Separation Anxiety

Though separation anxiety is considered to be part of normal development, when a young child's separation anxiety is severe and prolonged he or she may by diagnosed with Separation Anxiety Disorder (American Psychiatric Association 1994). Separation Anxiety Disorder is diagnosed when a child, under the age of eighteen years, shows excessive anxiety about separation from a primary attachment figure or home which lasts for at least four weeks. Some of the symptoms associated with this disorder are unrealistic worry that either the child or the caregiver will be harmed during separation, refusal to go to school, and becoming physically ill or complaining of illness before or during the separation. This disorder is estimated to occur in approximately 4 percent of children (Anderson et al. 1987). It is assumed that Separation Anxiety Disorder may manifest itself in other psychological disorders when the child becomes an adult; however, little research has been completed to support this hypothesis (Majcher and Pollack 1996).

The symptoms associated with Separation Anxiety Disorder may decrease the number of positive interactions that the child has with his or her parents. For example, a child's school refusal may lead to daily prolonged negative interactions, with the parent attempting to get the child up and ready for school and the child refusing to cooperate and complaining of physical illness as a means to avoid school. Parents may respond to school refusal with increased harshness and develop feelings of guilt because of their child's behavior and their inability to manage this behavior.

The possible causes of Separation Anxiety Disorder are diverse and it is often difficult for the therapist to determine the exact cause. Cases of Separation Anxiety Disorder have been noted due to prolonged parental separation (e.g., if parent or child is hospitalized) and death of a significant figure in the child's life (e.g., grandparent). In some cases, the parents have also been found to have experienced a high level of anxiety as a child. Though theory and research show a connection between separation anxiety and protest and the child's quality of attachment, research is still needed to determine if the quality of the child's attachment relationships has an impact on the development of Separation Anxiety Disorder (Greenberg 1999).

There are several treatment options available for children with Separation Anxiety Disorder. Research is still needed to determine the most effective method to treat this childhood disorder. Therapies used to treat Separation Anxiety Disorder include behavioral therapy and cognitive-behavioral therapy, which have been found to be effective in decreasing the level of anxiety and overt separation protest behaviors produced by children (Mash and Barkley 1998). Examples of behavioral and cognitive-behavioral therapy include rewards for appropriate behaviors, modeling of appropriate behavior, and systematic desensitization.

With systematic desensitization the child is exposed to a series of events with each event in this series eliciting more separation anxiety than the preceding event. The first event usually causes the child to experience very little separation anxiety, the next event would cause the child to experience a little more separation anxiety, and so forth. These events may be imagined by child, if they are old enough and have the cognitive ability to imagine events, or the environment is manipulated so that the child actually experiences the events. Starting with the least anxiety producing event (e.g., the child imagines his/her mother explaining that she will need to go to the store to get an item of food for dinner or the mother actually explains to the child that she will need to go to the store to get an item of food for dinner), the child is taken through relaxation steps or counter conditioning (child receives a positive reward) that leads to a decrease in the anxiety. Once the child is experiencing little or no anxiety to this stimulus the next separation anxiety producing event is presented.

Family therapy and pharmacological interventions have also been used to treat Separation Anxiety Disorder. Family therapy may include child management training and parent education. The parents are given information about the disorder, how to manage their child's reactions to separations and school refusal, and how to support their child's emotional needs. In most cases family therapy is provided together with individual therapy for the child. Pharmacological interventions for Separation Anxiety Disorder are relatively recent and are usually integrated with the other forms of therapy described above. More research is needed to determine the effectiveness of pharmacological interventions on Separation Anxiety Disorder (Allen, Leonard, and Swedo 1995).

Treatment for school refusal, one of the possible symptoms of separation anxiety, varies depending upon how quickly the child develops this symptom. For children who develop this symptom quickly, a method developed by Wallace Kennedy (1965) appears to be effective. Kennedy's approach is to get the child into school, keep them at school, and provide them with positive reinforcement for attending school as well as modeling appropriate behavior. For other children, the development of school refusal occurs over an extended period of time and many different factors may play a role in the development of this symptom. In these cases treatment usually consists of individual therapy for the child as well as family therapy.