The dance that is Separation Anxiety – wave, scream, cling, stay, repeat.

There are times when most young children are reluctant to say goodbye to their mum or dad and head off to crèche/kindergarten/school/child care. Some children are quite spectacular in their protests, while others prefer the silent, cling-like-an-oyster-to-a-rock arrangement.

Some children will experience an intense anxiety experience that is excessive and developmentally inappropriate (not quite right for their age).   Children with Separation Anxiety Disorder experience such intense anxiety that it interrupts their lives (and the lives of their family members) and causes an impairment in their education, their school and family relationships and thier social functioning.

Separation Anxiety Disorder is the earliest and most common mental disorder in childhood and, while it is true that many children may experience some anxiety from time to time, ongoing seprartaion anxiety issues have been repeatedly linked to problems with a child’s mental health throughout the life span. Clinical levels of separation anxiety are a risk factor for other mental issues in adulthood – anxiety, depression, and substance issues. It’s very important that separation issues that don’t resolve themselves get some early attention.

It has long been thought that parents who have mental health concerns and who have insecure attachment with their children will be more likely to raise children who are anxious. It makes sense, that if a child has an anxious temperament and then their attachment figure is unavailable or a bit “hit and miss” with the relationship, that they will feel less secure in the world.

However, while there is a link between maternal depression and separation anxiety, researchers have found that there is a stronger link for separation anxiety and the child who has greater than normal fear of strangers.  It is usual for all infants to have a period of stranger anxiety, but it would seem that those who do not properly resolve this early fear may be those most at risk of developing separation anxiety as they get older. It almost seems that the stranger anxiety “thing” is a good early learning ground for the child to master being able to assess and manage a threat. If they do not master this skill, separation anxiety can follow and be maintained.

To understand separation anxiety, you first need to understand how many psychologists currently view excessive fears and worries. Whilst it is important that we all remain fearful of things or situations that are truly dangerous to us, it is equally important that we learn how to turn down our anxious feelings in situations where there is actually no real threat. Children with separation anxiety most often are frightened by the idea that something will happen to them or to their carer in their absence and that they will never get to see the person again. If a child is living in a very dangerous environment, then these thoughts and feelings would make sense, but for some reason, children with Spearation Anxiety think and feel this way even though there is no imminant threat to them or their parent.

The other important part of anxiety is avoidance. Again, it’s important that we avoid dangerous things, but if we avoid things that are not really dangerous, we never get to challenge our fears or beliefs about our vulnerability and it can get in the way of leading a full and happy life. For children with Separation Anxiety, their behaviour often results in them not having to be separate from their caraer. Parents may abandon their own plans to stay with their child (because the parent is also avoiding the fear or inconvenience of a tantrum or distress) and the child avoids being separated. This avoidance perpetuates or keeps the anxiety going, and grows the anxiety.

So, the dance continues….detect a chance that Mum or Dad may go, scream (to communicate your distress), cling (to reassure and soothe you), stay (Mum or Dad stays and helps you avoid the scary idea if her going), repeat.

It is also fascinating to know that children with Separation Anxiety are like heat-seeking missiles to the idea they might be left alone and that things could go wrong or be dangerous. We call this being more “vigilant” or even “hyper-vigilant” to threat. Studies of children’s eye movements have shown that anxious children will more quickly pick up images about danger than their non-anxious peers. Also, anxious children will then be quicker to avoid looking at the threatening image than their non-anxious friends. Once detected, anxious children are quick to look away or avoid material that makes them feel uncomfortable. By avoiding the material, they do not give themselves a chance to think the whole thing through clearly and do an accurate assessment of risk.

To manage the “dance” that can be Separation Anxiety, most treatment includes parent training as well as child sessions. Treatment involves collecting information about the child and the child’s separation behaviour (and their thoughts/beliefs if they are old enough to share these) so that each step of the treatment can be comfortably paced. It can be handy to capture some details in a diary.

Current evidence suggests that Separation Anxiety needs work with parent and child and that both need to learn about anxiety – what is normal anxiety and what is clinical anxiety. They need to know how to focus on their body and their behaviours, measure their feelings and test the ideas that might be keeping things scary. This may mean working through a hierarchy of least scary to most scary situations

Again, though, if a child has been through a trauma and been in an unsafe situation it would make sense that they will likely be fearful for some time until they can be helped to discover that the world is mostly a safe place. However, for those children who are caught in a cycle of too-quickly noticing possible threat and then avoiding doing things about it, the effects can be debilitating if left unaddressed.

A child needs the world to be “filtered” by a loving parent or carer who will allow a child to face fears, where appropriate, in a gradual and guided way.

Gentle, supported and guided exploration of things that may be a little scary makes for a much more enjoyable and healthy “dance” between adult and child.

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