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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7664
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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My nephew is almost 5. He seems to suffer from extreme and

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My nephew is almost 5. He seems to suffer from extreme and debilitating anxiety to the point that he CANNOT behave appropriately around other people if his mother is not there. To site a few examples, if ANYONE walks into the room he's in he will put up his hand and start shouting "NO NO NO NO!" before that person even says hi. He'll then run screaming to find his mother with a constant, panicked and escalating"mommy mommy mommy mommy!" as if he's being chased by a monster. Sometimes he'll do that and then he'll hide under a table.

I have spent 2 weeks on vacation with him and his family for the last 3 years, along with seeing them a few times a year during the holidays. I send school pictures of my kids and little notes from them to him when were not together so we stay fresh in his mind, and so we move beyond being "strangers" every time we get together. Usually by the end if 2 weeks of vacation he'll be okay if I walk in the room, but sometimes still acts as if I'm an evil spirit coming to kidnap him. I have also noticed that if he will talk to me at all usually it's in a "dinosaur" voice which is loud roaring instead of words. He doesn't know how to play because he is so intent on where his mother is that he can't stay focused and even if she goes to the bathroom, he has to go with her.

For a long time I thought he was REALLY shy, but this is beyond shyness. My sister asked what I though about his behavior and I didn't know what to tell her. She's already planned on not sending him to kindergarten because he couldn't possibly last one minute with all of those other kids. Do you have any thought about what might help him or a thought about what this might be? I would appreciate some direction!!
Submitted: 5 years ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 5 years ago.
Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Dear concerned aunt/sister,

Your nephew is exhibiting the classic symptoms of Separation Anxiety Disorder. Here are the diagnostic criteria according to the DSM-IV TR, official manual of the American Psychiatric Association:

A. Developmentally inappropriate and excessive anxiety concerning sep­aration from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

· recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated

· persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

· persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g. getting lost or kidnapped)

· reluctance or refusal to go to school or elsewhere because of fear of separation

· persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

· persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home

· repeated nightmares involving the theme of separation

· repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The duration of the disturbance is at least 4 weeks.

C. The onset is before age 18 years.

D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia.

Specify if:

Early Onset: if onset occurs before age 6 years

This disorder is treatable with psychotherapy and a competent child psychologist should be sought. This should not be treated with drugs. The best approach is Cognitive Behavioral Therapy, clinically proven effective The treatment for children and adolescents is usually short-term and focuses on teaching the children and their parents specific skills linking behavior and emotions.

Though not a substitute for a skilled therapist, I recommend the following book:

Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parents by Andrew R. Eisen, Linda B. Engler and Joshua Sparrow

I hope that this information proves helpful.

Warm regards,

Elliott Sewell, LPCC, NCC, CCMHC
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