Re: Seeking Advice for Severe Separation Anxiety

[Guest guest]

Normal anxiety and fear tends to follow a developmental sequence. These

tendencies seem to be

hard-wired and seem to have a developmental purpose. Infants commonly show a

fearful response to

loud noise or the sudden loss of physical support. Reluctance to be separated

from one's caregiver

is a normal, healthy response in young children and indicated the development of

healthy

attachment. When a child starts to walk on its own, fear of strange animals is

an adaptive

response. Performance anxiety can appear in late childhood and social phobia in

adolescence.

Some degree of separation anxiety is a sign that the preschooler has developed

healthy attachments

to loved ones. In many cases, it stops within 3-4 minutes after the parent

leaves.

Temperament. Some children seem more irritable and clingy as infants, have more

trouble

establishing a regular daily schedule, and have more difficulty with

transitions. (This is more

enduring than a couple of months of colic) Such children may be more vulnerable

to separation

anxiety. Such a child may require more work and attention. However, having a

more difficult

temperament, does not invariably lead to problems in later childhood.

Normal Development of Separation: Most common times for separation fears: eight

months, twelve

months and anywhere between 18 months to three years. Separation anxiety

generally emerges around

nine months of age and peaks around 12-24 months. The child's crying and

clinging can express two

different messages. First, the child may cry when the parent leaves because they

fear that the

parent will be gone forever. The second situation is when the child, often after

a fairly good

day, begins to cry when the parent returns. This is because the parent's return

reminds the child

of how he or she felt when the parent left. Sometimes, children between one and

two years of age

may walk or crawl away themselves, and then become anxious at the separation

they themselves have

created. Separation anxiety generally decreases between 2 and 3 years of age.

The child often

tends to be shy with strangers, but morning separations become easier. The

degree of separation

difficulty may vary from day to day. One day, the child may be anxious to go and

another day,

clingy and sad. Many two-year-olds go through a phase when they prefer a

particular parent. This

can exhaust the desired parent and make the other parent feel unloved. The child

has more of a

drive toward independence. Still transition times can be difficult, and lead to

temper tantrums.

For toddlers, those who have had either very few or very frequent separations

from loved ones

experience the most separation anxiety. Adults, too, experience anxiety when

separated from loved

ones, but it is usually not so overwhelming. The adult has a better concept of

time and has had

more experience dealing successfully with separation.

Factors that may contribute to separation anxiety

Tiredness

Minor or major illness

Changes in the household routine

Family changes such as birth of a sibling, divorce, death or illness.

Change in caregiver or routine at day care center.

Parents usually are not the cause of the separation anxiety, but they can make

things worse or

better.

Factors that may reduce the chances of developing separation anxiety

Start occasionally using a babysitter by six months of age. This helps the child

tolerate short

periods away from the parent and encourages him or her to build trust in other

adults.

Even though children of this age do not engage in cooperative play, start

contact with peers by 12

months. By age three, the child should be experiencing play groups.

Some form of preschool may be helpful by age 3 or 4. This is especially

important for children who

seem overly dependent on their parents.

Supporting a child through periods of separation anxiety.

Positive experiences with caregivers, short times at first.

Help child become familiar with new surroundings and people before actually

leaving the child

there.

Rituals (bedtime and morning)

" Lovie " or " Cuddly " represents closeness to parents. If possible, allow the

child to take the

" Lovie " along.

Do not give in. Let the child know that he or she will be all right.

Remind the child of previous brave things he or she has done. Talk about how a

fictional character

might handle it.

Let child know, in words he or she can understand that you appreciate how

distressing it must be

to be separated from loved ones. Understanding and acceptance, but not excessive

sympathy.

Never make fun of a child's separation distress. Do not scold child for it.

Do not bribe child to mask the distress. If you plan a special activity after

you pick the child

up, let it be unconditional.

Focus on the positive things that happened in daycare. Don't let them dwell on

fears or

imagination of what might happen.

