By Dr. Melissa Fiorito-Grafman
For the most part, separation anxiety is a normal part of the developmental process. Although some degree of separation anxiety is a sign of a healthy attachment to the primary caregiver, signs of anxiety in excess or lack thereof, can also be suggestive of something of a more serious nature. That is, a small percentage of school-aged children and adolescents may develop separation anxiety disorder (SAD); a condition in which a child becomes fearful and nervous when away from home or separated from a caregiver to whom the child is attached. They typically develop an intense fear of harm to parents and a refusal to separate from their caregivers, albeit for school or sleep.
In any given situation, it is important to understand that the degree of separation difficulty can vary from day to day depending on the child’s temperament, their age, and additional extraneous variables that may be occurring at home and/or school (i.e., transitioning from home to pre-school, divorce, anticipating the arrival of a baby brother/sister, etc.). Therefore, despite some generalities of what is to be expected, we must also be cognizant of how each baby/toddler differs in their individual circumstances. For example, although by the age of 5, most children are secure enough to be left with a babysitter, this may not be the case if a toddler has had his/her first experience with the loss of a family member. In this situation, it is not unusual to see some regression. It could be the case that your child is fearful of losing “you” and subsequently may exhibit clingy behavior when it’s time to go to school; perhaps, something you had not seen since he/she was in pre-school.
Studies suggest that infants prefer and distinguish between their primary caregivers and strangers. Despite their preference for mom/dad, during the first few months of infancy, your child will likely respond willingly to most people they come in contact with. However, around the 7-8 month mark, you can expect to see a change in your infant’s behavior when you, let’s say, step out of the room. They may cry when you leave and become very distressed in your absence. You may also begin to observe your child being fearful or shy around strangers; a behavior sometimes referred to as “stranger anxiety.” From a developmental perspective, your child is beginning to understand that objects continue to exist even when they cannot be seen, heard, or touched; a stage of cognitive development Jean Piaget termed object permanence. Therefore, when you leave, your baby is aware that you continue to exist, but just not in their presence. This is quite troubling to them. They have yet to learn that you will come back.
Although the course and duration of separation anxiety varies considerably, it generally emerges during the second half of the first year (7-9 months) and may peak again around 12-24 months, with each peak lasting a few months at a time. However, in some instances, there may not be a clear distinction between the two peaks, resulting in several months of ongoing separation anxiety. Although older children (5 or 6) can also experience some form of anxiety when separated from loved ones, it is not usually so overwhelming as what is exhibited by a child during infancy and the toddler years. As your child progresses through the stages of development, emerging language skills and a better concept of time will help alleviate the anxieties associated with separation. Further, by the time your child is 5 or 6, hopefully they have had plenty of successful experiences with separation.
When your child is experiencing anxiety about the anticipation and/or the actual act of separation, they may do the following:
-Clinging to caregiver
-May become introverted (i.e., silent) or extroverted (i.e., agitated), depending on the child’s temperament.
Aside from normal anxiety that tends to follow a typical developmental sequence, additional factors that may contribute to separation anxiety include:
-Traumatic events (i.e., divorce, death, etc.)
-Changes in the home (i.e., mom/dad re-marrying, moving to a different home, the anticipation of a baby brother or sister, etc.)
-Changes in routine and/or transition (i.e., starting pre-school, kindergarten, changing schools, etc.).
While separation anxiety is a part of the developmental process. However, parents can do a few things to help ease the course of separation anxiety:
-Now that your infant has learned the concept of what “leaving” means, foster the concept of “returning” by playing simple games like peek-a-boo or “hello and bye-bye.”
-When your child gets a little older, embrace opportunities when he/she can interact with peers and other adults, albeit on the playground, play dates, and, perhaps, some form of pre-school (early education).
-Gradually increase the time you spend away from your child.
-Using a babysitter on occasion will help the child tolerate short periods away from the parent. Consistency is always good, so try to find a good and reliable caregiver in your absence. Also, it may be better if the babysitter comes to your house rather than dropping your child off at an unfamiliar place. If it’s unavoidable, let your child become comfortable with their new surroundings when your present. It may be a good idea to visit the place with your child before they are expected to go there. That way, the next time they go, it won’t be so new. This may be helpful for anything new a child may encounter; especially when school starts.
-Transitions can be difficult for children and can elicit feelings of anxiety. So, talk to your child and prepare them for what to expect. If they are starting school for the first time, read a book about going to school.
-Give them ample time to prepare for the transition whatever the case may be. Make sure to tell your child when you are going to leave and when you will be back. However, be sure to honor those words.
-Get them excited for an upcoming event, such as preparing for school by going “school shopping.” If they are excited to go to school, the separation may be easier.
-Remember that your child is learning from you—set a good example. If you remain in control of your emotions, your child will pick up on this. If you’re feeling secure when leaving, eventually, they should too. It’s ok, and good, to give your child a special good-bye wave that you both came up with or have a ritual for when you’re leaving. However, don’t stall, even despite the tears. If you repeat your good-byes and/or leave and then come back when you hear them cry, you are reinforcing their anxious behavior.
-You can and should be empathic to your child’s distress when departing from them. However, excessive empathy may be doing more harm than good.
-Provide reassurance that everything will be ok and even remind them of times when they were brave.
-Don’t yell or scold your child if they are having a difficult time separating from you. This will exacerbate the anxiety.
-Prior to dropping your child off, focus on the positive things they will experience, such as playing with their favorite toy or seeing their favorite ‘buddy’ and, if appropriate, acknowledge some of the drawbacks (i.e., “I know you will miss mommy but think of all the great things you are going to do!”)
-When you pick your child up, again, listen to what they have to say about their day, albeit bad or good. Praise them for good behavior and try not to dwell on their fears and anxieties. Acknowledge such things and process it for a bit, but don’t drag it out.
Although separation anxiety is to be expected, there are cases in which it can be excessive and age-inappropriate. In contrast to normal separation anxiety, which is a routine developmental stage in infants and toddler’s, any child whose fears are severe, persistent, and exaggerated to such an extent that it restricts their normal activity (i.e., school refusal) and/or interferes with their daily routines, may be indicative of something more serious, such as a Separation Anxiety Disorder or symptoms of another developmental disorder (i.e., Pervasive Developmental Delay). In such instances, it will be of paramount importance to consult with your pediatrician who can provide you with assistance and, possibly, refer you to a mental health professional who specializes in treating anxiety disorders in children (i.e., behavioral therapy).
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Dr. Melissa Fiorito-Grafman is a licensed psychologist in the state of New Jersey and New York. She completed her residency training at New York University Langone Medical Center-The Rusk Institute of Rehabilitation Medicine, which is an accredited program by the American Psychological Association. Thereafter, she completed a two-year fellowship specializing in Pediatric/Adult Neurospychology. Dr. Grafman’s education and training is unique in that it has afforded her the opportunity to serve children, adolescents, young adults, and families at the individual and group therapy level, as well as providing psycho-educational and neuropsychological assessment. Dr. Grafman currently maintains a private practice in Ridgewood and Closter, New Jersey. If you would like to discuss the contents of the articles on this site or have questions about services, you can contact Dr. Melissa Fiorito-Grafman directly at the Center for Neuropsychology & Psychotherapy, LLC in Ridgewood & Closter, New Jersey at (201) 252-2528 or www.neuropsychandtherapy.com