Separation anxiety disorder is an emotional disorder whose onset is specific to childhood. Many children turn out to be anxious when they are separated from their loved ones or primary caretakers. As children develop, they understand that their loved ones will return, and they find ways to comfort themselves while their loved ones are away. However, some children continue to be extremely or exceptionally anxious when they are separated from their loved ones.
Each child may experience different symptoms and the degree to which they experience these symptoms may also vary.
The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Separation Anxiety Disorder.
Children who are found to have Developmentally inappropriate and excessive anxiety concerning separation from home manifest three or more of the following characteristics:
1) Recurrent excessive distress when the child is separated from home or anticipates separation
2) Persistent and excessive worry about losing, or about probable harm befalling loved ones or an untoward event like natural disasters, accidents, kidnapping or getting lost that will lead to separation.
3) Persistent refusal to go to school and excessively fearful to be alone at home without the loved ones because of fear of separation
4) Reluctance to go to sleep without being near a loved one or to sleep away from home and repeated nightmares involving the theme of separation.
5) Repeated complaints of physical symptoms (such as headache, stomachache, nausea, or vomiting) when separation from loved ones occurs or is anticipated.
The disturbance causes clinically significant impairment in social, academic and other important areas of functioning in the child`s life.
Separation anxiety disorder is diagnosed only when symptoms persist for a minimum period of 4 weeks and significantly impairs the child’s functioning.
If left untreated, the disorder can recur throughout childhood and adolescence, significantly interfering with the child’s academic progress and peer relationships.
Let us look at the potential causes of separation anxiety in children.
Firstly, children with separation anxiety disorder tend to have a family history of anxiety and depressive disorders.
Secondly, some children are born high in behavioral inhibition —they are shy, fearful, and irritable as toddlers and cautious, quiet, and introverted as school age children. Hence, they tend to avoid or withdraw from novel situations and are clingy to their parents. They are found to be at an increased risk for developing anxiety disorders in childhood.
Thirdly, parenting experiences are crucial in the early years of child development. Children may learn to be anxious from their parents and parents may encourage fearful behaviour & not encourage appropriate independence.
Fourthly, some children develop separation anxiety after experiencing a traumatic event such as getting lost in a shopping mall or seeing a parent hospitalized for a sudden illness.
Treatment plan: Cognitive-behavioural therapy is found to be effective to treat separation anxiety disorder. Children are taught self-talk to challenge negative thoughts & relaxation techniques are practised to extinguish anxiety.
Self-talk is basically your inner voice, the voice in your mind that says the things you do not necessarily say aloud. We often don’t even realise that this running commentary is going on in the background, but our self-talk can have a big influence on how we think about who we are (influences our self-esteem). There are two types of self talk: Positive and Negative self-talk
Positive self-talk makes you feel good about yourself and the things that are going on in your life. It’s like having an optimistic voice in your head that always looks on the bright side.
For eg.: ‘These clothes look pretty awesome on me’, ‘I can totally make it through this exam’.
Negative self-talk makes you feel pretty pessimistic about yourself and the things that are going on. It can put a downer on anything, even something good and can even impact on recovery from mental health difficulties.
For eg.: ‘I look stupid in these clothes’, ‘Everyone thinks I’m an idiot’, ‘Everything’s crap’, ‘Nothing’s ever going to get better.’
As therapy progresses, periods of separation from parents are increased in number and duration. Parents are taught to model & reinforce nonanxious behaviour for their children.