New Harbinger Publications: Is it true that separation anxiety is limited to childhood?

Andrew Eisen and Linda Engler: Separation anxiety is most common during the childhood years, between ages seven and twelve. However, if left untreated, it continues to affect individuals across the lifespan. Separation anxiety is associated with panic attacks, obsessive compulsive disorder (OCD), and depression in older children and adolescents, as well as a wide range of adjustment problems in young adults. We find that early intervention clearly has preventive value.

NHP: How common is separation anxiety?

AE&LE: In large scale community surveys, more than 40 percent of children and adolescents report at least one symptom of separation anxiety, for instance, a fear of being alone. Separation anxiety disorder (SAD) which requires experiencing at least three different separation anxious symptoms over a one-month period, is less common, and is reported in 3 to 13 percent of community samples.

NHP: In your book, you talk about four types of separation anxiety. Can you tell us a little about the differences among these types?

AE&LE: We refer to the first two types as the Follower and the Visitor. The Follower is afraid to be alone during the day whereas the Visitor is afraid to be alone at night. Followers fear getting sick, so they constantly shadow their parents just in case illness occurs. In some cases, the shadowing is so disruptive that the child’s parent cannot even go to the bathroom alone. Visitors fear an intruder break-in, so they need someone to remain alert throughout the night. Visitors may stay up very late, visit their parents’ bedrooms repeatedly, or even end up sleeping with their parents every night.

The Misfortune Teller and the Timekeeper are both afraid of being abandoned. Misfortune Tellers don’t like to venture far from home because of the possibility of a personal catastrophe such as a panic attack or serious physical illness. They often refuse to participate in social and extracurricular activities unless a “safe” person remains nearby. Timekeepers worry about dreadful things happening to their parents, such as a fatal car accident. Timekeepers may refuse to leave their parents to go anywhere unless granted constant information (e.g., cell phone) about their whereabouts. Timekeepers keep track of their parents’ every waking moment.

NHP: What is school refusal behavior?

AE&LE: Children with school refusal behavior have trouble getting ready for, going to, and staying in school. School refusal, in its mildest form consists of regular pleas to stay home or visits to the school nurse. Chronic school refusal behavior is less common and includes severe difficulties attending school as well as long standing absences.

NHP: Do all children with school refusal behavior experience separation anxiety?

AE&LE: Although school refusal and separation anxiety can overlap, school refusal is more often due to social anxiety, panic attacks, or depression. Many children with separation anxiety do not experience school refusal behavior. These children have trouble being alone, sleeping alone, and being dropped off at various places such as birthday parties or extracurricular activities.

NHP: Is school refusal behavior manipulative?

AE&LE: Children and adolescents who refuse to attend school regularly are generally not being manipulative. They are typically so debilitated with anxiety or depression that even thinking about attending school can be overwhelming. The resulting oppositional behavior—disrespectful, tantrums, explosive outbursts—is best viewed as a survival strategy that youngsters use to protect themselves from unbearable anxiety rather than evidence of manipulation. Some parents, educators and school personnel may think differently, however, and believe that these youngsters could attend school if they wanted to. In the book, we help parents understand the variety of reasons behind school refusal behavior.

NHP: How can a parent tell if his or her child’s separation anxiety or school refusal is a serious problem requiring intervention or simply a phase that will be outgrown?

AE&LE: It’s important to look at how much the separation anxiety or school refusal is interfering with the child’s or the family’s life. Some examples of significant disruption include too many sleepless nights, a horrendous morning routine, or academic or social difficulties due to inconsistent school attendance. Our real-life stories will help parents identify genuine problems and learn how to manage them effectively. This book was written to help parents get their lives back.

NHP: What are some of the treatment strategies that help children overcome separation anxiety or school refusal?

AE&LE: Our program is clinically proven and based on the latest treatment research. The book provides parents with step-by-step guidelines how to teach, practice, and implement relaxation, cognitive therapy, and problem-solving strategies with their children. Although intended for parents, the material will also be helpful for educators and school counselors. In addition, mental health professionals can use the book as an adjunct to their own treatment approaches.

Separation anxiety or acute school refusal has one of the highest recovery rates of all childhood problems. This book may help parents prevent minor problems from developing into more serious conditions. When major difficulties are already evident, this book provides parents with the tools to make them more manageable. Additional resources are also provided for families who continue to experience significant problems.