Temper Tantrums, Tears, Tummy Aches and Possible School Refusal
Posted on February 19th, 2014
Parents are often included in social events, such as birthday parties, that their young children might go to. However, as children start Prep, or return to school after the holidays, it is expected that they will go to school and be apart from mum and dad for the school day. Most children cope quite well with this change; some even consider themselves “grownup”. Then again some children, and their parents, find this change both difficult and anxiety provoking.
Anxiety disorders are quite common in children and adolescents. Research suggests that approximately 20% of children and adolescents experience some form of anxiety. One of the most common anxiety disorders in childhood is Separation Anxiety Disorder (SAD). SAD is described as excessive and unrealistic worry about either being separated, or possibly being separated from parents or caregivers, and is estimated to occur in between 3 and 13% of children and adolescents.
Of course most babies and young children experience minor and brief forms of distress when separated from mum or dad. Frequently this starts around seven months of age, peaks around 12 months of age, and fades away by the time the child is 2- 3 years of age. This behaviour, which is considered usual in a child, is different from separation anxiety which typically appears when the child is aged 4 – 5 years.
It seems that about the same amount of girls as boys will experience SAD. However, boys more often come to therapy for SAD. This may be because the behaviours often seen in a child with SAD are not considered as socially acceptable for a boy.
What we might expect to see in a child with SAD is:
- excessive worry about the possibility of some sort of harm to themself (e.g. getting kidnapped) or to their mum or dad (e.g. car accident);
- nightmares about being separated from mum or dad;
- physical symptoms (e.g. headaches, tummy aches, nausea, racing heart, dizziness); and
- panic during separation.
Children with SAD desperately try to avoid situations where they will be separated from their parents, such as school or going to a friend’s house alone. In these situations the child may demonstrate quite challenging behaviours. This behaviour is aimed at avoiding the separation from mum or dad. Understandably, as a result of the temper tantrum, tears, and tummy aches, well meaning parents often give in and let the child avoid the situation. Unfortunately, this can actually strengthen the separation anxiety response in the child. This means that the next time the child is required to be apart from their mum and dad the process repeats itself.
Research shows that many children with SAD attempt to avoid school. SAD and school refusal behaviour generally occurs in children aged from 5-12 years. Phobic behaviour generally better explains school refusal behaviour in adolescents aged 13 years and over. As children miss more and more school it becomes quite difficult for them to return. They fall further behind socially and academically and may become embarrassed about their absence. Possible short term consequences of school refusal include child and family distress, academic problems, and a lack of adequate supervision for the child.
Given the consequences of SAD, and school refusal behaviour, therapy needs to be considered. The good news is that early therapy interventions for SAD appear to be both effective and long lasting and can help both the child and the parents to resolve these issues. Additionally, there is enough research evidence to suggest that cognitive behaviour therapy (CBT), for school refusal behaviour, be used as the first-line intervention for this behaviour.
Parents are actively involved in their child’s therapy for SAD. They will learn strategies to use with their child, oversee homework set by the psychologist, and assist the child to apply the skills and strategies they learn in the real world.