DEFINING SEPARATION ANXIETY

Separation anxiety is defined as the fear, worry and unease experienced by a child in situations when they have to separate from a caregiver. Situations can include having to stay with a new babysitter, going on a playdate, the first day of childcare, preschool, kindergarten, school, camp or even going back to school after a long break, or having to sleep alone.

SEPARATION ANXIETY AS PART OF NORMAL DEVELOPMENT

Anxious feelings are a healthy, normal and expected reaction when children have to separate from a caregiver. As part of normal childhood development separation is seen throughout early childhood, it is more difficult within these age groups: babies (around 8 months), toddlers (14-18 months), pre-schoolers (3 years) and can also reappear in the early school years.

SEPARATION ANXIETY DISORDER

For most children the fear, worry and unease fades away after a few days or a couple of weeks and they manage to settle into the environments smoothly. However, for others the separation anxiety that accompanies the transition persists consistently for four weeks or longer.

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) [American Psychiatric Publishing (APA), 2013], is a handbook that is used by mental health professionals. It defines separation anxiety disorder as the excessive fear, worry and unease about anticipated or actual separation from a caregiver (APA, 2013).

IMPACT OF SEPARATION ANXIETY

Separation anxiety affects everyone involved and the child who has separation anxiety requires necessary help to learn positive ways of behaving and managing their emotions.

POSITIVE BEHAVIOUR SUPPORT AND SEPARATION ANXIETY

Positive Behaviour Support (PBS) is an evidence-based approach that is used to eliminate or minimise the occurrence of challenging behaviours.

PBS recognises that there is no single cause for separation anxiety behaviour. It is a complex behaviour that is a product of the interaction between multiple factors contributing to its development and persistence.

In a context such as a childcare centre, kindergarten and school it is not possible to control all the factors that contribute to the separation anxiety outside of the immediate context. However, factors specific to the context such as the environment, activity and interactions can be addressed to help the child achieve better communication, social, emotional, behavioural and learning outcomes.

EXAMPLE:

Jenny has been going to childcare since she was two months old. She’s now three years old, but her mum says even now every day is like dropping Jenny off for the first time. Before they even leave the house, Jenny starts to complain that she doesn’t want to go to childcare. Her mum then struggles to put Jenny into her car seat, and Jenny cries for most of the car ride. When her mum takes her into the childcare centre, Jenny starts to scream, cry and clings on to her mum and begs her not to leave. Another staff member has to assist so that Jenny’s mum can leave for work. Afterwards, it takes staff an hour to calm Jenny down. The educators and the other children in the room are affected by witnessing and trying to support Jenny. There is a psychologist working with Jenny and her parents to address the separation anxiety issues.

By specifically addressing the characteristics of the transition to childcare, childcare staff can analyse and address the demands that are contributing to the separation anxiety by using the PBS approach.

  • Is there a consistent staff member who meets Jenny when she arrives?
  • Is there a consistent unpacking activity that Jenny completes with her mum and the staff member?
  • Does the staff member offer her a favourite activity to do?
  • Is there a routine that Jenny’s mum and staff follow to make the separation as structured, predictable and certain?
  • Is there a particular spot in the environment where Jenny goes with the staff member to say goodbye to her mum?

The example highlights that it is never too late to address separation anxiety, even if it has been occurring for a while.

PBS provides a road map to address separation anxiety by using a holistic approach to develop a comprehensive and individualised PBS plan in three stages: Assess-Manage-Prevent.

  • ASSESS: How to identify the reasons that contribute to the separation anxiety behaviour,
  • MANAGE: How to respond when the separation anxiety behaviour occurs, and
  • PREVENT: How to address any setting relating triggers that could be further contributing to the separation anxiety.

ASSESS STAGE

Assess Stage Aims

The Assess stage helps to identity:

  • Activities during which the separation anxiety behaviour occurs,
  • Environments in which the separation anxiety behaviour occurs, and
  • People dealing with the separation anxiety behaviour.

Assess Stage Checklist:

  • Child’s profile – Gather information about the child to create a comprehensive picture of the child, their abilities and needs.
  • Behaviour data collection forms – Record measurable details (e.g. frequency, intensity, duration) about the child’s separation anxiety
  • Functional Behaviour Analysis (FBA)- Systematically reflect on an incident by analysing the antecedents (what preceded the behaviour), describing the behaviour, consequences (what happened after the behaviour).
  • Hypothesis – Determine the purpose (function) that the behaviour served.

MANAGE STAGE

Manage Stage Aims

The Manage Stage outlines how to effectively respond to the behaviours.. Appropriate responses can help to safely defuse, redirect, and de-escalate the situation in the least disruptive manner.

Manage Stage Checklist:

  • Escalation stages – Help those supporting the child to recognise the number of stages the child exhibits as their emotion rises (i.e. mild escalation, moderate escalation, extreme escalation, and recovery stage).
  • Escalation profile– Help those supporting the child to recognise what non-verbal and/or verbal behaviours are exhibited in the different escalation stages and how long it can last.
  • De-escalation plan – Help those supporting the child with guidelines on how to immediately respond when the behaviour occurs, safely defuse, and de-escalate the situation in the least disruptive manner.

PREVENT STAGE

Prevent Stage Aims

The Prevent stage aims to address any setting relating triggers that contribute to separation anxiety by tailoring the activity, environment and interactions. The Prevent stage also aims to teach the child positive ways of communicating their messages and managing their emotions and behaviours.

Prevent Stage plan

The plan details strategies to minimise or avoid the triggers that contribute to the separation anxiety behaviour by providing the child with:

 

  • Supportive environments – Tailoring environment related aspects to minimise or avoid triggers that contribute to the occurrence of separation anxiety
  • Supportive activities – Tailoring activity related aspects to minimise or avoid triggers that contribute to the occurrence of separation anxiety
  • Supportive interactions – Tailoring interaction aspects to minimise or avoid triggers that contribute to the occurrence of separation anxiety behaviour, and
  • Teaching the child – Teaching the student positive ways of communicating their messages and managing their emotions and behaviours.

S FOR SEPARATION ANXIETY: POSITIVE BEHAVIOUR SUPPORT GUIDE

Use the practical tools (checklists, forms, and strategies) in S for Separation anxiety: Positive Behaviour Support guide to develop comprehensive PBS plans that can be used to support children of all ages consistently in all settings.

This invaluable guide is useful for parents, caregivers, educators in childcare, early childhood, primary and secondary schools, disability, mental health, allied health, and supervisory professionals.