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What is Separation Anxiety?

A common part of a child's early years.

Introduction

There is nothing worse than having to leave a highly distressed child at the door of their school or nursery - albeit in the arms of a caring and competent professional. But thousands of parents face this ordeal every day, usually riven by guilt as they walk away helpless. While it generally coincides with starting at a new school or childminder, often this extreme reaction at being parted from a parent or primary carer - known as separation anxiety - can appear to come from nowhere with a happy, balanced child regularly being reduced to a sobbing heap for no apparent reason. This is an enormously upsetting experience for all concerned and, once established, can become a daily ritual and horrendous ordeal.

A mother’s story

Childalert has heard from a headmistress of a south London Montessori school, Sandra Manning, who has been having an incredibly traumatic time - not as a result of one of her charges failing to settle down, but when it came to moving her own son into the first year of junior school. Michael, was the third of three boys and she had not encountered any problems at all with her two older boys who, like Michael, had been fortunate enough to attend their mother's school from a very early age, having her on tap all day and being in their family home, where the school was based. Sandra simply puts it down to Michael having a different temperament to his brothers, perhaps being slightly less sure of himself or even, as she puts it, 'Perhaps he just loves me too much. ' Sandra fell into deeper and deeper despair at the scenes she witnessed outside Michael's new school. Initially it began with him crying and clinging to her but things progressed fairly fast to being a lot more unpleasant. Michael started to vomit in the car on the journey in as well as on arrival and had to go up to class clutching a plastic bag. He would also pretend to be unwell on numerous occasions in the hope that he would be let off school. He also fabricated stories about what his teachers had said and done, making out that he was being badly treated, when he wasn't - all to gain his mother's sympathy and to get her to keep him at home. While Sandra was desperate to help her little boy overcome his terror and upset, she also had her responsibilities as a headmistress to contend with and could not simply give in and have her son at home, however much she was tempted. Nor could she hang around for hours at the new school trying to settle him in when she had her own classes to attend to. All this set him apart as 'different' in the eyes of the other children - and also, says Sandra, in the eyes of other parents who became wary of asking Michael round to tea, alienating him even further. A year on and the situation has gradually started to improve - it turned out that one the teachers at Michael's new school had witnessed this severe degree of separation anxiety once before and had some innovative ideas as to what might help. She started to come out to the school gate to meet Michael every morning to tell him that they had some 'special' jobs for him in the school office. Reluctantly at first, but then with increasing confidence - and still clutching his sick bag - Michael would accompany her in and given a ‘special’ seat and set a simple task such as sorting out tickets for some school event. Giving him a role in this way somehow built up a sense of security and, after about five weeks the vomiting stopped. Drop offs are not wholly without their drama, but a lot better than they used to be, and Sandra is slowly becoming reassured that there is a light at the end of the tunnel. Her guilt knows no ends - she is blaming herself for perhaps mollycoddling him too much while he was younger as he was her 'last baby.'

Sandra is probably being a bit too hard on herself - after all this is something we probably all do to one degree or another.

So how do you strike that balance between protecting your child and providing the stability and love he or she needs to grow into a confident toddler and child - and at the same time provide enough scope for independence and experimentation so that very same child develops a sense of security and self-sufficiency at the same time? Experts agree it is not easy and that so much depends on the nature, personality and temperament of each individual child. External events can also influence the situation - for example the arrival of a new sibling can de-stabilise the most tranquil of youngsters.

Understanding the problem

Experts agree that, in many ways, it is a totally reasonable reaction for a child to object to being left with someone with whom he or she is not particularly familiar or comfortable. However, a child might simply object because he or she would prefer to be with you and may not, as yet, be articulate enough to voice this emotion in anything other than a histrionic wail. It's a normal, understandable response and there may not be any cause for concern at all. As Dr Mandy Bryon, a clinical psychologist at Great Ormond Street Hospital said in an interview last year with The Times, 'Parents might feel tears indicate a problem at nursery, or that a child feels unhappy there, when usually the opposite is the case - the tears are just for you. It is perfectly natural for your child to protest and say how can you leave me, then be comforted and enjoy their day.' The same applies if you experience tears on collection - they do not mean that your child has been wretched all day - but just an emotional response tied up with the relief of seeing you and/or the exhaustion of coping with the day. A quick chat with the minder or teacher should be enough to put your mind at rest.