Minimize fears by limiting scary TV shows

If it is an older child, consider introducing him or her to some of the children

who are to be in

the class and arranging play dates in advance.

Preparing the child--reading books about going to preschool, pretending about

going on voyages or

quests.

Make shopping for school supplies a special event just for that child.

Expect a child to be more tired and possibly more irritable than usual when he

or she starts

Kindergarten or First grade for the first few weeks.

When leaving, give a quick kiss and hug and cheerfully say goodbye.

Don't prolong your departure or come back several times.

Don't sneak out of the room.

Even if you feel that a strict teacher or a bully might be part of the problem,

keep your child

going to school while these problems are being handled.

If your child does stay home, do not make it an extra fun, gratifying day.

The Anxious Parent--Suggestions for Teachers

Teacher should introduce self to child and invite the child to play with toys or

have a snack.

Offer to have the parent stay a while, leave the child alone briefly with the

teacher and then

return.

Suggest to the parent that he or she try role playing with the child to rehearse

the separation.

Teacher could have a ritual for the parent leaving the child.

If the child is in an absolute panic, ask parent to stay until the child is

quieter. Teacher

should ask parent to comfort child in a firm, loving voice.

Teacher should never criticize child for feeling sad or anxious.

Warning signals

Child is inconsolable for more than 2 weeks.

Repeated physical complaints in the morning before preschool.

Separation anxiety continuing into elementary school years and interfering with

activities that

other children do at that particular age.

No separation anxiety at any time.

School refusal in an older child or adolescent is often a more serious problem.

In such a case,

the parent should seek professional help early.

Separation Anxiety Disorder

Diagnosis and Symptoms: Severe, persistent anxiety about being separated from

home or parents. The

anxiety must be severe enough to interfere with normal activities. The child

generally shows

distress when separated from parents, and worries that the parents may suffer

harm when away from

the child. When separated, the child may have nightmares and sleep problems.

Physical symptoms

such as nausea, headaches and abdominal pain may occur before or during a

separation. The

diagnosis is not made if the symptoms are part of another disorder such as

Pervasive Developmental

Disorder, or a psychotic disorder. (These diagnoses are rarer and usually more

serious than

separation anxiety disorder)

Treatment

Behavioral-- Parents and child may benefit from counseling. Parent education and

family therapy

are often beneficial. In some cases, the child may also benefit from individual

play therapy.

Coordination is a key factor. The family should make sure that the mental health

provider is

willing to make the effort to coordinate between the pediatrician, the school

and the family.

Extended family may also need to be involved. The parents need to develop a

consistent morning

plan to help support the child in going to school. The school or day care

providers and the school

nurse are often included in the plan so that the responses to the child are

consistent. If the

child frequently complains of physical symptoms in the morning, the pediatrician

should do a

thorough physical exam to rule out any physical causes. Once this has been done,

the pediatrician

can reassure the parents and child if they call about the symptoms. If physical

symptoms show a

sudden change, the parents may need to have the child examined again. Once a

particular symptoms

has been carefully considered, it is often best not to do repeated medical

evaluations of the same

symptom. It is ideal if one or both parents are home and awake when the child

leaves for school.

If another caregiver is designated to see the child off to school, this

individual should be

involved in the therapy. I try to avoid home schooling in such children because

it tends to become

self-perpetuating. For many anxiety disorders, including phobias and COD, the

best therapy is to

face one's fears consistently. Daily school attendance often leads to symptom

remission.

Medication -- This is needed for a minority of children who have persistent

symptoms, resistant to

behavior modification and psychotherapy. There have been significant strides in

knowledge of

psychiatric medications for children. A number of studies have shown that

Imipramine (Tofranil)

can help separation anxiety disorder. However, one needs to follow EKGs (heart

tests) and blood

tests for safety reasons. Sometimes, high doses were necessary for improvement.

