Back-to-school & Separation Anxiety: 9 Proven ways therapists can support families

While the “back to school” transition is typically an interactive and exciting time, returning to school can cause intense distress for some children and adolescents. If a child or teen is refusing to go to school, it is important for therapists to work collaboratively with caregivers to determine if the child’s anxiety is standard jitters or if it is Separation Anxiety.

What is Separation Anxiety?

Separation Anxiety with children/teens is an extreme unwillingness expressed through intense distress to be separated from a primary caregiver. The specific “fear” of Separation Anxiety for children, is that something bad or frightening will happen during the separation. For teens, the fear is often that something bad will happen specifically to the caregiver during the separation. This fear can lead to clingy behavior, refusals, meltdowns, constant phone calls or texts, or severe tantrums. If the Separation Anxiety persists for over four weeks and/or interferes with daily functioning, then Separation Anxiety may become a Separation Anxiety Disorder.

What causes Separation Anxiety?

Separation Anxiety is a normal part of childhood and adolescent development, and the CDC claims that 4-10% of children ages 3-17 experience Separation Anxiety. While Separation Anxiety is more common in younger children, it may reappear at milestone moments in an adolescent’s life such as at the start of middle school and high school. In recent years, the percentage of children and teens with Separation Anxiety has increased due to many reasons, namely bullying, school shootings, and COVID-19.

Separation Anxiety triggers include:

• School – Because school is typically the most frequent, pro-longed separation, school is a primary trigger for Separation Anxiety.
• Parents – Anxiety and fears can be learned, and caregivers may inadvertently pass on worries to their children.
• Periods of togetherness – It is common for children to feel closer to their caregivers following an extended time at home, such as during quarantine or summertime, and they may panic when the comfort they’ve become used to goes through a transitional change.
• Life events and changes – Moving homes, divorce, or death of a close friend or loved one can all trigger Separation Anxiety.
• Overnight separations – Anytime separation occurs, Separation Anxiety can be triggered, especially with overnight separations such as with sleepovers at friend’s houses or when a caregiver goes on a business trip.

Separation Anxiety Symptoms

Young children typically struggle to identify complex emotions (such as Separation Anxiety) and generally lack the ability to verbally express feelings. Thus, parents should be counseled to be alert for physical symptoms such as a headache, upset stomach, or change in appetite. Children with Separation Anxiety may also follow their primary caregiver from room to room or refuse to sleep alone.

Adolescents or teens may text or call their caregivers constantly to express concern for their wellbeing, and if caregivers are unable to immediately respond to texts or pick up the phone call, the adolescent/teen may suffer panic. If Separation Anxiety is severe or continues for more than four weeks, adolescents and teens are especially at risk for developing depression-like symptoms and may internalize their distress through self-harming acts. Other symptoms such as nightmares, insomnia, lack of self-confidence, and social phobia are also common symptoms for teens coping with Separation Anxiety.

For caregivers, Separation Anxiety can lead to intense frustration, feelings of helplessness, and stress over managing work and life obligations amidst calls from the school regarding their child. Caregivers may even develop fears of their own, such as fear of poor work performance, fear that the situation will not improve, fear of the teen dropping out of school, etc.

Strategies for working with parents

The good news is that there are many effective strategies for successfully treating and managing Separation Anxiety. Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP) have proven to be highly effective with helping children cope with excessive fears or panic over separation. Additionally, here are 9 strategies for supporting families with children suffering Separation Anxiety during the back-to-school transition.

1. Remove blame
   Remind caregivers and children that Separation Anxiety is a normal part of development. Extend empathetic reassurance, encourage self-care, and remind caregivers that therapy can help support their anxiety and stress as well.
   
   
2. Explore potential causes besides back-to-school
   Sometimes divorce, remarriage, moving, illness, or death of a close family member or friend can trigger intense Separation Anxiety. Understanding the cause of the Separation Anxiety will help guide therapeutic efforts successfully.
   
   
3. Instill confidence through positive reinforcement
   Children and teens respond well to verbal affirmation, and caregivers are the primary people that anxious children/teens want affirmation from. Advise caregivers to reward their children with encouragement every time they reunite with their child following a separation such as at the end of a school day. Positive feedback is effective for reinforcing healthy behaviors in children and teens, and even something as simple as caregivers saying, “I’m proud of you for being courageous at school today!” can go a long way.
   
   
4. Give them a comforting object
   Sentimental objects such as a piece of jewelry from the caregiver or a special picture can help remind the child/teen that the Caregiver is always with them in spirit even while they are away at school.
   
   
5. Avoid avoidance
   While it is important for caregivers to be compassionate and supportive, avoidance of separation only makes Separation Anxiety worse, and it is crucial for caregivers to help their children/teens face their fears in a positive way.
   
   
6. Encourage parent and school alignment
   Coping expectations for the child at school should be similar to at home, and parents, caregivers, teachers, and school counselors should all be on the same page for Separation Anxiety problems to be handled as consistently as possible. You might also suggest that the caregiver identify a safe adult for the child to turn to at school when they experience emotional distress. Responses and expectations for what criteria should warrant picking the child up from school should also be discussed with the chosen safe adult in advance.
   
   
7. What caregivers can do at home
   There are many things caregivers can do at home to help children coping with Separation Anxiety. First and foremost, caregivers should be on the same page as their partner to ensure consistency. The second most effective at-home strategy is education. Being able to recognize anxiety and its symptoms is the first step in soothing Separation Anxiety for many children. Encourage caregivers to remind their child that anxiety is normal, and that there are many self-calming exercises (such as art, music, deep breathing exercises, stretching, holding a comforting object, etc.) that can help them through tough times so that they can enjoy important and fun experiences.
   
   
8. Prepare children for transitions
   Mental pivoting is a skill that children and teens need support with developing, and children need to be given time to warm up to changes - especially separations. For example, caregivers should not wait until the day of or the night before to tell a child that they are going to school or that a parent is going on a business trip. Giving the child a heads up allows them to feel more prepared for the change when it arrives and less afraid.
   
   
9. Avoid solving Separation Anxiety problems with isolation
   Some parents consider homeschool or cyber school as a solution for children with intense Separation Anxiety, and while there are certainly times where this may be appropriate, research maintains that it is best for behavioral and psychological development needs to be learned, supported, and addressed through social community. Navigating social communities outside the home is essential for well-rounded, academic, and interpersonal development.