help kids identify negative thoughts and to modify those thoughts. The theory is that there are mistaken thoughts and beliefs behind behaviors and feelings.
If a child believes that if they are away from their parent, something bad will happen to their parent, or themselves, feelings of anxiety arise. Then, the child may do things (behaviors) to avoid the separation. Parents may also do things to avoid the upset.
In therapy that uses CBT interventions, a therapist will work to teach the interconnection between thoughts, feelings, and behaviors. One of the goals is to help children face situations that are causing them to feel afraid, rather than avoiding them.
With anxiety, CBT typically includes some or all of these components:
Education through books and games
Learning and practicing relaxation techniques
Role-playing to rehearse
Examining self-talk
Working to face fears, gradually
Learning coping skills
Many children are helped through the use of CBT; however, for some children, a combination of therapy and medication may be necessary.
Using CBT and Art Therapy in San Diego to Treat Child Anxiety
As a Registered Art Therapist and Licensed Marriage & Family Therapist, I incorporate CBT interventions along with Art Therapy when I am treating Anxiety in Children. Art Therapy can help kids examine self-talk and face their fears initially through creating images and working with art materials. Art making itself can calm the nervous system, be deeply relaxing, and help kids cope at home as well.
Separation Anxiety can also be treated through supporting parents and teaching them to deal directly with the anxiety at home.
Consultation with a San Diego Child Therapy professional.
To learn more about how I help kids with anxiety, visit my Anxious Children service page.
If you would like more information about how I support parents, visit my Parent Coaching service page.
Sources:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Disclaimer:
This blog is for informational and educational purposes only and is not intended as a substitute for professional psychological, psychiatric, or medical advice, diagnosis, or treatment. Always seek the advice of a qualified mental health provider with any questions you may have regarding a mental health condition. Reading this blog does not establish a therapist-client relationship.