Understanding and helping youth with separation anxiety and school refusal
Reprinted from "Young People: Transitions" issue of Visions Journal, 2015, 11 (2), pp. 31-34
It’s normal for young children, aged two to five or six, to sometimes feel worried or upset when faced with routine separations from their parents or other important caregivers. They may cry, cling or refuse to part. This is developmentally normal behaviour that usually fades as children mature, begin school and gain confidence.
In school-aged children, mild to moderate levels of fear and distress can also occur, emerging during important transitions such as starting a new school, moving and other stressful situations. Such behaviours are also normal, and many children will adapt to these situations, learning to cope effectively.
Yet, for other children, their response to such transitions, situational demands and separations is far more extreme than what is evident in their peers, and/or it continues well beyond the first few months. These children may have an anxiety disorder.
How to identify the anxiety underlying school refusal and separation anxiety
Typical signs of anxiety in young children include physical complaints of stomach ache, nausea and feeling “bad,” as well as clinging, crying and having a tantrum, among other behaviours.
While these behaviours are expected to lessen and then disappear as the child adjusts to entering school for the first time, some children fail to adjust. They may engage in ongoing and persistent refusal to separate or go to school. This occurs most days each week, for much of the school year, or during most times when separation occurs.
Other children may experience intermittent bouts of school refusal, often coinciding with a return to school on Monday mornings or after school holidays. Although their anxiety isn’t daily, it often has a consistent pattern (e.g., every September and October) that lasts for several weeks or months, and even can persist for years.
Preteens and adolescents behave differently than younger children. They no longer cry, cling and have a tantrum, and are more likely to identify their specific fears. For example, they may express fear of embarrassing themselves, making mistakes, academic failure, or something bad happening to a parent when separated from them. As a result, these young people may decline invitations to hang out with peers, preferring to stay home on weekends. They may also fail to turn in assignments, cut school to return home, or even use drugs or alcohol to cope.
The impact of anxiety disorders on youth
Anxiety disorders can greatly interfere with, or limit, a child or teen’s normal activities. They can become isolated from peers, and have difficulty developing and maintaining friendships. They may miss opportunities to learn new things and engage in fun activities. School attendance and performance can drop, resulting in youth failing to reach their full academic potential.
The bottom line: A problem exists when your child’s anxiety occurs more often than not, seems unreasonable given the situation, and interferes with their functioning. No matter when separation anxiety emerges, if you believe it’s becoming a problem, it’s important to seek clinical help from a mental health professional.
Assisting a child with separation anxiety and school refusal
With a newborn, parents quickly learn that their infant’s survival depends on their ability to meet his or her many needs, from feeding, soothing, changing diapers and much more. Learning to meet these needs is adaptive behaviour—the infant’s life depends upon it.
For some parents of anxious children, however, this “meet the needs” approach continues unchanged despite the child growing up and becoming more capable. This occurs because the child has been anxious from an early age, and the parents continued to meet their child’s needs regardless. Or, it occurs because the child developed anxiety later in childhood, and the parent resumes the early infant-toddler system of need-meeting, as it had worked so well.
An example of need-meeting behaviour is if the child is too anxious to go on a play date or attend school, the parent will go with them. Alternatively, some parents don’t make any demands of the child, believing their child cannot cope. So, play dates are never scheduled, or invitations to sleepovers are declined.
Although many parents’ decision to “meet the needs” is well intentioned—they simply want to reduce their child’s suffering—this goal can be achieved in ways that will benefit their child well into the future. For example, never making your child go on a play date because he or she is anxious is detrimental to your child’s social development. Rather, teaching your child how to feel confident and safe, and thus to gradually work his or her way up to a full two-hour play date, is far more beneficial.
The following section outlines a variety of ideas—things to avoid and to encourage—that will best meet your anxious child’s needs.
Pitfalls and lifelines: The dos and don’ts of helping an anxious child
Continuing to rely on the “meet the needs” approach can cause both you and your child to become stuck. It prevents your child from having the courage to try new things and discover whether his or her fears are warranted. It can also cause your child to depend on you for everything, which is unsustainable in the long term. In some cases, this leads to parental irritation and resentment that children feel. What was once adaptive can become maladaptive. The following pitfalls exemplify how this can happen:
Providing excessive reassurance: “For the fifth time, I promise you you’ll be fine playing at Jon’s without me. We know Jon’s family well and have been there many times together. You always like it.” Although a few occasional supportive assurances that your child can cope are fine, repeated reassurance only feeds the anxiety and fails to convey useful information.
Consequence: Child hears mom’s irritation and feels dismissed by her. He thinks, “What if I’m not fine? What if I don’t like it?” He remains afraid and has little fun as he spends the time waiting for catastrophe to occur. Although nothing bad happens, nothing good happens either. He assumes it was a close call and his vigilance protected him from disaster.
