1. Anxiety Disorders Focus: Separation Anxiety
AAPPR – 2010
Renee Reynolds, LCSW
Anxiety Disorders Focus: Separation Anxiety

2. Anxiety Disorders
Anxiety is a normal human emotion that everyone experiences at times.
Anxiety is the emotion that protects people in “fight or flight” situations. When anxiety is prolonged or occurs at other times, it is an anxiety disorder.
Anxiety disorders are serious mental disturbances.
For people with anxiety disorders, worry and fear are constant and overwhelming.
The anxiety is so severe that it interferes significantly with occupational and educational functioning, social activities and close relationships.
Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality and life events.
There are often physical symptoms that occur along side anxiety disorders. Some symptoms may include, heart palpitations, sweating, faintness, stomachaches, difficulty sleeping and irritability.
It is estimated that 40 million adult Americans suffer from anxiety disorders.
13% of children and adolescents are affected by anxiety disorders each year.
Anxiety disorders are highly treatable with therapy and/or medication.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has several different categories of anxiety disorders.

3. Generalized Anxiety Disorder (GAD)
A general tendency to be worried or anxious about many areas of life (health, money, career, etc). The anxiety is exaggerated and anticipatory—”making a mountain out of a mole hill.”
Children with GAD may be described as “worry warts.” They worry about many general problems such as school, sports performance, health, burglaries and even their parents’ jobs. Children with GAD will repeatedly ask questions and seek reassurance.

4. Social Anxiety
This disorder is characterized by extreme anxiety about being judged by others. People with this disorder feel they are being judged at all times. This fear makes them avoid social situations whenever possible.
Children with social anxiety worry excessively in situations where they have to interact with other people or be the focus of attention. These children fear that other people will think badly of them in some way.

5. Obsessive-Compulsive Disorder (OCD)
These individuals are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fear. The obsessions then cause the person to perform a ritual or routine (compulsions) as a way to relieve the anxiety caused by the obsession.
Obsessions=unwanted repetitive thoughts.
Compulsions=the behavior the person is compelled to perform to alleviate the anxiety.
Children with OCD have thoughts and themes that play on in their mind over and over again.
They may worry about dirt or germs or about keeping things neat and orderly. They may also fear harm or danger to a loved one or self. They feel a need for perfection. These children may, therefore, perform a ritual and/or routine as a way to alleviate anxiety.

6. Panic Disorder
People with panic disorders suffer severe attacks of panic, which may make them feel as if they are having a heart attack , dying or “going crazy.” These people worry excessively about having an attack.
A panic attack is a sudden rush of fear that comes with lots of physical symptoms (racing heart, dizziness, trembling, tingling, and breathlessness).
People with panic disorder feel that they can’t leave the house (this disorder can lead to agoraphobia).
Panic disorder is not common in children. It is more likely found in adolescents and young adults.

7. Posttraumatic Distress Disorder (PTSD)
PTSD develops after exposure to a traumatic event in which grave physical harm occurred or was threatened. A traumatic event may be a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or a natural disaster.
There are three main symptoms associated with PTSD: “reliving” of the traumatic event (such as flashbacks and nightmares); avoidance behaviors (such as avoiding places related to the trauma) and emotional numbing (detachment from others—feeling different).
PTSD in children is a reaction to a serious traumatic event in which the child was extremely afraid or injured. Children may keep remembering the event or have bad dreams about it. They may suddenly act or feel as if the event is happening again and become upset. They may show jumpiness, sleep difficulties and irritability.

8. Separation Anxiety This is an anxiety disorder specific to children.
It is one of the most common problems in childhood. 1 in every 25 children experiences separation anxiety.
It is the fear of being away from a main caregiver. Children with separation anxiety fear that something terrible will happen to parent or child while they are apart and that they will never see each other again.
Majority of separation fears emerge without a specific triggering event. However, it can be triggered by a stressful life event (real or imagined) These life events could be- -parents’ divorce, illness, death, family violence, being bullied etc).
The development of separation anxiety has a lot to do with genetics (anxiety runs in families), the child’s personality and temperament (child may have always been sensitive or clingy).
Symptoms of separation anxiety:
-constant thoughts and intense fears about the safety of caregivers
-refusal to go to school
-frequent stomachaches and other physical complaints
-panic and tantrums at times of separation from caregivers
-trouble sleeping or nightmares
Children with separation anxiety will try to avoid separating. Avoidance is the key to keeping the anxiety alive.

9. How to help children with separation anxiety in school:
Be reassuring of their safety (just remember that lots of positive attention to anxious behavior reinforces the anxiety).
Connect with a “safe” person at school (Refer to school social worker or psychologist).
Gradually expose the child to the situation (take 1 step at a time).
Provide social skills development so children can learn to cope. They need to learn that they will be okay—they can do it.
Increase child’s assertiveness skills so they can learn to ask for what they need—stick up for themselves.
Teach these children relaxation/self soothing techniques.
Teach these children to self talk.
Boost their self esteem/confidence (have them identify strengths).
Provide support to parents during this stressful time.
School social worker may refer student for outside mental health counseling (outside of school, a parent may wish to have their child participate in Cognitive Behavioral Therapy, family therapy or try medication).
*Separation Anxiety is usually temporary and part of normal development (children figuring out the world around them).

10. Books to Ease Separation Anxiety
The Kissing Hand by Audrey Penn
Llama Llama Misses Mama by Anna Dewdney
I Love You All Day Long by Francesca Rusackas and Priscilla Burris
Mommy Don’t Go by Elizabeth Crary and Marina Megale

11. Resources
Helping Your Anxious Child, by Ronald Rapee, PH.D, Ann Wignall, D. Psych., Susan H. Spence, PH.D, Vanessa Cobhan, PH.D and Heidi Lyneham, PH.D
Helping Your Child Overcome Separation Anxiety or School Refusal, by Andrew R. Eisen, PH.D and Linda B. Engler, PH.D
Help For Worried Kids, by Cynthia G. Last, PH.D
“Treating Anxiety Disorders in the School Setting,” by Jordana McLoone
American Academy of Child and Adolescent Psychiatry website