Hi Dr Justin
I have a 5 year old who has severe anxiety issues.
She wakes during the night to ensure I am still at home and often wakes to come into my bed. I send her back to her bed but she will wake every 40 mins or so to check that I am around. She has never been left unattended at home at any time obviously as she is only 5!
She doesn’t like being left at school although she loves the thought of school and getting there isn’t an issue as she seems to forget that I am going to leave her there and go home. She is in prep and gets good results. She has now got so bad, she won’t sleep over anywhere even her maternal aunty’s house or go there for the day without tears and tantrums. She won’t play at friends houses if I am leaving either.
I need to sleep through the night and leave her at school preferably without the tears and tantrums and the teacher literally having to restrain her.
Any advice would be great – as I am thinking the worst and she has a severe separation anxiety disorder that she will need medication for.
My first thoughts on reading your email are that you and your daughter would benefit from a visit to your doctor to get a referral to a psychologist. When a child (or anyone for that matter) is experiencing anxiety or a phobia to an extent that it causes genuine distress and interferes with normal functioning, some professional help should be sought.
While I would most certainly not provide any kind of diagnosis online, it’s worth exploring childhood separation anxiety a little as you’ve identified some significant separation issues. We can also talk more generally about meeting some of your daughter’s needs to help her feel better.
Children with separation anxiety have a persistent – and unrealistic – worry that something will happen to them or their parents while they’re separated. This can lead to many of the issues you’ve described: children being unwilling to go to school or friend’s homes because of their fear. And refusing to sleep alone is another outcome.
All children experience some kind of separation anxiety. It’s completely normal. However, a clinician will be best able to judge whether separation that’s being experienced is greater than should be expected at a given age. It certainly seems that your 5 year-old is experiencing higher levels of anxiety around separation than most children her age. (About 5% of children have separation anxiety powerful enough to be ‘clinical’.)
In terms of treatment, there are many different suggestions you can find online or from well-meaning friends.
However, in a situation like this I am inclined to encourage you to follow the guidance of a qualified professional. Often treatment suggestions that are not individually tailored by a clinician can make things worse.
While not dealing specifically with separation issues, I think you’ll be able to do a few small things that may strengthen your relationship with your daughter in a safe way.
First, when your daughter experiences big emotions (or any emotions for that matter), be accepting of the emotion. That is not to say she can do whatever she feels like. Instead, I’m suggesting that your daughter be allowed to feel whatever emotion she feels. Rather than being dismissing or disapproving of the emotion, be accepting that she feels fearful, or angry, or frustrated.
Second, when your daughter experiences these emotions, talk with her about the emotion. Give it a name. “You’re feeling afraid.”
Once something has a name we feel better about it. We feel like it’s ‘normal’. And we feel as though we can control it.
Third, let your daughter know how perfectly normal it is to feel like that.
Fourth, as she calms down talk with her about what she thinks the best solutions might be. It’s amazing how often the solutions to our children’s challenges are inside them.
The beauty of these suggestions is that they allow you to spend time in real discussion with your daughter, being emotionally available. You show understanding. And over time, research tells us that these strategies of working with your daughter (rather than doing things to her because her emotions are inconvenient) are likely to see her grow in emotional intelligence, emotion regulation, social skills, and more.
Is your daughter ok?
It’s too hard to determine that with any clarity with the limited information in your email.
Does she need medication? I suspect not. But visiting with a GP and a psychologist will help you make plans to guide her best.
And as you spend time coaching your daughter through her emotions and working with her, you’ll validate her, help her to feel normal and in control, and increase her feelings of emotional regulation. It will probably take a little while – perhaps a few months or more – but with patience and compassion (and a little help from your psychologist) your daughter should develop through these anxiety difficulties.