Tackling the problem

But what about cases that are a bit more extreme, or which do indicate that there might be something more deep-rooted going on? The advice to parents appears to be to start being alert to problems at a very early age - and pre-empt them by putting into practice some precautionary measures:

1. It is a good idea to try and introduce other carers into the mix at around the age of 6-9 months, the age at which babies first start to get a sense of the 'otherness' of strangers. Even if all you do is to leave your child for half an hour with another family member, it helps to establish confidence in the experience and, most importantly, trust in your return. If other children are around as well, so much the better as early interaction with other infants, however limited, will form the basis of good social skills in future.

2. Another flashpoint is around the age of two to two and a half, when nursery generally starts. Even if your child seems hyper-confident, arrange to go in beforehand and look around together and generally spend some time in the nursery environment. Talk about what is likely to happen, how much fun it will be, what time you will be coming back and how you will go home for tea/bath/bed together. When the time comes to start for real, stay for 15 minutes on the first day, gradually reducing the length of time you spend there before you leave. The same would apply in the case of starting with a childminder, or when there is to be a change of childminders. In both cases, you can expect the settling-in process to last anything up to about two weeks. If your child persists in being reluctant to go in, recruit the help of the teacher or childminder to make the handover as calm as possible. But, on leaving, if you hear crying persisting, resist the temptation to go back inside and reassure your child. Hard as it is to do this, it is far better for the child in the longer term - if you need reassuring yourself, wait within earshot until the sobs have subsided. That way at least you will feel slightly better about walking away. Alternatively, phone in half an hour later to check things have settled down.

Troubles with older children

It is more rare for childr en of five and over to display separation anxiety tendencies, though not impossible as illustrated in the case of Michael Manning. Michael's situation could be nothing more sinister than simply a case of him having to make a harder transition than most, having got used to being with his mother in a domestic as well as educational environment up until the age of five, which is fairly exceptional. However, in the case of prolonged demonstrations of distress, do discuss your concerns as early as possible with a health visitor, GP or form teacher who might be able to help you get to the bottom of the problem or suggest you have a chat with an educational psychologist .

You're not out the woods completely though - anxiety can manifest itself in just an alarming manner in young teenagers in the form of panic attacks. Unfortunately incidences seem to be on the rise - increased pressure, competition and stress is being held to blame, with children being urged to achieve in all fields at all levels. It is not simply enough to do well at school, extra curricula sports and hobbies demand just as much attention and commitment. Plus there is the overwhelming imperative to be attractive and popular. All very hard to contend with at a time when the hormones are surging and life is hard enough to deal with at the best of times.

Panic attacks in older children

Panic attacks are not 'all in the mind' and it would be a big mistake to write them off as such. They come on from nowhere and can involve one or more of the following symptoms: racing heartbeat, sweating, choking, a sense of disassociation, light-headedness, breathlessness and a conviction that death is imminent. Indeed, in extreme cases, the attacks have led to suicide according to child psychotherapist Peter Wilson, who has heard sufferers describing the experience of an attack as ' A horrible feeling, like staring over the abyss.'

Attacks can happen any time of the day or night and can either pass off ten minutes later all by themselves or last for several hours and require medical intervention - as was the recent case of a 16-year old girl who was rushed to hospital for massage to her carotid artery when a panic attack took her heart rate up to 137 beats per minute.

Panic attacks are believed to be caused by surges of adrenalin released in reaction to stress - a throwback to the time when our forbears were faced with a 'fight' or 'flight' situation requiring an immediate physical response and so needed the adrenalin to supply an extra burst of energy. These days, our battles tend to be more psychological - and it is not always immediately apparent that they are going on at all. However successful, outgoing or accomplished your teenager appears on the outside, there could be a lot of churning and anxiety happening underneath, threatening to break through at any time. As Peter Wilson points out, 'Adolescence is a very scary time for some. They feel so out of control - their bodies are changing so fast.'

All parents can do is stay vigilant and be there to offer emotional and physical support as and when necessary. Further information is available from Peter Wilson who runs a charity called Young Minds, a charity working towards the greater understanding of adolescents.

Young Minds - parents information line: 0800 0182138. 

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