Many children eagerly enter their first classroom excited and a little nervous. It is perfectly natural, after all, to feel jittery when confronting something so new as school. But some children come bearing more than a normal amount of trepidation; some, in fact, are deathly afraid of saying good bye to their mothers.

“I had a student who would scream, kick, and bite for the first hour of class everyday,” says Lisa Frasure, a former teacher at Alexander Local School District in Athens County, Ohio. “He would hide under the table and I would have to take him into the bathroom, which was someplace he felt safe, and after a while he would begin to calm down. There was no question in this case that his anxiety was disrupting everyone’s day.”

These children may be experiencing separation anxiety, a condition that, in its worst form, can ultimately affect children’s ability to adjust to the classroom and may inhibit their ability to learn.

What is Separation Anxiety?
According to most experts, separation anxiety is a natural event in human development. It begins at around eight months, when infants are starting to differentiate between objects in the world. At this time, a child begins to understand that objects exist even when they disappear from view. Consequently, children also begin to realize that they have parents. This recognition spawns deep concerns for children surrounding the periodic absence of these caregivers. Who, the baby seems to ask, is going to take care of vulnerable me?

Evolutionarily speaking, it makes sense that babies would develop tactics for keeping a parent close at hand: they cry, whimper, and cling. And when a child is in the throes of being separated from her parent, you might be in for one of those heart-rending, high-decimal rages that nobody within earshot soon forgets.

That is part of the joy of being a parent. But if these behaviors-and the anxiety behind them-continue well past three years of age (particularly up to six years and beyond), then a child might be experiencing separation anxiety disorder. Affecting some 4 percent of children in the United States, separation anxiety, says Phil Cowan, director of the Institute of Human Development at the University of California, Berkeley, “is often a problem for parents, sometimes [one] for children.”

To reach the diagnostic threshold for an anxiety disorder, according to the American Psychiatric Association’s Diagnostic and Statistics Manual-IV (DSM-IV), “the anxiety or fear must cause distress or affect social, academic, or job functioning and must last at least one month.”

A child with separation anxiety can exhibit a number of behaviors, including clinging to parents and having difficulty being away at school or camp. Sometimes it’s difficult for a child to spend time at a friend’s house. Occasionally, children will even develop health problems like insomnia, dizziness, nausea, or heart palpitations. In addition, mounting evidence suggests a link between separation anxiety disorder and other later-developing disorders, most notably, panic disorder, depression, and post-traumatic stress disorder. A French study, published last year in the journal Encephale suggests a connection between separation anxiety disorder and anorexia nervosa and bulimia.

Judy McDougal, a senior clinician at Victoria University of Wellington’s Institute for Early Childhood Studies, in Wellington, New Zealand, says there are a number of different “causes” for separation anxiety disorder. “The etiology of childhood disorders is messy,” she says. For this reason, she steers away from pathologizing separation anxiety as a disorder of the child: “Separation anxiety disorder rests in the relationship with the caregiver.”

Which raises important and interesting questions.

British psychologist John Bowlby, argued as early as the mid-1940s that separation anxiety was the result of a much more sophisticated version of imprinting, which he called “attachment.” (Bowlby’s research was based on earlier studies of goslings.) In Bowlby’s model, the urge to attach oneself to a parent is hard-wired, and the failure of a child to “separate” from that parent at the appropriate time–usually starting around two and a half or three years in humans–is the result of some malfunction in the relationship. “Perhaps the primary caregiver has separation issues with his or her own mother, which certainly carry over to the child.”

“Perhaps the primary caregiver has separation issues with his or her own mother, which certainly carry over to the child.”

More recently, a behavioral genetics position has emerged. Typified by the work of Harvard psychologist Jerome Kagan, this view suggests that many of the traits explained by attachment-including separation anxiety-are hard-wired themselves, or at least leanings toward them are, in the form of temperament.

Griffith University’s Dadds says that children’s separation anxiety results from some marriage of the two ideas. “There is a biological or genetic component,” he says, “in that kids with an ‘inhibited’ temperament-they don’t, for instance, like novelty-are at higher risk. Learning, however, is also involved; bad experiences with separation like getting bullied at school or a parent going A.W.O.L. play a role. Furthermore, anxious parents often feel uneasy about separation themselves and so this, too, influences the child. Once established, the patterns of [reinforcements] available for separation versus closeness can maintain the problem all by themselves.”

An Anxious Brain
While psychologists debate the causes of separation and other anxiety disorders, neuroscientists have made appreciable headway into the mechanics of the processes of anxiety in the brain.

