This article is a follow up from our first article: Strategies for Parents to Help Their Child with Separation Anxiety. This intro is the same, but as you go further down the article, you will see strategies for schools to use to Help children with separation anxiety.
What is Separation Anxiety Disorder?
According the American Psychiatric Association, a person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood. Children with separation anxiety disorder may be at-risk for school refusal in the future. Behaviors related to school refusal may include:
- severe emotional distress about attending school (e.g., anxiety, temper tantrums, depression, or somatic symptoms – such as pain or fatigue)
- the child often tries to persuade parents to allow him or her to stay home
- the child often attempts to conceal absence from parents
- child stays home during school hours because it is safe and secure
- child expresses willingness to do schoolwork and complies with completing work at home
Some separation anxiety, which may manifest itself as clinging to parents, crying, and resistance when going to another caregiver (e.g., school, daycare, babysitter, etc.) is typical in young children such as those ages three and four. However, if the anxiety seems severe (in young or older children) in that it is causing extreme distress and interfering with daily functioning, parents should consult with a child therapist.
Some children may receive a diagnosis of separation anxiety disorder from a child psychologist or psychiatrist. Other children may manifest symptoms that are never officially diagnosed. Regardless of where there is an official diagnosis, there are strategies we can put into place to assist a child with symptoms of separation anxiety. As previously stated, some children would benefit from therapy with a child psychologist or counselor, but in addition to that, there are ways that schools can provide support to children with symptoms of separation anxiety. For parent strategies see Strategies for Parents to Help their Child with Separation Anxiety.
How Can Schools Help?
When examining therapeutic options for treating separation anxiety disorder, research indicates that psycho-educational interventions, which include, education of child and parents, collaboration with school personnel, and training to increase child’s autonomy and competence, are effective methods of treatment. For more on this research see Separation Anxiety in Children and Adolescents.
One of the most commonly recommended strategies by mental health professionals aims to teach parents/caregivers and school personnel how to provide the child with a flexible and supportive environment to overcome his/her separation anxiety symptoms. Below is a list of suggestions for school management strategies. Remember that for some children this is not enough, and they may need psychological or psychiatric intervention. If the school is concerned that a child may need more than what the school can offer, it is important to arrange a meeting with parents to discuss your concerns. When working with a therapist, the most effective/research-based non-pharmacological (not involving medication) method for reducing separation anxiety in children is cognitive-behavioral therapy (CBT). To read more about CBT and how it has effectively been utilized to treat separation anxiety, see Separation Anxiety Disorder in Youth: Phenomenology, Assessment, and Treatment.
Remember to see Part 1: Strategies for Parents to Help their Child with Separation Anxiety
Strategies Schools Can Use to Assist Children with Separation Anxiety
Have a trusted, familiar school staff present when the child arrives at school if possible, preferably the same person every time, at least until the anxiety is reduced.
For younger children, who are not in kindergarten yet, they may benefit from a shorter school day that is increased gradually.
Identify a safe place where the child can go to reduce anxiety during stressful periods. Some children benefit from taking some time to adjust in the counselor’s office or other safe space before going to the classroom.
Identify a safe adult to whom the child can go to during times of stress. This adult should speak to the child with empathy, being understanding of their feelings. However, they should encourage the child to return to their class or activity once they are calm, and review self-calming strategies that the child can use when anxiety arises. Self-calming strategies may include deep breathing, counting, muscle relaxation, holding an object that provides comfort (e.g., picture of parent, favorite item from home), drawing a picture, writing down their feelings, thinking of a funny time, thinking of another time that they had anxiety but got through it and it turned out fine, reminding themselves that they will be okay and they will be going home at a certain time.
If a child asks questions like, “will I be okay, is my mom coming back, when am I going home,” it is okay to reassure them one time, but stay away from reassuring them over and over, as this could just prolong the time they stay away from the classroom or class activity, and feed into the anxiety. You can say something like, I am here if you need me, but I am confident that you will be okay. At three o’clock your mom will pick you up. If they keep asking questions seeking more reassurance, remind them the you already reassured them once, and it is not effective to reassure over and over.
For more on the topic of reassurance as it related to separation anxiety see: Home Management Strategies for Separation Anxiety Disorder
Educate children about anxiety. Talk about what anxiety feels like (e.g., knot in stomach, pounding heart, sweating) so children know how to recognize it when it occurs. Remind them that everyone experiences some anxiety sometimes and it is completely normal. Some anxiety is good because it is our body’s way of warning us of potentially dangerous situations. However, sometimes anxiety occurs due to a perceived fear that may be highly unlikely or non-existent. When anxiety tells us to stay away from non-dangerous situations and causes us to avoid experiences that may actually be good for us or when normal anxiety becomes so intense that it is hard to focus, get through an activity, or interact with others, we need to learn coping strategies to get through these times, rather than avoiding these situations.
Promote practicing relaxation techniques developed at home…see Part 1: Strategies for Parents to Help their Child with Separation Anxiety for suggestions regarding relaxation techniques that can be taught by a parent or school counselor.
Provide alternative activities to distract the child from physical symptoms associated with the anxiety (e.g., draw a picture, write feelings down, join a preferred classroom activity).
Encourage/model small group interactions (e.g., games, art projects, discussions). This can start with only one classmate. With time, if the child increases his competency, the group may be enlarged gradually. This is something that can be done in the counselor’s office or when students are paired up with peers for classroom activities.
Give positive feedback when the child makes efforts to get through anxiety provoking situations or uses strategies he/she has learned to cope with anxiety.
Help the child prepare for transitions. For instance, give the child time to prepare that a change is coming (e.g., in five minutes we will be going to music class, or after math is over we will be working on an art project). Children with anxiety may be apprehensive to change from one activity to the next, especially if they are unprepared for the change.
If the child has been staying out of school, initiate a plan to promote the child´s return to school as soon as possible (the school team including the school counselor, teacher, and principal, can talk to the parents/and therapist if applicable, to come up with a plan for when the child will return and how to facilitate this return). The school may need to help the parents come up with a plan. See suggestions for how parents can encourage their children to return to school in Part 1: Strategies for Parents to Help their Child with Separation Anxiety.
Maintain frequent meetings with parents, in order to collaborate regarding what type of support is appropriate for their child to have while in school. It is important for parents and school to handle problems related to separation anxiety in a consistent way using a team approach. Expectations for how the child copes with his/her anxiety should be similar in school and at home.
If the child is refusing to attend school, assess what may be the trigger for the refusal and work with the child to address the concern if possible (e.g., are there problems with friends, fear of a teacher, etc.?).
Two research-based programs for treating Separation Anxiety Disorder include the Coping Cat Program and the FRIENDS Program. These programs are intended to be utilized by mental health professionals treating children for anxiety related conditions such as separation anxiety disorder. For more on the research regarding the effectiveness of these programs see Separation Anxiety Disorder in Youth: Phenomenology, Assessment, and Treatment.
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