Separation Anxiety and School Phobia

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Separation Anxiety andSchool Phobia

• Children with Behavioral Problems

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What is Separation Anxiety?

• It is an anxiety disorder consisting of excessive
  anxiety beyond that expected for the childs
  developmental level related to separation from
  the attachment figure.

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Emotional Symptoms

• Unrealistic worries about the safety of loved
  ones.
• Reluctance to fall asleep without being near a
  primary attachment figure.
• Excessive distress
• Nightmares
• Homesickness

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Physical Symptoms

• Dizziness
• Nausea
• Stomach ache
• Cramps
• Vomiting
• Muscle aches
• Palpitations

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Warning Signs

• Child is inconsolable for more than two weeks
• Repeated physical complaints in the morning.
• Interferes with activities that other children
  are doing.
• School refusal or school phobia.

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Causes

• Tiredness
• Minor or major illness
• Changes in the household routine
• Family changes
• Change in caregiver or routine at daycare, or
  school.

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Treatment

• Behavioral- Counseling for the parent and child.
  The child can also benefit from individual play
  therapy. The parents should develop a consistent
  morning plan to support the child in going to
  school.

• Medication- For children who are resistant to
  behavioral modification and psychotherapy there
  is imipramine or SSRIs which have been proven to
  help with separation anxiety.

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What Can We Do?

• Teacher should introduce self to child and invite
  the child to play with the toys and have a snack.
• Offer to have the parents stay awhile.
• Suggest the parents try role playing with the
  child to rehearse the separation.
• Establish a ritual for the parent leaving the
  child.
• If child is in absolute panic, ask the parent to
  stay longer until the child is calmed.
• Never criticize the child for feeling sad or
  anxious.

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What is School Phobia?

• Also known as Scolionophobia, fear of school, and
  separation anxiety
• It is a symptom of anxiety disorder in childhood.
• Identified as when a child stays home from school
  or misses a lot of school because of their fears.

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What is School Phobia contd

• In reality the fear of school faced by these
  children is usually anxiety over having to leave
  home and is better termed separation anxiety
• The children generally feel fear about leaving
  the safety of their homes and they often lack the
  self-confidence that comes from handling lifes
  normal stresses without the help of their parents.

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Characteristics

• Refusing to go to school.
• Overly clingy.
• Constant thoughts and fears about safety of self
  and parents.
• Shadowing of mother and father around house.
• Having tantrums when forced to go to school.

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Continued.

• Having trouble when going to sleep.
• Extreme worries about sleeping away from home.
• Nightmares.

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Anxiety Symptoms

• Crying
• Headaches
• Diarrhea
• Feeling faint
• Hyperventilation
• Vomiting
• Rapid heart beat

• Shaking
• Sweating
• Stomach aches
• Dizziness

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School Related Triggers

• Fear of failure
• Teasing by other children
• Threats of physical harm
• Existing learning difficulties or disabilities
• Social problems
• Unsafe neighborhoods or schools
• Perceptions that school personnel and teachers
  are mean.
• Starting a new school

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Non-School Related Triggers

• Home problems
• Fear something terrible will happen at home while
  they are at school
• Stress from transitioning
• Preference to stay home because they can have
  parental attention.
• Unrealistic worries that family members will be
  harmed or that a parent will be unable to handle
  a catastrophe if the child is not there to help.

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Statistics

• 1.3 of teenagers aged 14-16 years experience
  separation anxiety/ school phobia
• Between 4.1 and 4.7 of children aged 7-11 years
  experience separation anxiety/ school phobia.
• 3.9 of children aged 12-14 experience separation
  anxiety/ school phobia
• The average age for the onset of school phobia is
  7.5 years.

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How Long Will It Last

• Important that school phobia is dealt with a soon
  as possible.
• Can improve dramatically within a few weeks if
  attendance is enforced.
• If you do not require the child to attend school
  every day the physical symptoms and the desire to
  stay home will become more frequent and their
  anxiety about leaving their parents and home will
  become more intense.

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What Can We Do?

• Identify the cause of the anxiety (school or home
  issues).
• If possible, be in contact with the parents about
  family issues.
• Plan a customized approach to help the child.
• Help the child to learn how to relax, and develop
  better coping skills.
• Be consistent with routines.
• Be reassuring that their family will be fine, and
  they will be able to see them soon.

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Continued.

• Identify things the child can look forward to the
  next day.
• Encourage the child to explore social situations.

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Other Treatment Options

• Behavior therapy- The individual learns to cope
  with difficult situations, often through
  controlled exposure to them.
• Cognitive Therapy- The individual examines
  feelings and learns to separate realistic from
  unrealistic thoughts.
• Cognitive-Behavior Therapy- The individual learns
  recovery skills that are useful for a lifetime.

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Continued.

• Relaxation Techniques- Helps individuals develop
  abilities to cope with the stresses that
  contribute to the phobia.
• Neuro-Linguistic Programming- Views school phobia
  as a result of programs or constructs that we
  have created that dont work well. This approach
  reprograms them.

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Resources

• www.Emedicine.com
• www.ncpamd.com
• www.phobics-awarenes.org
• www.med.umich.edu
• www.amazon.co/uk/school-phobia-attacks