In the past 10-15

years, a new class of antidepressant medications has made treatment of childhood

depression and

anxiety disorders safer and more effective. The SSRIs, Prozac, Zoloft, Paxil

etc. When used

carefully and monitored closely, can help separation anxiety disorder. At this

point, an SSRI

would be the medication of choice instead of Imipramine.

shell

kind regards shell

http://groups.msn.com/autismaspergersinthefamily

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[Guest guest]

Daddy has to get with it. His daughter is needy, and he can help. Tell him that his involvement will save him some money, because if he doesn't do it, you'll have to hire a babysitter at $12.00 an hour (for a very experienced adult). After Daddy has watched her successfully for a while, perhaps you could introduce a grandparent and slowly get them to watch her.I think the school's plan is a good one. But I would also suggest that you work in tandem with a psychologist or licensed social worker who does play therapy.I think it would be great if she could stay in preschool. Could she get a one-to-one aide so you wouldn't have to stay? That's all my poor brain can come with at the moment. If I think of something else, I'll pass it along.LizOn Sep 5, 2007, at 1:58 AM, Amie wrote:My 3 yr old daughter is starting up preschool through Early Intervention again next week, and I am dreading it. She went several times in July before the summer break, and each time was a nightmare. She has such severe separation anxiety, and also has severe anxiety around other children. I do not know what else to do and thought someone here might have some advice. I have taken care of her 24/7 since she came home from the hospital (Daddy does not help) and I am really the only person she has bonded too. She is getting better and will let Grandma and Grandpa hug her and will sometimes let Daddy hold her or will sit next to him. However, this is the extent of her physical contact with just about anyone else. She is getting somewhat better, and will let me go to the other floor in our house with melting down now. I also get an occasional run to the grocery store with Daddy watching her without her having a meltdown. However, any other situation she melts down completely. When she has a meltdown she screams nonstop until I come back, throws up (everywhere) and also chews on her fingers/hands/arms till you can see the teeth marks and she bruises. It took two teachers to safely contain her in July when I left the classroom for just a few minutes. I am the only mom they have let stay in the class for more than 1 session, and they asked me to come back as her separation anxiety is so bad. The only thing that they can recommend is slowly building her trust by having the same teacher take my daughter into the classroom, and me coming in 5 minutes later, ten minutes later, 15 minutes later, etc until she is reassured that I am coming back and I can stay away the whole class period. However, at this rate I will never be able to leave her the whole time. I have tried everything I can think of, role playing school with her dolls, talking about school and the step by step routine they have in the classroom, I got her a "P" to chew on that her preschool teacher recommended to replace her arm/hands for oral stimulation when upset. I have tried taking her to the park/zoo/etc twice a week for socialization. I have also tried getting Daddy to watch her more (he is very uncooperative in this so it does not happen often, but I got him to do it twice last month!)In addition, I work full time from home doing customer service (keeping a set schedule). My supervisor has been supportive so far, but it was with the understanding that after one more month of twice a week preschool she would be able to take the bus and go to class alone as the preschool time is in the middle of the busiest part of my shift.Any advice would be greatly appreciated…I feel my anxiety levels rise as Monday fast approaches! I hate to take her out of the preschool as when I am there she gets much needed speech, occupational and socialization therapy, and from everything I read this is so important especially at the younger ages. But at this point I am almost wondering if it is doing more harm than good. I also need to consider job security so I can still afford her insurance and private therapy.Amie

[Guest guest]

Hi. I have a now 10 year old who had extreme anxiety when he was younger. I can only say that I wished I had not sent him to special education preschool at 3 1/2. He just was not ready for that kind of separation. I think if I had waited another year the adjustment would have been easier. I left him everyday for the first six weeks he cried everyday, carried his diaper and hid under the teacher's desk. I really beat myself up for sending him. His is still a very anxious child. We did try medication for a while when he was young and it did help him. Feel free to ask any other questions. Pam :)Get a sneak peek of the all-new AOL.com.

[Guest guest]

Pam,

Thank you for your response. What were some of the " non-medicated "

approaches that you tried to help your childs anxiety at that age?

