What’s Inside this Article: An overview of separation anxiety disorder and the official diagnostic criteria in the DSM V. Plus, helpful resources to help ALL children who struggle with separating from a caregiver, regardless of diagnosis.
Feeling a bit anxious when separating from caregivers is a normal part of childhood development and generally nothing to worry about.
Most kids overcome this worry by the time they enter kindergarten. By then, they’re separating from their parents regularly and learning that it’s safe and that their parents will soon return.
Unfortunately for some kids, these anxious feelings just continue to intensify. We’re going to talk about how to help these children overcome those fears.
Separation Anxiety Disorder
Some children experience what is known as Separation Anxiety Disorder.
This diagnosis is only given when kids’ distress associated with the separation is unusual for an individual’s developmental level, and is prolonged and severe.
However, your child might struggle significantly with separation and not have that official diagnosis. These are still helpful strategies if your child is struggling with separation regardless.
Symptoms of Separation Anxiety Disorder
- Unusual distress at the discussion or experience of being separated from their main caregiver
- Excessive fears that harm will happen to their caregiver
- Persistent worry about an unexpected event that could lead to separation from their caregiver
- Refusal to leave the caregiver
- Excessive fear of being alone
- Nightmares about separation or abandonment
- Anxiety about sleeping alone
- Physical complaints when separation is imminent – such as stomach pain, headache, etc.
Diagnostic Criteria
The following is the official diagnostic criteria, as listed in the DSM-V (Diagnostic Statistical Manual)
- Developing inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
- Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
- Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
- Excessive worry about experiencing an untoward event (eg. Getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
- Persistent reluctance or refusal to go out, be away from home, go to school, go to work, or go elsewhere because of fear of separation.
- Excessive fear or reluctance about being alone or without major attachment figures at home or In other settings.
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (eg. headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.
- The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
- Disturbances cause clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
- The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.
How to Help Kids Overcome Separation Anxiety
The following strategies can help your child overcome their separation anxiety.
1. Validate, Validate, Validate
You always need to validate your child’s feelings.
The last thing they need is to feel like you’re dismissing their feelings or that you don’t take their fears seriously.
Even if you don’t understand why your child is so anxious, you can still validate that feeling.
Use the statement “It makes sense that you’re _________________, because _______________”
For example, “It makes sense that you’re scared about me leaving because you don’t know what’s going to happen while I’m gone and because it makes you feel alone”
Avoid “but” statements, such as “I know you’re scared, but I’m coming back.”
Emotion coaching is a great tool for validating emotions and helping kids learn to express and regulate their emotions at the same time.
2. Talk Openly About Your Child’s Worries
Sometimes, we want to avoid talking about all these worries kids have or bad experiences that may have led to them.
We don’t want to bring them up and make kids feel worse.
But the opposite is actually true – the more your child is able to talk about their fears openly, the easier it becomes.
Getting comfortable talking about your fears can help you overcome them. Don’t shy away from discussing their separation anxiety with them.
If you can, share a story with your child about when you also felt the way they did. This helps them know they aren’t alone.
3. Create a Separation Plan with Your Child
This is one thing that really helped ease my own child’s separation anxiety.
A separation plan is just a plan about how you will say goodbye when you and your child need to separate.
You might need multiple plans for different situations—for example, one for dropping them off at school and one for leaving the house without them, etc.
This gives your child some control over how they separate from you.
For example, our separation plan was to wait in the car for the bell to ring and then walk inside together. I’d give him three hugs at the elevator, and he’d be the one to press the button for me to leave.
Later, it was changed to 3 hugs at the main door, as he became more comfortable leaving me for school, eventually separating went more and more smoothly until it was rarely a problem at all.
4. Don’t Enable
Don’t allow your child to stay home from school or stop you from leaving them at home or with responsible childcare when you need to.
This will enable the behavior. Keeping them home sends the message that you’re right – there is something to be afraid of when I’m gone, so I will let you stay home.
Instead, you need to continue validating, reassuring, talking about their worries, and following your separation plan, as well as the other strategies that help your child.
In severe cases of separation anxiety, where there is so much panic and distress that the separation is leading to meltdowns, this can seem impossible. You should seek professional support for your child — an anxiety disorder is beyond the scope of day-to-day parenting, so typical parenting strategies won’t be successful and it’s okay if managing this kind of challenge isn’t in your repertoire.
