Originally published 2/19/2001
Mrs. Brown brought in nine-year-old Debby for a consultation. It seems the child, who is a born worrier, has now reached the point of worrying herself out of control.
In the past academic year she has missed over half the school year. She says she is afraid to attend school because she is worried something bad is going to happen to Mom or her eight-month-old baby brother. She cries and complains all the time. Whenever Mom is at home Debby needs to be physically near her or in the same room. Mom could not recall any traumatic experience Debby might have suffered to bring this all on.
Routinely, on Sunday night, Debby will complain of a stomachache, which in turn has kept her home from school on Monday morning. Her pediatrician says there is nothing physically wrong and suggests that we see a counselor.
It must be understood that all children have certain fears and anxieties at certain ages. This is normal developmentally, and the fears generally pass with time. Anxiety symptoms take on a different meaning when they interfere with a child’s ability to function normally in his home, at school, or in the community environment.
With some children anxiety over separation from loved ones takes hold, characterized by anxiety symptoms ranging from distress and uneasiness to full-blown panic attacks. The child worries about being separated from parents or loved ones. It is brought to the pediatrician’s attention when they refuse to attend school, or have abdominal pain, or other recurring symptoms.
When a child is evaluated for separation anxiety disorder one must make sure the child does not have a medical problem which could be causing the symptoms. Generally, though, Sunday night stomach pain and symptoms on school mornings point toward the pain being a symptom of anxiety.
One must consider that children who refuse to go to school may also be truant. However, these children do not refuse to attend school in order to be near a loved one. They are much more likely to roam when not in school, and may also have other types of symptoms.
A death or an illness in the family or any other disruptive changes at home or school may be more at risk to develop a separation anxiety disorder. Entire families can be effected by these disturbances and suffer from the same anxiety or depressive disorders.
Separation anxiety disorder treatment begins by discussing the problem with all members of the family, and getting the teacher’s perspective. Has there been any major trauma, illness, death or accident in the family or in the child’s circle? It is important to get the parent’s perspective on their child’s anxiety level and overall level of independent functioning. Counseling appointments scheduled for several times per week have proven to have a significant benefit over once-a-week therapy. Issues such as self-esteem and autonomy are discussed. Most important, useful coping skills are learned. Occasionally medications are prescribed in order to help decrease anxiety symptoms and enable the child to return to school.