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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Hello, I have a 5 year old child. I was told OKMH829100

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Hello, I have a 5 year old child. I was told that he had separation anxiety disorder when he was about 3 years old. At that time I was going through a very stressful divorce. He became very depressed. He started stuttering. He also started sleep walking and wetting the bed (he was completely potty trained at age 2). It took over a year to get over the depression. About 6 months to stop the sleep walking and bed wetting. And Almost 2 years to stop the stuttering (he still stutters when he becomes stressed about something). We never really dealt with the separation anxiety because we just always stayed together. He recently started school. He never went to preschool and he just started KG. He is very stressed about going to school. From the moment he wakes up he cries. He cries the entire car ride to school which is about 20 mins. When we arrive he cries all day at school. Yesterday the school had to call because he cried so long. When I pick him up he cries about the next day. He literally cries all day at home. We he sleeps he has nightmares. He wont eat, I have to force him to take a few bites. He has started having nightmares are crying in his sleep. When he is not crying he is praying that he dont go to school. He told me today that he wants to go to heaven instead of school. He has headaches and stomach aches which I am sure comes from crying all day. He is always nausea. I have tried dropping him and leaving. I have tried just leaving him. I have tried volunteering at the school for a few hours each day. Nothing helps. Everyone in the Mental health field that i have spoken to wont see a child his age for this and many has told me that they wont even treat him until age 12. There is the option of homeschooling, which I have done with my other children in the past. there is also a half day program at the school. There is also a waive that I can get from the state for delayed KG start and he will have to start at age 6 instead of 5. What should I do at this point?

Hi! I'll be glad to help you with this issue.

I can imagine how frustrating this situation must be for you. You are clearly a loving and caring mother and you recognize the deeply traumatic effects of the divorce on your son. You've done an amazing job in shepherding him through all the various signs of distress that he exhibited. It must have been a harrowing experience for you but you have been truly loyal and loving to your son. He's very fortunate to have you.

I'm surprised by this idea you've been told, both that he's not the right age to be treated for being treated for separation anxiety. This is not accurate; I say this both from my training and experience. I am very concerned that you have been steered away from finding a child therapist to work with him when this would be so helpful to you and beneficial for him. I can only give you two directories to look through to see if there's someone in your area who qualifies, which I'll put at the end of my answer. But I want to make sure you don't feel abandoned by the psychotherapy community; there are even journals on working with children his age and younger!

Now on to the techniques to use: you're looking for behavior modification techniques. You can look that up if you like. It's so well documented today that you for sure won't get many strange results on the Google websites.

The first thing is very sweet. It will get you in the spirit of behavior modification. I want you to have a handkerchief that gets put in his coat pocket, pant pocket, or lunch when you take him to preschool. The handkerchief is something you and he will cuddle with when he's on your lap or next to you on the couch at home. You'll use it in story time about a boy who's so sad when his mother has to leave in the morning and he has to stay in the school she took him to. But he has this handkerchief his mom left with him to remind him she will always be back at the right time to pick him up and give him a big smile and kiss and go home happy again. And you kiss the handkerchief and he kisses it and you hug it and he hugs it. Etc. Get the idea? This handkerchief IS your love for him. And you do this every night for a while. And it goes into his pocket. Keep repeating this until it's a ritual. Then when you get to school he takes it out and you kiss it goodbye and he kisses it, then it goes back in his pocket. And then you kiss him goodbye and then you leave. And after a few nights you discuss with him if maybe the pretend boy would like his teacher to hold on to the handkerchief in her desk each morning until he leaves in the afternoon. And maybe the pretend aide can put it in the teacher's special place on/in her desk. (If all this is practical.) You begin including them as your surrogates while you're gone. So that's a sweet and important ritual to set up for him so that he begins to know there is constancy in the world. He doesn't have to have anxiety about mom disappearing. She comes back. Okay?

Please note that I'm not hesitant to let him be young. He's six but he's dealing with trauma he doesn't really remember in cognitive terms, only emotional terms. And it's in the present for him. That's stretching his developmental abilities, even though he's a bright little boy. So, don't worry about my treating him young, that's okay.

That one is very sweet and loving. Next, practice all the usual ones for regular separation anxiety: a stable schedule as much as possible (again constancy in the world); continually reassure him of your love each morning and when he comes home from school; reward him for any slight improvement (SMALL rewards, but very important); discuss at home each evening what fun thing he did at school that day. To vary the above routine, you play with him with some of his little plastic figures (animals okay) going to school, how the little boy (animal) cries that mommy leaves, but knows he's going to have a good day because he will...then supply the nice thing that happened that day...and how he knows mommy will be back to pick him up for a fun evening with supper. In other words, start rehearsing having a good time at school, having a nice time seeing mommy, having a nice evening home. You insert each time you play more of how the little boy cries less when mommy leaves. Oh, and you also don't make a big scene when you leave him in the morning. You remind him of the game you played and how much you are going to enjoy coming to pick him up in the afternoon so you can go home and play some more. Then you leave and breathe deeply and prepare your strategy for the evening. Okay?


So, follow these procedures. See if there are other ways to involve the teachers as well. And at home, let him be young.

Now, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list children as their focus population and play therapy or sandtray (a good method). Interview the therapist and make sure his/her values are similar to you and you feel confident and comfortable with him/her.


http://therapists.psychologytoday.com/rms/

Good Therapy is a non profit directory. Same idea as the one above:

http://www.goodtherapy.org/advanced-search.html

Okay, I wish you the very best!

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Dr. Mark and other Mental Health Specialists are ready to help you
Hi! I'm very glad that I was able to help you with this and thank you for your positive rating. If I can help you in the future in any way, please don't hesitate to let me know.


All the best,
Dr. Mark

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