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Separation Anxiety

Separation anxiety is very common in young children aged 6 months to 3 years old [1], where children may become clingy and cry when separated from their parents or carers and become fearful of strangers. This is a normal stage in development indicating that a young child is learning about their dependence on the people who care for them.

As a child begins to build an attachment to the people around them, for example their parents or carers, grandparents, or other family members, they start to learn how much they can trust and rely on this person or group of people. At the same time, at around 4-7 months of age, babies begin to develop a sense of “object permanence”, which is the understanding that people and things still exist even when they are out of sight [2]. Once infants begin to understand this concept, the fear of parents potentially not returning often arises. Therefore, infants from around 6 months and older may start to feel unsafe or upset when they are not around their parents or carers. This can make it difficult and stressful for parents to leave their child with carers and return to work or other responsibilities. The emotional reactions of the child might also start to cause problems in the wider family dynamic, for example with siblings, or outside of the family home, such as in school with teachers or peers.

Separation anxiety usually stops around age 2 to 3, and how long it lasts can vary depending on the child themselves as well as how their parent or carer responds. In some children, separation anxiety may be particularly intense, or may last longer than typical separation anxiety would in a healthy development. This may be an indication of a condition known as separation anxiety disorder (SAD), which is diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning [3].

The most common signs of SAD are:

· Fearful and reluctant to be alone

· Refusing to go to school

· Being very clingy, even when at home

· Refusing to sleep alone or away from home

· Repeated nightmares with a theme of separation

· Lots of worry when parted from home or family, including fears about getting lost from family

· Panic or temper tantrums at times of separation from parents or caregivers

· Excessive worries about the safety of self or another family member

· Frequent stomach aches, headaches, or other physical complaints such as muscle aches or tension [4]

​Some factors that may contribute to the development of separation anxiety disorder include life stresses that result in separation, such as the illness or death of a loved one, divorce of parents, moving to a different location, going away to school, or experiencing some type of disaster that involves separation [3]. Some children may also have certain temperaments that are more prone to anxiety disorders, and some individuals may have a family history of anxiety disorders that increases the likelihood of them developing anxiety [3].

It can be very difficult for the parents of children with separation anxiety disorder to know how to help their child most effectively with minimal upset. Parents do not want to see their child in distress, and they may feel guilty leaving them, so it often feels like the best option is to help the child avoid the things they are afraid of, for example, by avoiding separation whenever possible. However, in the long term, avoiding the source of anxiety will likely reinforce it over time, as the child will be unable to resolve their fear if they do not learn to overcome and cope with it themselves. It is most helpful for parents to try to understand their child’s experience by listening and allowing children to talk about their difficult feelings if they can. It is the responsibility of the parents to model an appropriate reaction by staying calm and gently reminding them that they do not need to worry. Demonstrating calm support will put the child at ease and teach them that they can trust that their parent will return and that they are safe.

Sometimes children might need additional help to understand and deal with their feelings so that they can feel more secure in their growing independence and learn to cope without their parents. Cognitive behavioural therapy (CBT) focuses on the relationship between thoughts, feelings, and behaviours, and can help children with SAD to test and reconsider their concerns about being separated from their parents or carers. CBT is an effective treatment because it provides the child with the skills and understanding to control and handle their anxiety on their own. CBT teaches children to think rationally about separation, and deal with their fears in a productive and healthy way. For example, using positive self-talk and slowly starting to do things they wish to avoid, such as going to school. The guidance of therapy can enable the process of behaviour change in a safe and structured way in order to reduce anxiety over time with the end goal of age appropriate and healthy independence. Engaging in therapy can also help parents to understand how and why they may be unintentionally playing a role in maintaining their child’s anxiety [5]. This may be through the ways in which they interact with their children to provide short-term reassurance, which is not always the most beneficial in the long run. With the help of a CBT therapist, parents can learn how to provide more helpful reassurance by allowing their child gain control of their own fears.

Early identification of separation anxiety disorder in children, followed by suitable treatments and plans to reduce the anxiety can allow children to feel confident and engage fully in all aspects of their lives. If you feel your child or someone you know may be experiencing separation anxiety, we at Surrey Therapy Practice have a team of experienced professionals who offer a range of treatments tailored to your needs. If you would like to find out more or make an enquiry, get in contact with us here.



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