5. Use a Visual Schedule
A visual schedule is easily understood, even by children who can’t yet read or are nonverbal.
It also provides stability – uncertainty may cause major stress for kids with autism. This usually stems from not having a full understanding of how the world works.
The most important part of the visual schedule for a child with separation anxiety is that it includes COMING HOME.
Your child should be able to keep this with them and look at it throughout the day. It can serve as a tangible reminder that they will be reunited with you at the end of their school day.
You can find some great tips and free graphics for creating your own visual schedule in this article.
6. Have a Consistent Routine
Children need structure, plain and simple. Some more than others.
The more predictable your child’s day is, the less anxious they will feel.
The consistency of the pick-up routine is just as important as the separation plan.
If you can, get to the school a couple of minutes before the bell so your child sees you as soon as they come out the door. Standing and waiting for you, looking around, and not seeing you as the other children leave may amplify their anxiety.
If you are going to be late – sometimes things beyond our control happen – call the school/their childcare provider, or them if they’re old enough – to let them know you are safe and you are coming.
Whenever possible the same person should be picking your child up every day.
7. Books
I’m sure you’ve noticed, but most children’s books have an underlying theme that intends to teach children moral or social lessons.
Well, that’s for good reason.
Researchers found that the brain activity that occurs when we read fiction is very similar to experiencing that situation in real life, so reading about a situation helps children work out how to solve it in reality.
Check out some of the many books about separation anxiety for children.
I’m including read-aloud videos that I found on YouTube in this post because they’re easy for you to watch and decide if the story is a good one for your child. Plus, you can watch the videos with your kids. If you do want to purchase one of these books, they are all available on Amazon.
The Invisible String
In this relatable and reassuring contemporary classic, a mother tells her two children that they’re all connected by an invisible string.
“That’s impossible!” the children insist, but still they want to know more: “What kind of string?” The answer is the simple truth that binds us all: An Invisible String made of love. Even though you can’t see it with your eyes, you can feel it deep in your heart and know that you are always connected to the ones you love.
Llama Llama Misses Mama
It’s Llama Llama’s first day of preschool! And Llama Llama’s mama makes sure he’s ready. They meet the teachers. See the other children. Look at all the books and games. But then it’s time for Mama to leave. And suddenly Llama Llama isn’t so excited anymore. Will Mama Llama come back?
The Kissing Hand
Chester Racoon is nervous about going to school for the first time. He would rather stay home, where things are familiar. But his mother has a secret to share that will help him overcome his fears. What do you think it could be? Come read with me and find out!
8. Something Sentimental to Remind Them of You
Give your child something sentimental to hold onto that will remind them that even though you’re apart, you love them and are coming back.
This could be literally anything – a piece of matching jewelry, a clothing item, a small toy from your childhood, a picture of the two of you together, etc.
9. The Step Ladder Approach
The step ladder approach is a step-by-step way of helping children with anxiety. This is a research-based anxiety treatment used by mental health professionals.
It involves breaking down your child’s fears into smaller steps (hence, the step ladder) and working through them in order from easiest/least scary to hardest/most scary.
Your child determines how long they stay at each step of the ladder. It’s not a one-and-done technique. They’ll stay at each step until they feel less anxious and then move up to the next step. They may need to repeat a step 100 times, or they may be ready to move up after just a couple of times.
There are rewards for completing steps, with bigger rewards for bigger accomplishments. Along the way, you’ll check in and have your child rate their anxiety levels on a 1-10 scale.
This works best when your child is directly involved in creating their step ladder.
Learn how to implement the step ladder approach here.
10. Get Additional Support
Separation Anxiety Disorder is a mental health problem that may require additional support from mental health professionals.
If your child needs support, reach out to your child’s family doctor, psychologist, and/or school counselor.
Treatment for SAD often involves a mix of the following:
- Cognitive-behavioral therapy (CBT): This treatment helps a child learn how to better handle his or her anxiety. The goal is also to help a child master the situations that cause anxiety.
- Family Therapy: Parents play a vital role in any mental health treatment for kids.
- School Input: You child’s school may also be involved in care. The behavior specialist may help develop and implement an evidence-based plan to help your child overcome separation anxiety.
- Medication: Sometimes, a child may need medication like antidepressants or anti-anxiety medication to help them feel calmer while using other strategies for managing the anxiety.