Allowing your child to avoid or escape various demands: “I know you’re worried about the sleepover. How about you stay home with me and your baby sister.” Avoidance not only prevents your child from learning how to tolerate discomfort and be brave, but it can also convey a lack of confidence in your child’s abilities.
Consequence: Child misses out on a fun sleepover and her self-esteem lowers as she begins to believe, “I’m weak.”
Lowering expectations: “You don’t need to stay for math. I’ll get you at lunch.” Like avoidance, lowered expectations prevents learning and lowers esteem.
Consequence: Child never gets to see if math class is as bad as he thinks it is. He eventually falls behind in key academic concepts and his anxiety goes unaddressed.
Accommodating the anxiety: “I know it’s hard to switch schools, but you can text me anytime, all day. I’ll be right at the other end.” It’s reasonable to break down a large task into smaller parts with the plan to have your child eventually be able to do it all. For example, texting a few times on the first day, followed by one text the next, and then none from then on. What’s not helpful, is breaking it down but never getting past the first step.
Consequence: Teen spends the time texting her parent rather than making new friends. This confirms her belief that the new school would be unwelcoming.
You can help your anxious child by cultivating a partnership that encourages warmth and curiosity toward understanding anxiety. Together you can acquire factual information about anxiety, learn helpful skills and convey confidence. This can be done at home—though for youth with more excessive and pervasive anxiety, support from a mental health professional is recommended.
The following strategies (not an exhaustive list) can help you and your child become unstuck and start moving forward:
Knowledge: Teach your child some important facts about anxiety (for useful sources see the links above). For example, you can let the child know that unwanted anxiety is the body’s natural “fight-flight-freeze” response to danger during a non-dangerous time. This is called a “false alarm.” Another example is that while panic attacks may feel scary at first, it’s important to let your child know they are harmless. It can help to compare a panic attack to hunger pains, something that is annoying and uncomfortable, but harmless and quick to go. Finally, many kids like to learn facts. One such fact is that in an average elementary classroom, approximately five to six children (20%) have an anxiety disorder.1 This can help your child feel he or she isn’t the only kid dealing with these struggles.
Bossing back the bully: In addition to physical symptoms, anxious thoughts are common, often telling kids that bad things are likely to happen and that they can’t cope. For example: “The kids will laugh at you, and you’ll have the worst day ever!” Teach your child to treat these thoughts like a bully or a nosey neighbour. For younger children, simple “boss back” statements—“Go away!” or “You’re not the boss of me, you’re just a liar!” for example—may be enough. For older youth, encourage them to look for the evidence for and against a fear thought, and to challenge the “worry bully.” This can help your child feel empowered to change the situation.
Setting and working toward small goals: Once your child can reduce anxiety through self-soothing and bossing back nosey, bullying thoughts, the next step is to encourage small steps toward a goal. Have your child choose a goal they are ready to work toward, and break it down into small steps. Start with the easiest step and move up from there. For example, if your child wants to attend a play date, begin with you staying for most of the play date, but leaving for the last 15 minutes to ‘run a quick errand’ (you can always just sit in your car—but don’t tell your child!). The next step might have you leave for the last 30 minutes, and so on, until your child can stay alone for a full play date.
Rewarding bravery: Reaching a goal requires bravery. Bravery is defined as being anxious but going for it anyway. Rewards can provide a child with the added incentive to approach his or her goals. A reward could include stickers, small toys, privileges and more.
Being consistent: Once you start encouraging your child to tackle his or her anxiety, don’t stop. Be consistent with your expectations. Every. Single. Time. Anxiety thrives on inconsistency—it’s always looking for ways to take back control.
Transitions and changes are frequent throughout childhood and adolescence, typically resulting in some degree of stress and anxiety for most young people. Although it’s tempting to want to do things for your child and to protect them from experiencing anxiety, it’s not a long-term solution. It’s far more adaptive for your child to learn to tolerate and cope with anxiety-provoking situations, than to try to eliminate or avoid anxiety. Using the strategies described above can assist children and teens to be more resilient to routine demands. If you find the help these ideas provides is insufficient, however, getting support from a trained mental health professional is highly recommended.
For additional resources, go to www.anxietybc.com/parenting/parent-child
About the author
Katherine is a Registered Psychologist at the Vancouver CBT (cognitive-behaviour therapy) Centre and co-author of the book Your Anxious Mind: A Teen’s Guide to Anxiety and Panic (Magination Press, 2009)
Costello, E. J. & Angold, A. (1995). Epidemiology. In J. S. March (Ed.), Anxiety disorders in children and adolescents (pp. 109–124). New York: Guilford.