Transcription:
Separation Anxiety: How To Help Your Child Say 'See You Later'

Melanie Cole (Host):  Tearful, tantrum-filled goodbyes are common during a child's earliest years around the first birthday.  Many kids develop separation anxiety getting upset when a parent tries to leave them  with someone else.  Though it's a perfectly normal part of childhood development, it can be very unsettling for parents.  My guest today is Allison Berry.  She's a licensed clinical social worker at Summit Medical Group.  Welcome to the show, Allison. So, let's talk about separation anxiety.  What is it?  When does it usually start?

Allison Berry (Guest):  Thank you.  Hi. Thank you for having me.  So, separation anxiety is really an anxiety disorder that disaffects to separation from the caregiver.  Children that have separation anxieties do not feel safe or comfortable unless they're right next to their parent or their caregiver.  It's normal for children to not want parents to leave their side but most children can come distracted and that's usually resolved by, I would, say, age 5 around kindergarten.  From ages  12-18 months, through that age, kids are really learning through practice and separation like a school trip or playing on a jungle gym or spending time with grandparents, that mom or dad or caregiver will return or will be here when I'm back.  Children with separation anxiety really have what we refer to in sessions here as a “glitch in the brain” where they see each separation as an event that’s a crisis.  

Melanie:  Let's start with babies, because as a parent, it's so unsettling, as I said in the intro. Give us your best tips for the baby thing because I remember even as a parent standing there trying not to come back in when you hear your baby cry when you leave for the first couple of times.  What do you tell people every day, Allison, about dealing with that feeling?

Allison:  Absolutely.  I think , you know, that's a great question because, really, I work with a lot of parents who deal with that.  My best advice is really to try to help the parents themselves with their own anxiety around hearing that. It's normal for babies to cry.  They need to be fed, they need to be held, they need their diaper changed and that's a normal part of childrearing and I think there are a lot of times parents can become very uncomfortable and unsettled with that.  So, for parents, they may not realize it but sometimes they are at times sort of reinforcing the anxiety that the child is having by seeing the crying almost as something that they can't tolerate; that it’s something that’s unbearable; and trying to really help the child learn to self-soothe at that age.  

Melanie:  So, that's really the most important point.  We have to take a stand and deal with our own anxiety about this and teach the child to self-soothe.

Allison:  Absolutely.  I mean, in elementary age children, you know, it's different.  There are going to be different signs.  Crying, of course, but there are going to be a lot of avoidance behaviors that we see.  So, maybe a child doesn't want to go to a sleepover or they are scared to go to school in the morning.  A lot of times it’s around night time worries.  Kids want to sleep in their parents' bed.  So, those are signs really around the elementary aged child where it's becoming separation anxiety; where it's outside of the norm after the kindergarten years when it's usually resolved by then.  

Melanie:  So, in the elementary and even the kindergarten years, what do you  tell parents about being consistent in those goodbye rituals because kids do hang on and they say, “Don't leave me, Mommy. Don't walk away.”  And they can talk at that point.  So, it's even harder on the parents?

Allison:  Absolutely.  Well, really what we're doing with parents is to help them try, and I know that this is difficult, but to try to cease reassurance.  They're providing a lot of reassurance and often that ends up reinforcing anxiety.  It's one of the biggest challenges that we feel as parents.  They don't always realize that they are reinforcing anxiety by providing reassurance.  But, really the goal is not to talk the child out of the fear but to teach him how to work through the fear.  You know, a lot of times I use a metaphor, you know, encountering a hurdle.  Like when we encounter a hurdle, we don't move the hurdle out of the way, we have to learn to jump the hurdle. So, the parent's' job is to teach the child how to jump that hurdle.

Melanie:  So, how do you teach the children to jump that hurdle?  How do you talk to a child and you say you don't want to reinforce it or give them that avoidance technique?  But, how do you sort of reassure the child that you will be back and to be consistent?  How do you speak to your kids about this?

