Separation anxiety is normal for a child. Sfter about six to nive month of age, children realize that their parents leave them from time to time. That's why they become uncomfortable around strangers. This discomfort, which usually peaks around age two, lasts until first or second grade.
But some children experience separation anxiety well past age 7. They may avoid sleep-overs with friends. Nightmares may drive them to climb into bed with their parents. They may worry about being kidnapped. Or they have persistent unreasonable fears that their parents will be harmed or killed. They cry, cling, throw tantrums, or get physical symptoms.
But the most difficult sign of separation anxiety may be when a child refuses to go to school.
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Signs of "School Refusal"
This problem is quite painful for everyone in the family. Children who fear school may:
- Take forever to leave the house
- Cling, cry or dawdle while dressing, and then miss the school bus
- Look for ways to leave school before the end of the school day
- Complain of a headache or tummy ache during the week, which goes away on weekends
- Become particularly anxious Sunday night, especially when it is the last day of a vacation
- Show more symptoms after an illness, an accident, or death in the family
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Many Possible Causes
Refusal to go to school isn't always a sign of separation anxiety. It has many possible causes:
- The child may fear most social situations, not just school.
- Particular conditions at school might be making it a scary place for the child. For example, the school may be more impersonal or authoritarian than the child can easily tolerate.
- He or she may have difficulty adjusting to rules made outside the family.
- The child may be afraid of the teacher. For example, the teacher may shame students who make mistakes or are mischievous.
- The child may be the victim of a bully.
On the other hand, the problem might not be specific to school or related to social situations at all. The child may be suffering from anxiety or depression that requires treatment.
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How To Help
Parents can help head off school refusal by getting their preschool children used to the idea of school. This can help the child feel less anxious about going to school. Here are some suggestions:
- Take your child on trips.
- Arrange brief, practice separations, leaving him or her with another trustworthy adult.
- Involve your child in shopping for school supplies; finding a special item your child can bring to school can give him or her a comforting emotional link to you.
- Tell your child about the first day of school in a straightforward way, so your child knows what to expect. For example, explain where he is going and who will pick him up and bring him home.
- Arrive early at school to help your child settle in.
- Walk around the school with your child, so he or she can become familiar with the environment.
- Arrange to meet other children in the class so the setting feels more familiar to your child.
- Try a system of small rewards or prizes for school attendance to motivate your child.
- Always say goodbye to your child. Resist the temptation to sneak away. Scooting out the door while your child is distracted can undermine his or her trust and make matters worse the next day.
- Try to control your own anxiety. When you communicate anxiety, your child gets the message that there must be something to be anxious about. Rather, try to remain matter-of-fact, calm and firm, even if your child is screaming when you leave. Teachers usually have experience with this problem and know that most children stop crying soon after the parent leaves.
- When your child is in pre-school and kindergarten, consider meeting with teachers and other school staff to develop a strategy to work out a school refusal problem.
- Consult with teachers and school nurses about any physical symptoms your child is complaining of.
If school refusal persists, there may be something other than separation anxiety going on that needs attention, such as an anxiety disorder or depression. Have your child evaluated by a mental health professional. When possible, set appointments at a time that will minimize your child's absence from school. If your child is being bullied, make the school aware so they can deal with it, but you or a therapist can also help teach your child more effective ways to respond to a child that is causing him or her trouble.
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Moving Forward, Growing Up
Although it may seem compassionate, letting a child stay home from school only makes it more difficult for him or her to go the next day. Remind yourself that staying home can never be a satisfying choice for your child. The real satisfaction will come when he or she works through the anxiety and has met the challenge of separating successfully.
Michael Craig Miller, M.D. is Editor in Chief of the Harvard Mental Health Letter. He is also associate physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. He has been practicing psychiatry for more than 25 years and teaches in the Harvard Longwood Psychiatry Residency Program.