So far the biggest help has been the " P " which is a green rubbery

chew in the shape of a P that she chews on to help deal with her

anxiety

I have been telling her about school, how much fun it will be, and

describing the " class routine " in detail for a couple days now, and

she has woken up with nightmares the past two nights and is in a

panic when I am not in the room. Bedtime, which is usually very easy

for us has been a nightmare.

I think I will try the school route for a month (6 classes), and if

it is not better, then think about other avenues other than the

preschool. It is good to know that someone out there also wonders if

preschool is more detrimental than good in some cases.

-Amie

>

> Hi. I have a now 10 year old who had extreme anxiety when he was

younger. I

> can only say that I wished I had not sent him to special education

preschool

> at 3 1/2. He just was not ready for that kind of separation. I

think if I

> had waited another year the adjustment would have been easier. I

left him ever

> yday for the first six weeks he cried everyday, carried his diaper

and hid

> under the teacher's desk. I really beat myself up for sending

him. His is still

> a very anxious child. We did try medication for a while when he

was young

> and it did help him. Feel free to ask any other questions. Pam

>

>

>

> ************************************** Get a sneak peek of the all-

new AOL at

> http://discover.aol.com/memed/aolcom30tour

>

[Guest guest]

On May 6, 11:17am, " Amie " wrote:

} Thank you for your response. What were some of the " non-medicated " =20

} approaches that you tried to help your childs anxiety at that age?=20=20

} So far the biggest help has been the " P " which is a green rubbery=20

} chew in the shape of a P that she chews on to help deal with her=20

} anxiety

Chewing is a big help for Bam, too. He has graduated from a chewy

tool to sugar-free gum, which is more socially acceptable.

}

} I have been telling her about school, how much fun it will be, and=20

} describing the " class routine " in detail for a couple days now, and=20

} she has woken up with nightmares the past two nights and is in a=20

} panic when I am not in the room. Bedtime, which is usually very easy=20

} for us has been a nightmare.

Bam had some nightmares right before school too. None since it started.

I hope this will temporary for your daughter, too. :-(

Willa

[Guest guest]

We used social stories and constant reassurance. Unfortunately for my son his anxiety was so intense that he wasn't learning and was extremely fearful of the other children. I finally agreed to put him on a low dose of medication and it helped alot. It seemed there was no way to even deal with his anxiety at the level it was before medication. Pam :)Get a sneak peek of the all-new AOL.com.

[Guest guest]

Amie,

My now 18 yo, hfa, was this way as a little boy. He clung to me constantly and was extremely afraid of everything. He would headbang when he got overly stressed. When they put him in pre-k because he was dev. delayed, I was told I could not come with him. I used to peek in the window to see him and he was almost always hiding under a table. He did hide for the first year. The second year, he did better.

I wish now I had not left him. It was really traumatic for him. But also, if I had gone, I am not sure how long it would have taken him to adjust - he might have needed me the whole year. His stress steadily grew worse over time until by 1st grade, he was getting off the bus and screaming all the way home - as if he was on fire. This is when we finally started him on anxiety meds. It changed his world for the better right away. He was able to handle things and was not so scared of everything. He started being able to talk to other people, a first for him. I wish we had started the meds sooner in retrospect. We were trying "everything else" to avoid meds, like many parents. But this is what worked for him.

You could try some things such as making her a book about school. Take pictures of a few fellow friends, the teacher and aide, therapists, desks, toys, etc. Get the class schedule and go over it in the book (first, we sit in circle time and sing some songs....) Giving her an outline of what is going on can be a huge huge help. Often it's the fear of not knowing what comes next that feeds the anxiety. You could also see if the teacher would spend 5 or 10 minutes before or after school just playing with your dd - to form a relationship with her, which would help as well.