Allison:  Really what we want to do with parents is to help them put, help them help their child put the worry into words, right?  So, a lot of times, worry can really manifest itself physically. So, the child might have a stomach ache before school or have a hard time falling asleep and the parents are going to speak to provide the reassurance but first we really need to help the child identify like, "What is it that I am actually worrying about here?"  So, we help the child put the worry into words. "What am I imagining is going to happen?"  So, the kid may say something like, "Oh, I'm worried that Mom's not going to pick me up after school' or that something bad's going to happen.  So, instead of providing the reassurance, they're helping the child label the worry by identifying and then labelling it.  We sometimes use a tool that I would recommend to parents for kind of labelling the worries as sort of the “worry bug” or the “worry bully” and kind of giving that child an understanding that the worry bully or the worry bug exaggerates how bad something is going to be, underestimates the child's ability to be able to cope with that. You know Mom will be back.  So, we use that strategy.  I also help parents use coping cards or statements that can kind of be helpful to the child if a worry arises.  “That's just the Worry Monster talking. I can deal with this.”  Another thing, too, is to really try to have the parent and the child work on a hierarchy of exposures where they're actually engaging in separation and being able to label the worry and talking back to it while that's happening.  So, it might be starting with the easiest, maybe it's just leaving the room when the child's playing in the kitchen or something.  Go outside in the garden while the child is playing, depending on the age of the child and slowly sort of removing yourself from the situation to help the child learn when mom or dad or caregiver goes away, they come back.

Melanie:  So, in other words, practice being a part, maybe for short times at first and then maybe a little bit longer because parents are afraid they're not going to be able to leave the kids with the babysitter and they need to practice that, correct?

Allison:  Absolutely.  That's one of the biggest ones we get a lot here is parents are worried that the child is going to cry or be upset that the babysitter is coming or even the grandparents are coming to watch when parents are having a date night so they don't do it.  But then, like I was saying earlier, that's reinforcing the anxiety because, you know, they're not going to give that child the opportunity to actually encounter the hurdle.  They 're removing the hurdle.  “Oh, I'm just not going to go out” instead of about having a conversation, helping the child understand what the worry is and having them come up with that reassurance themselves, to know that mom and dad are going to return; they're going to have a good night.  And, you know, distraction is also a good technique. Kind of coming up with a plan for the night.  "What am I going do with the babysitter?" "What am I excited about?"  A lot of times I ask kids, you know, "If you weren't worrying, what would you be able to do with the babysitter?" "What would you be able to do at school? At the sleepover?" Kind of like helping them understand what they're missing out on because this Worry Monster is bothering them so much.  
Melanie:  When do you worry about separation anxiety?  As the child gets older, when are some of the signs or red flags that separation anxiety has gone a little further than just a normal part of childhood?

Allison:  That's a good question.  I mean, a lot of the signs have to do with, again, avoidance--those avoidance behaviors.  Extreme distress during a separation or even prior to the separation.  You know, there's talk of a business trip coming up for the parents or something  like an event coming up.  Extreme distress around that; a lot of clinging to the parents; there can be a lot of physical symptoms like I was  talking about--stomach aches and things like that.  Another big sign is really the difficulty to not be able to fall asleep, wanting to sleep in the parent's bed.  We get a lot of that. Now that kids have cell phones, of course, even elementary age kids, there's a lot of texting going on with parents during the day.  That's a big sign, too.  "Is everything okay? Am I okay?" A lot of questions, sometimes even as the child is in the other room, they might just ask a random question, it doesn't sound like a reassurance seeking  question but they're asking the question, or any question, just to make sure the parent is in the other room.  That's how we sort of know that there's a lot of avoidance going on.

Melanie:  So, wrap it up for us, Allison, if you would.  It's great information for parents in separation anxiety and making those goodbyes easier.  What you tell them every day?

Allison:  Just try to cease the reassurance that the parents are giving to the children.  That the more you allow your child to experience the separations and recognize what their own worry is, they're going to be that much stronger.  And, to really try to help parents deal with their own anxiety around the separation themselves, making sure that they're not doing anything that's reinforcing their child's worry.

Melanie:  That's great information.  Thank you so much for being with us today, Allison.  You're listening to SMG Radio.  And for more information, you can go to www.summitmedicalgroup.com.  That's www.summitmedicalgroup.com.  This is Melanie Cole.  Thanks so much for listening.