All anxiety is of a kind, according to Joseph LeDoux, professor at the Center for Neural Science at New York University. Anxiety elicits what is known as the stress response, which releases a group of neurotransmitters called catecholamines (dopamine, epinephrine, and norepinephrine) into the central nervous system. Catecholamines, says Amy Arnsten, associate professor of neurobiology at Yale University Medical School, effectively “‘turn on’ our heart muscles and ‘turn off’ the stomach to prepare for ‘fight or flight’ responses.”

Interestingly, these same neurotransmitters, says Arnsten, “may turn on a structure called the amygdala (the brain region that is responsible for fear), and turn off the prefrontal cortex (the brain region where thinking occurs), allowing posterior cortical and subcortical structures to control our behavior.” In other words, under these conditions, we stop being rational and are only emotional–in this case, fearful.

And fear affects memory. J. Douglas Bremner, an associate professor of psychiatry at Yale University’s medical center, has done extensive research during the last decade into the effects of stress on the hippocampus, the region of the brain most widely associated with conscious memory and learning. Using MRI imaging, he has observed that the hippocampus of survivors of trauma–for example war veterans, and survivors of childhood abuse–has shrunk. These patients, according to LeDoux, “exhibit significant deficits in memory ability, without any loss in IQ or other cognitive functions.”

The Connection to Learning
It might follow that children suffering from separation anxiety disorder could have problems learning. There is no research to date examining this particular connection, but experts working in the field seem to agree that a child’s ability to learn is most certainly affected.

“Because people with separation anxiety are preoccupied with what is not happening in the here and now, it must inevitably affect learning.”

Phil Cowan and others say that school attendance, in and of itself, can sometimes be a problem for children with separation anxiety disorder. Certainly not all of children’s lack of enthusiasm for going to school is the product of separation anxiety, Cowan claims, but some part of it is: “A few [children] at the extremes have separation anxiety so severe that it interferes with normal developmental milestones, like going to school. And because people with separation anxiety are preoccupied with what is not happening in the here and now, it must inevitably affect learning.”

The line between first-year nervousness and separation anxiety may sometimes be murky for scientists, but where most teachers are concerned, it is clear enough: when the behavior begins to disrupt the student’s or the class’ ability to learn, then it is a problem and needs to be dealt with.

“The cognitive-behavioral treatments are the best and have a good success rate,” says Dadds. Called CBT, this is a form of therapy that examines and attempts to correct both negative thinking and behavior. “[CBT trains] the person to cope with his or her anxiety (physiological, cognitive, and behavioral methods) and then supportively helps the person to face their fears in small graduated steps, with lots of rewards for each little step.”

A number of pharmaceuticals have also been applied to the treatment of anxiety disorders in children, drugs like tricyclic antidepressants (TCAs), benzodiazepines, buspirone, and SSRIs. More recently, fluoxetine (Prozac) and fluvoxamine have been studied, according to Juan F. Velosa and M.A. Riddle, authors of a study conducted at the University of Alabama, Birmingham, on pharmacological treatments of anxiety disorders in children and adolescents. They concluded, among other things, that “considering safety and efficacy, the SSRIs appear to be the first-line treatment.” That said, however, they suggested that “there is a need for more studies to examine the safety and efficacy of different pharmacologic treatments.” Furthermore, they argued that “studies that compare medication, psychosocial treatments, and their combination are needed.”

“Some kids just need to know that you are there and accessible. Most often, they need love and reassurance.”

If a child is suffering from separation anxiety in the classroom-even a mild version of it-the best approach seems to be to make the child feel comfortable; it is, in many cases, after all, their fear of what will happen to them that makes them anxious in the first place. “They need to feel safe,” Frasure says. “They may need space. Some kids just need to know that you are there and accessible. Most often, they need love and reassurance.”

Gerald Gabriel is a freelance writer currently residing in Wellington, New Zealand. He holds degrees from The Ohio State University, Northern Arizona University, and the Iowa Writers’ Workshop. His fiction and non-fiction have appeared in a number of magazines and newspapers.

References
American Psychiatric Association’s Diagnostic and Statistics Manual (DSM-IV), American Psychiatric Association, Washington, DC. January, 1994.

Arnsten, Amy. “The Biology of Being Frazzled,” Science. June 12, 1998.

Bailly-Lambin, I, Bailly D. “Separation Anxiety Disorder and Eating Disorders,” Encephale (article in French). May-June, 1999; 25(3): 226-31.

LeDoux, Joseph. The Emotional Brain: The Mysterious Underpinnings of Emotional Life. Simon and Schuster, New York: 1996.

Manicavasagar V, Silove D, Curtis J, Wagner R. “Continuities of separation anxiety from early life into adulthood,” Journal of Anxiety Disorders. Jan-Feb, 2000; 14(1): 1-18.

Velosa JF, Riddle MA. “Pharmacologic treatment of anxiety disorders in children and adolescents,” Childhood and Adolescent Psychiatric Clinics of North America. Jan, 2000; 9(1): 119-33.