Saturday, March 27, 2010

Separation Anxiety

How do I get my child to let me leave him?

A frequent question about childhood behavior is how to handle separations when the child clearly doesn't want Mom or Dad to go. Separation anxiety is a normal developmental process, but sometimes it can represent a failure of normal development. How do you tell the difference?

Separation anxiety usually appears between 6 and 8 months of age. The smiling infant who would happily be passed from lap to lap at the family reunion just a few months before, now becomes visibly anxious and fretful when Mom or Dad hands him off to someone else. Unfortunately, this is often the age when Mom and Dad want to be able to leave the baby with a sitter for a night out!

The onset and resolution of separation anxiety requires the achievement of three developmental milestones: attachment to a care giver, realization of object permanence, and development of trust. Here's how this works: a 6 month old infant is not “spoiled” just because she cries when Mom leaves the room or is handed to someone else. Instead, her crying represents her developing sense of attachment to her Mom and Dad. (I used the terms “Mom” and “Dad,” but I really mean whoever is the primary care giver.) If she did not have a sense of attachment, she would not be concerned when they left the room.

On the other hand, until the infant develops the realization that Mom and Dad are permanent figures, known as object permanence in developmental terminology, she will continue to cry or fuss when she cannot see them. She does not know that just because she cannot see them doesn't mean they have ceased to exist. She cries when they leave because she's attached to them (that is she loves to be with them - they are her favorite things) but, she thinks they have vanished because she cannot see them. Finally, she must learn that Mom and Dad will return and will love her still even after they have been gone.

Although separation anxiety shows up between ages 6 and 8 months and object permanence appears roughly at 9 to 10 months, separation anxiety may take until age 2 to 3 years to finally peter out. As in much of infant development, the child's temperament plays a role. A child who adapts to new situations easily will probably have less anxiety than the child who has a difficult time with change.

Parents can help their children with separation anxiety by making sure that any temporary care giver is a familiar figure. This may mean having the sitter come over and visit while the parent is still there before attempting a night out. It may mean bringing the child to daycare and planning on staying with the child the first day and leaving together, then trying a brief stay the second day without the parent, gradually increasing the time the child is left with the substitute care giver. It means leaving with clear reassurances that Mom and Dad will return at a certain time. It also means recognizing that some anxiety is normal.

When does separation anxiety become abnormal? This occurs when the child has reached an age when these three development milestones should have been completed, but the child is still having excessive anxiety upon separation. This is known as separation anxiety disorder.

This can happen for a couple of reasons: failure to form a secure attachment to a care giver or repeated disruptions to that attachment from outside influences such as hospitalization or jail or travel. Another risk factor for separation anxiety disorder is a history of anxiety disorder in the parent. Some signs in the child can be

* recurrent excessive distress when separated
* excessive worry about harm occurring to the major attachment figure (e.g., Mom or Dad)
* reluctance to go anywhere without the major attachment figure
* reluctance to be alone
* reluctance to sleep away
* repeated nightmares with the theme of separation
* vague complaints of physical symptoms like stomachaches or headaches that occur in anticipation of a separation from the attachment figure.

Although even children without this disorder can occasionally express what seems like excessive worry or concern about a parent or other care giver, children with this disorder have these symptoms for at least 4 weeks and have impairment of normal functioning such as not being able to attend school or be left with a sitter. The treatment includes behavioral therapy, play therapy, and desensitization. Occasionally, medication can help reduce feelings of anxiety. If you think your child shows excessive anxiety with separation, inappropriate for her age, talk to your pediatrician about getting help.

by Barb Durso, MD

Posted by Fang Jui, T3

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