RoxannaAutism Happens

( ) Re: Seeking Advice for Severe Separation Anxiety

Pam,Thank you for your response. What were some of the "non-medicated" approaches that you tried to help your childs anxiety at that age? So far the biggest help has been the "P" which is a green rubbery chew in the shape of a P that she chews on to help deal with her anxietyI have been telling her about school, how much fun it will be, and describing the "class routine" in detail for a couple days now, and she has woken up with nightmares the past two nights and is in a panic when I am not in the room. Bedtime, which is usually very easy for us has been a nightmare.I think I will try the school route for a month (6 classes), and if it is not better, then think about other avenues other than the preschool. It is good to know that someone out there also wonders if preschool is more detrimental than good in some cases.-Amie>> Hi. I have a now 10 year old who had extreme anxiety when he was younger. I > can only say that I wished I had not sent him to special education preschool > at 3 1/2. He just was not ready for that kind of separation. I think if I > had waited another year the adjustment would have been easier. I left him ever> yday for the first six weeks he cried everyday, carried his diaper and hid > under the teacher's desk. I really beat myself up for sending him. His is still > a very anxious child. We did try medication for a while when he was young > and it did help him. Feel free to ask any other questions. Pam > > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour>

[Guest guest]

Thank you both for your responses. Roxanna, your son does sound a

lot like my daughter.

Just today I had my yearly doctor visit and Daddy had to watch her,

she screamed for 55 minutes straight. She even had some nurses

running into the room, as when I was called back into the doc office

as she screamed so loudly and reacted so violently they thought she

must have seriously injured herself.

I have been putting her into situations where she has to be around

other children, but not necessarily interact with them once or twice

a week (zoo, park, train ride, farmers markets, etc) and this has

helped out tremendously with her " personal space " issues. I keep on

hoping that with some desensitization, she will get better with her

separation anxiety as she has in so many other areas.

Thankfully, one of her teachers in her preschool classroom has a 6yro

HFA boy, and is really reaching out to my daughter. My daughter has

opened up to her a little, and has even let this teacher hug her!

This is the 3rd person outside of the home that she has let do that.

It gives me such hope!

I will try the story book idea, as the verbal discussion seems to do

more harm than good, as she is panicking now whenever I leave the

room (even at home). I will take a camera on Monday and see if the

teachers will let me include their pictures in the book

Thank you again, it helps knowing that others out there have dealt

with it too, and that there is some light at the end of the tunnel,

even if it requires medication. If this isn't resolved, I will look

into the medicated route in the near future, I am just not quite

ready to do that yet. Is your child still on anxiety medication, or

was it temporary?

-Amie

>

> Amie,

> My now 18 yo, hfa, was this way as a little boy. He clung to me

constantly and was extremely afraid of everything. He would headbang

when he got overly stressed. When they put him in pre-k because he

was dev. delayed, I was told I could not come with him. I used to

peek in the window to see him and he was almost always hiding under a

table. He did hide for the first year. The second year, he did

better.

>

> I wish now I had not left him. It was really traumatic for him.

But also, if I had gone, I am not sure how long it would have taken

him to adjust - he might have needed me the whole year. His stress

steadily grew worse over time until by 1st grade, he was getting off

the bus and screaming all the way home - as if he was on fire. This

is when we finally started him on anxiety meds. It changed his world

for the better right away. He was able to handle things and was not

so scared of everything. He started being able to talk to other

people, a first for him. I wish we had started the meds sooner in

retrospect. We were trying " everything else " to avoid meds, like

many parents. But this is what worked for him.

>

> You could try some things such as making her a book about school.

Take pictures of a few fellow friends, the teacher and aide,

therapists, desks, toys, etc. Get the class schedule and go over it

in the book (first, we sit in circle time and sing some songs....)

Giving her an outline of what is going on can be a huge huge help.

Often it's the fear of not knowing what comes next that feeds the

anxiety. You could also see if the teacher would spend 5 or 10

minutes before or after school just playing with your dd - to form a

relationship with her, which would help as well.

>

> Roxanna

> Autism Happens