Psychology: Separation Anxiety Disorder – Who, What, Why and How to deal with it

22nd August 2010

Separation Anxiety Disorder (SAD) is often overlooked or trivialised because typical behavioural patterns are wrongly assumed to be bad behaviour or the child being unnecessarily difficult. Yet this irrational panic at an older age can cause far more stress, emotional strain and even violence than people expect and without spreading awareness of such disorders, families are deprived of vital information which can mean make or break for early intervention strategies.

Is SAD normal?

It is common for children up to age three or four to panic and throw tantrums on separation from their immediate care-givers. At age 3 I vividly remember refusing school, gymnastics classes, being left at the babysitters with hours or tears and screaming tantrums, to the point where I was put on a probationary period at my nursery as they weren’t sure they could cope with such ‘bad behaviour’. Although this continued up to around age 5, I grew out of (most of) these dramatic outbursts and eventually settled in quite happily. I grew up perhaps shy at times but now as sociable as the next person.

But what if your child randomly developed the same symptoms, or worse at an older age? How would you cope? According to the charity Anxiety Care, SAD affects 4-9% children and adolescents and can be a traumatising experience for all involved. This article holds some vital information on how to recognise symptoms and potential causes of this irrational panic and offers basic practical advice on how to address these effectively.

Diagnosis: Common Signs & Symptoms

Fear is nature's defence mechanism

The most basic definition of SAD is to describe the child as having mad, frenzied fits or tantrums on separation from a caregiver which causes disruption in daily life for over a month. 

  • The child is over 6 and under 18 years old
  • Immediate anxiety or irrational panic on separation from care-givers, or in refusal of a situation they are uncomfortable with (i.e. attending school). In some cases this can be as extreme as being left alone in the next room.
  • An ongoing irrational concern that bad things will happen to their loved ones or themselves if they are separated. 
  • Physical conditions such as stomach complaints or headaches – these could be invented but often the physical trauma induced by the notion of certain situations can cause genuine conditions.
  • Personalising negative current affairs and convincing themselves that similar tragedies will befall their family.
  • Fear of being alone, especially whilst sleeping
  • Sometimes an awareness of the irrationality of their behaviour. They will often feel out of control of their anxiety and be unable to contain it, thus concocting further frustration and confusion into their panic.

Potential Causes

Severe trauma or family upheaval can trigger SAD

SAD can be caused by one or many of the following causes and all individual cases are different. A friend’s close connection developed SAD to an extreme level of refusal to attend school at around age 9. It was thought to have been triggered by falling behind in an IT class, building up to a level of depression and anxiety over school which many would not expect to culminate from such a seemingly minute event. So what else?

NB: according to a study in 2011, SAD and school refusal are linked in 75-80% cases Please see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249814/

  • Lack of closure or information on such issues which leave the imagination to run wild and develop incorrect interpretations and assumptions. This can leave children believing they are responsible for a turn of events and are trying to prevent it happening again.
  • This can link to distant relationships and a lack of support from care givers which cause worries to be bottled up and internalised. This is why pinpointing causes can be difficult as issues are often complex and underlying. If the child is worried about confiding in you they are more likely to try and cope alone.
  • Overprotective/intrusive parenting; on the other hand, too much invasion into their life which restricts the child from learning and experiencing the world alone creates a suffocating safety net. They become so reliant on the caregiver’s presence that when this is suddenly removed it can trigger sudden panic and self doubt.
  • Learning by imitation; similarly, anxious or critical parenting can rub off on the child and so that unfounded fears and avoidance strategies are passed on by example.
  • Anxiety is thought to be genetically inherited making some children more sensitive to particular situations although this is nearly always influenced by environmental factors.

NB: Useful link with reference to genetic factors of SAD can be found here: http://www.emedicinehealth.com/separation_anxiety/page2_em.htm

What should you do?

Early intervention is vital as the usual procedure is to identify the roots of the problem and effectively ‘unlearn’ the behaviour. This is usually done through counselling sessions where they will set up individual programmes for the child to follow.

Drugs will only be administered in extreme cases and this would always be in conjunction with other therapy, and after rigorous investigation into the child’s case. Although behavioural therapies may take several months to complete, they are more adaptable to individual cases and offer more long-term solutions. Drugs can also have withdrawal symptoms or side effects which are often inappropriate for the patients’ age group.

Treatment to try at home first

Opening the lines of communication is vital

Here are some tactics for you to try yourself before investing in professional help:

  • Mental imagery can be used to reconstruct the child’s false sense of danger through their imagination. First ask them to conjure the image of stress and then talk them through how to change their instinctive reaction positively, telling them how they will react alternatively to panic. This should also include where the care giver will be going and reassurances that they will be safe and returning soon.
  • Find an item for them to carry around such as a photograph, small gift or bracelet to serve as a source of familiarity and comfort.
  • In new environments such as school, try forming an attachment figure such as a supervisor or fellow peer to temporarily replace the caregiver during school hours. This could work similarly with a sense of responsibility over something such as the classroom pet or library duties, which gives them a feeling of purpose and control – also serving as both a distraction and reward.

Counselling & professional intervention – What can you expect?

  • Counsellers will begin by assessing the severity of the situation using self-report questionnaires; the child is able to reflect on what happens, why their anxiety kicks in and recognise their irrational behaviour.
  • They will then be provided with solid facts to challenge the false realities they flag up, replacing it with practical, honest information. This could also be done at home on a less formal scale although it is worth remembering your child is probably more likely to listen to a professional, partly because of the authority presence and partly because you may simply be repeating information you have been drumming into them for months; consider whether they need to hear it from somebody else’s perspective.
  • Self report cards will often be shown before and after experiments in order to build confidence in both the child and their care givers that significant progress is being made so they will be encouraged to continue their routines and exercises.
  • Family counselling is also useful in opening up closed lines of communication if the counsellor feels the family environment is having a significant influence on the child’s anxiety. This will help make progress last in the long-term by addressing underlying issues and allow the care-giver to address any issues they may also be avoiding which alters their attitude, perspective or reaction to certain situations.

One step forward, two steps back ..

reinforcement must be positive and consistent

It is commonly a long-winded process and you must be prepared for it to be challenging and emotionally draining. To keep progress systematic and moving forward you must be careful to watch out for potential obstacles along the way and deal with anything that may hinder this in a certain way:

  • Context changes, i.e. holiday breaks, larger upheavals such as moving house, divorce etc.
  • Lack of reinforcement with routines and dealing with momentary lapses appropriately
  • An unstable family environment
  • Random, unfortunate experiences

How to keep progress moving forward

Follow some of these guidelines to help ensure you cope with adverse situations appropriately and avoid a downward spiral of events:

  • Gradual exposure or separation in the new environments, practising brief, warm farewells
  • Plenty of positive reinforcement at each stage to systematically de-sensitize them to fear
  • Extend and repeat routines in day-to-day life beyond sessions. This ensures consistency as well and encouraging self help and confidence in their abilities.
  • In holiday breaks, arrange regular separation times to ensure routines continue to be adhered to on some level. This could work well if caregivers continue to work over the holidays and/or the child is comfortable enough to spend time with peers as well as at summer camps or activity sessions.
  • Do not allow yourself to give in to emotional or physical stress – keep strong and think of the positive outcomes which lie ahead. Although it can be heart-breaking to see your child’s apparent trauma, they will remain safe and their anxiety will pass with time and distraction so try to keep a level head for their sake.

Good luck!

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2 thoughts on “Psychology: Separation Anxiety Disorder – Who, What, Why and How to deal with it

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