Separation Anxiety Disorder

Is my child clingy? Or does my child have Separation Anxiety Disorder?

“Mummy… No… I want mummyyy!”

It is a common sight to see children crying at the entrance of their school, clinging onto their parent’s leg, and looking highly distressed at the thought of leaving their parents for even a few hours. If you’re a parent, you would know this well!

Separation anxiety is a common fear that children experience when they have to separate from their significant caregivers which can be their parents, grandparents or domestic helpers. It is normal for children to go through this stage of separation anxiety in their childhood. In fact, separation anxiety serves a role in a young child’s survival, and absence of it in childhood may reflect an insecure attachment.

Under normal circumstances, parents need not be too concerned about separation anxiety as most children eventually outgrow their separation anxiety as they get older.

Separation Anxiety Disorder: When Separation Anxiety Becomes Maladaptive and Disabling 

Separation anxiety could be a concern when a child displays developmentally age-inappropriate, excessive, and disabling distress that stems from separation from their parents and the fear of being alone. The fear and anxiety persist for at least 4 weeks, and are severe enough to impair routined daily activities such as going to school or participation in social activities. When these happen, it may be indicative of Separation Anxiety Disorder.

Here are some red flags that suggest Separation Anxiety Disorder in children:

Ψ Worries excessively about loss of caregiver or possible harm to caregiver
Ψ Reluctant to be away from home (e.g., going to school) for fear of separation
Ψ Experiences excessive distress (e.g., scream, cry) during or in anticipation of separation
Ψ Reluctant or unable to go to sleep without being near caregiver
Ψ Complains about feeling physically sick (e.g., headaches, stomachaches, nausea, vomiting) when separated
Ψ Experiences repeated nightmares related to separation (e.g., being kidnapped, death of caregiver)
Ψ Excessive requests for caregiver’s attention (e.g., cling onto parents, follow them around all the time)

Given that the symptoms displayed by children with Separation Anxiety Disorder are intense, it is unsurprising that those parents feel highly distressed too (you aren’t alone!).

What causes Separation Anxiety Disorder? 

In some cases, a child may develop separation anxiety disorder after encountering a stressful life event (e.g., the loss of a family member or pet, a change in living environment). Some children may be influenced by their caregiver’s anxious disposition.

Seeking Help: Early Intervention is Key 

Children with Separation Anxiety Disorder may become socially isolated, depressed, and are more likely to develop other anxiety disorders during adolescence or in adulthood.

Furthermore, Separation Anxiety Disorder is typically associated with school refusal, which could affect the child’s school performance and ability to socialise.

School refusal behaviour is the refusal to attend classes or difficulty remaining in school for an entire day. It includes children who resist going to school in the morning but eventually give in, those who leave school early, and those who miss school entirely.

To reduce the effect of separation anxiety disorder on the child’s development, early intervention is key. Consult a child psychologist  if you realise that your child has been presenting with these red flags for at least 4 weeks and/or if the disturbance causes significant distress or impairment in you or your child.

How is Separation Anxiety Disorder Treated?

Can Separation Anxiety Disorder be treated? Yes! Treatment often involves psychotherapy. In more severe cases, treatment would be accompanied by medication that is prescribed to alleviate some of the anxiety symptoms.

Cognitive behavioural therapy (CBT) is often employed. In CBT, a child is taught strategies to cope with their fear and anxiety. These strategies include relaxation techniques and ways to identify unhelpful (and often inaccurate) thinking styles that result in the anxiety that they are experiencing.

Treatment could also involve exposure exercises where the child is gradually exposed to situations which are anxiety-provoking and/or situations which they might have avoided previously. In exposure therapy, children are allowed to “practise” the skills taught during CBT. Exposure therapy also highlights to the child that their distressing thoughts are just thoughts, not fact. By slowly exposing the child to their feared situations in a controlled and supervised environment, the exposure technique aims to get the child to be more comfortable with unpleasant feelings or experiences.