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SCHOOL AND SEPARATION ANXIETY
By Steve Ruff, LMFT
Separation Anxiety Disorder (SAD) is the most common anxiety disorder in children, and affects 2-3% of grade school children. SAD is most common in children ages 5-7 and 11-14, because there are times when they are transitioning either into school for the first time, or into a new middle school. It also occurs more frequently after the child has spent more time with a parent, such as after summer vacation, a holiday break, or a brief illness. It can also occur after a stressful event, such as a death of someone close, a pet, or a significant change in the child’s life (parent’s divorce, change of schools, a move).
A common presentation of separation anxiety is the child having a physical complaint—a sore throat, stomach ache, headache—before it’s time to leave for school. If they are allowed to stay home, the symptoms go away. But since the anxiety is related to the act of separating from parent or caregiver, it normally subsides or decreases once they are in school.
Children with school and separation anxiety often also have one or more of the following:
• Unrealistic fears of animals, monsters, burglars
• Fear of being alone
• Nightmares
• Clingy behavior
• Difficulty going to sleep
• Crying, clingy behavior when forced to go to school
• Fear of a family member getting hurt or killed
How to help
Since the anxiety is generally felt less once the child is in school, the goal becomes getting them there. Allowing the child to stay home only worsens the problem over time, so getting the child to go to school as quickly as possible results in the best outcomes. Like with other anxiety or phobia issues, the therapeutic modality of exposure-response prevention can often be effective. This means gradually exposing the child to the fear itself (going to school) while teaching and modeling calming and relaxation strategies, as well as helping the child find the most effective ways to think about the anxiety. Psycho-education—teaching the child about anxiety, that we all have it, that it can’t exactly hurt us—can help build understanding and normalize what they are going through. Here are some practical tips for parents and caregivers that get at these principles:
1. Acknowledge the child’s fears, while at the same time reassuring them that they will be safe, that they don’t need to worry.
2. Gradual exposure can include giving the child certain times to call his/her mom or dad during the school day to check in. In more extreme cases it can mean a parent stays in school for a specified amount of time with the child, which is gradually reduced. Be clear and calm about when and how long and what the child can expect—reduce the unknown for the child.
3. Do not punish, rather encourage and come up with a plan. Also, it may backfire to give rewards for success, as any external pressure may raise the stress level.
4. No tricks or surprises—again, the fear of the unknown and “what if” is strong for the child.
5. Be open to talking about their fears as much as they are, but don’t force long conversations about what’s happening.
6. Allow a transitional object to be brought from home to school—a stuffed animal, picture of a parent—something that provides comfort.
7. Praise any efforts toward separation, and ask how they did it. Focus on successes, however small, instead of failures. Get them thinking about what they do that helps them be successful. The more they can internalize their own success, the more learning happens about how to manage their emotional life in the future.
8. Use a Feeling Thermometer to help them gauge their feelings and level of intensity, and to help them be less black and while about their feelings. This can help them see that they aren’t always at a “10” intensity wise.
9. “Externalize the problem”—this is a therapeutic techniques that I often use with kids. I have them name the problem, like the “nervous monster,” then draw a picture of it, and then we set about finding ways to defeat, or manage, the problem. This gets them feeling less like they are the problem. We might imagine that we are playing a video game or a sport (something interesting to the child) as we find solutions to the “nervous monster.” Better to battle something else than ourselves.
10. Teach calming strategies—deep breathing, counting backwards 10-1 when at the height of anxiety, imagining being in a calm, happy place.
11. Parents should try to remain calm, matter of fact and firm during the separation.
References
SchoolBehavior.com
Medical News Today www.medicalnewstoday.com
American Academy of Child & Adolescent Psychiatry www.aacap.org
Cincinnati Children’s Hospital Medical Center www.cincinnatichildrens.org
COPING WITH BULLYING AND TEASING
When a child is being bullied, we do not want to place the onus on that child to fix the problem. Similar to abuse, the one being abused needs to find a way out, but it’s not up to them to change the abuser. The problem with giving the child ideas about clever “comebacks” to bullying, is that they may not be equipped to actually give a comeback, which is why they are targeted in the first place. So if they try and fail, they end up feeling more shame and helplessness, and believe that somehow the bullying is their fault. As caregivers, the mindset that the bullying shouldn’t be happening in the first place (as opposed to the “It’s part of life” mindset), can be the most affirming to the child, and lead us to our most effective approaches, such as the following:
1) Listen, support, and validate the child’s feelings. Commend them for having the courage to talk to you about the bullying.
2) Ask the child what they think should happen, what they’ve already tried. This may help you gauge what they really need, and what parts of it they can manage themselves.
3) Encourage them to avoid the bully by walking away, taking a different path to class, surrounding themselves with friends.
4) Coach them on how to respond in an assertive manner to the bully. This isn’t about a clever comeback, but may include firmly telling the bully to stop, and then walking away. Role playing this can be helpful.
5) Teach the child what the bully is after, which is often to push buttons. I use the analogy of a child playing with a pop-up toy. The bully’s goal is to see their target “pop-up” with an emotional reaction. This leads to number 6.
6) Teach the child to have a “poker face.” This may mean holding in the feelings of anger or upset, at least until they can get away from the bully. Teach them to not “pop up.”
7) Help the child find ways to ignore the bullying, such as by acting uninterested, talking to someone else, or walking away.
8) Reassure the child that the bullying isn’t their fault. Sometimes they feel that if they were different, it wouldn’t be happening. Send the message that it shouldn’t be happening, period.
References
U.S. Department of Health and Human Services www.stopbullyingnow.hrsa.gov
American Academy of Child and Adolescent Psychiatry www.aacap.org
Kids Health http://kidshealth.org
COURTESY OF CAPERNAUM PEDIATRIC THERAPY AND STEVE RUFF, M.A., LMFT
To learn more about Capernaum’s services, visit www.capernaumpeds.com, or call 952-285-2840 (Edina clinic) or 763-533-0363 (New Hope clinic).
ACTIVITIES TO IMPROVE GRASPING SKILLS
Growing and developing is one of the major tasks of childhood. Luckily much of our growth and development comes through play and exploration of our environment. Handwriting, grasping and visual motor skills are often learned through pretend play, practice with daily self care tasks, and trying new activities. Here are several ways to encourage your child to develop in these areas:
Play “Pick-Up Sticks” with spaghetti noodles (uncooked)
Make fruit kabobs
Make necklaces
Build Lego towers and castles
Play with lacing cards or practice lacing shoes
Play with stickers
Pull “treasures” out of Play-Doh/putty
Use tweezers to move game pieces around a game board
Use chop sticks or tweezers to eat a meal or snack
Count and put coins in a bank
Open candy wrappers for fun cookie recipes (Hershey Kisses, Star Burst, etc.)
Play board games using your “baby sharks” to move pieces