Separation Anxiety Disorder in Kids

Separation Anxiety in Infants

Separation anxiety reaches its peak between 14 and 18 months and typically decreases throughout early childhood. Stranger anxiety (wariness and distress in the presence of an unfamiliar person) is common between 8 and 10 months and continues through the first year, decreasing in the second year. This is a very normal part of development. This coincides with children’s increased ability to move about and so it makes sense from a survival point of view: If children were suddenly mobile and had no fear of separation or strangers then they would easily become separated from parents and become lost. Nevertheless, this part of development can be very draining on parents, particularly if it persists throughout childhood and prevents the parents from being able to go out alone.

Prevalence

Problems with separation anxiety are more typical in younger children and less common in adolescents. Approximately 3-4% of children will develop separation anxiety disorder (Schniering, Hudson & Rapee, 2000).

Separation anxiety disorder is diagnosed when:

the anxiety interferes with the child’s life and subsequently the parent’s life
the severity of the anxiety is inappropriate for the child’s developmental level and
the symptoms have persisted for at least 4 weeks.

Children with separation anxiety fear that some harm or tragedy will occur to those they love leading to loss or long term separation. Separation fears are most commonly centred on the primary caregiver but other family members can sometimes be included. Children with separation anxiety experience a great deal of distress on separation or even the threat of separation. They may cry, plead desperately with the caregiver or throw tantrums. They are often clingy and like to stay in close proximity to the caregiver (often following the parent around the house). Children who develop significant problems with separation anxiety may complain of headaches, nausea or other illnesses when faced with a separation. Some children may even vomit from the distress caused. The child may experience nightmares about separation, death or loss (e.g., begin kidnapped or in an accident) and may have associated sleep difficulties. These children will do whatever is in their power to avoid separating from important attachment figures: they may avoid attending school, sleeping alone and staying away overnight.

What can I do if my child has separation anxiety?

A number of general steps to reduce your child’s anxiety are explained on the ‘Anxiety and Fears’ page (Link here to ‘anxiety and fears’ page). Here are some specific examples for dealing with separation anxiety.

Stepladders for separation anxiety:

Here is an example of a stepladder for a 7-year-old girl who is fearful of leaving her mother, even for a short period. At the start of the stepladder, this child was unable to sleep alone and would sleep in the parent’s bed. Each stepladder needs to be set up so that it matches the child’s level of fear. The steps in the stepladder below may be too slow or too fast for some children. It will all depend on your child’s anxiety.

Encourage and reward my child to:

Stay inside and play while Mum puts the washing on the line
Stay in my bedroom and play for half an hour while Mum is in a different room
Stay at home with Dad while Mum visits the next-door neighbour for 10 minutes
Sleep on a mattress on the floor (next to Mum and Dad’s bed)
Stay at home with Dad while Mum goes shopping for half an hour
Stay at home with Dad while Mum goes out to lunch
Sleep on the mattress on the floor but move it is closer to the door (away from Mum and Dad’s bed)
. Stay at home with my aunty while Mum and Dad go out for lunch.
Stay at home with Dad while Mum goes out for the night.
Stay at home with my aunty while Mum and Dad go out for the night.
Sleep in my own bedroom.
Stay at home with my aunty while Mum and Dad go out for the night and sleep in my own bedroom

Coping Skills for the stepladders:

Toddlers (1-3 years): Repeat a phrase to the child “I will come back after lunch” “You will be ok”

Younger children (3-6 years): Help your child to come up with a phrase that they could say to themselves when they are in the situation such as “I can be brave” “Mummy will come back”

Older children (7+ years): You can help the child learn more quickly during the stepladders by helping them to think more realistically in the situation. Encourage your child to ask herself “What happened last time Mum went out for dinner?” “How likely is that Mum will be in car accident?”

Other helpful tips for separation:

Tell your child when you are leaving and when you will be back. Some parents feel it will be easier to just sneak out the back when the child is settled. This will make it more difficult in the future when you are telling your child you might be leaving…
Make the goodbye brief and don’t drag it out.
When the child becomes distressed on separation briefly remind them of the plan you have developed (e.g., stepladder, coping skills, a reward for being brave) and when you will return.
Settle your child in an enjoyable activity before leaving. For example, start playing blocks…
If the setting is new (preschool, friend’s house, babysitter), spend time at the new place with your child before the separation occurs. The child needs to know this is a safe place/person. Your child will be less distressed if they are left in a familiar place with familiar people.
Putting in the time initially to allow your child to feel safe, will save you time in the end.
To increase your child’s feelings of safety, allow your child to take loved objects from home with them. These can be gradually phased out as the child becomes more confident.
Keep a relaxed /happy expression on your face. If you show your child worried and distressed facial expressions, then they will think the place is not safe. It can be useful to tell your child’s crèche, preschool or kindergarten and inform them of your approach to your child’s separation fears. They can help you to achieve the steps on the stepladder.
Avoiding separations from your child will exacerbate the problem. Gently encourage your child to separate and providing safe experiences of separations and reunions (using ‘stepladders’).
No matter how frustrated you feel avoid criticising your child or making subtle negative remarks (like “he’s such a mummy’s boy”, “Don’t be such a baby”) about his/her difficulty separation.

Did you know?

90% of 10-month-old infants will become upset if a stranger approaches them in an unfamiliar room. Only 50% will become upset if the child is given time (10 minutes) to become familiar with the room (Sroufe et al., 1974).

Separation anxiety peaks in infants between 14 and 18 months and should slowly taper off

Stranger anxiety is first common between 8 and 10 months of age continues through the first year but drops off in the second year.