All About Separation Anxiety in Children with Special Needs

Separation anxiety is a normal stage in a baby’s development that helps them to understand relationships and master their environment. Crying, clinginess or tantrums are healthy reactions to separation and are a normal stage of child development. Typically, it ends around 2 years of age, as toddlers start to understand that a parent/caregiver may be out of sight but will return later. Separation anxiety disorder exists when the anxiety symptoms are excessive for the developmental age and cause significant distress in daily functioning.

At around 8 months old, a child may fear less familiar people and places. This usually peaks between 10-18 months of age and disappears by 2 years of age, however both attachment and the ability to easily separate may develop at an older age in a child with developmental delays or special needs. Some children experience severe anxiety—even as newborns—that does not improve over time and may even worsen. These children are often diagnosed later with a mood disorder or a neurological disorder such as autism or ADHD.

While some separation anxiety shows that a child has formed attachments with loved ones, leaving a child with child care providers or others can be stressful for everyone. To ease typical separation anxiety, parents can make partings easier for a child in several ways:

-follow a goodbye ritual; children with special needs find structure reassuring

-stay with him until he becomes familiar with a new person or place

-do not sneak away or scold a child for being upset

-reassure the child that you will be back after naptime or at dinnertime; keep that promise

-do not leave a child when he is tired, hungry or ill

-leave your child with his favorite blanket or other “lovey”

Separation anxiety disorder is not the same as separation anxiety and is not a normal stage of development. It is a serious emotional problem characterized by extreme distress when a child is away from the primary caregiver. Since both situations share many symptoms, it is sometimes difficult to differentiate which your child is experiencing. The main differences are the intensity of your child’s fears and whether these fears keep him from normal activities. Separation anxiety disorder is the most common anxiety disorder in children under 12 years of age. Symptoms must be present for at least four weeks for separation anxiety disorder to be considered.

Some causes and risk factors for separation anxiety disorder in children include: change in environment (new house, school, or day care), major stressor or loss (death of a loved one or pet, change of schools, divorce) and overprotective or intrusive parents.

Symptoms of separation anxiety disorder may include:

-excessive distress when separated from attachment figures or the home

-worry about harm coming to attachment figures

-refusal to go to school because of fear of separation

-refusal to sleep away from home or to go to sleep without attachment figures nearby

-nightmares involving themes of separation from home or attachment figures

-repeated physical complaints such as headache or nausea when separate has occurred or is anticipated

-clinging to the caregiver; the child may shadow you around the house or cling to your leg if you try to leave

-for a child with special needs, he may show distress by regressing or becoming hyperactive

It can be very upsetting to see your child stressed, and sometimes parents inadvertently reinforce the anxiety by helping a child avoid things they are afraid of. Instead of avoiding separation, it is helpful to learn more about the disorder and take steps to make a child feel safer. Strategies for dealing with separation anxiety include:

start with very brief separations: begin with increments of 5 minutes and gradually increase time spent apart

teachers should use positive language: try “your dad will pick you up after story time” instead of “he left”

try a photo story: make a picture story that includes photos of your child with alternate caregivers and school classrooms; if possible, you can arrange for a school/teacher visit before school starts so you child can see the photo of his teacher and classroom before school begins; he’ll know exactly what to expect on the first day of school

-“magic bracelet”: this bracelet can chase away anxiety; it can be made of materials that remind the child of his parents, or it may be something that belongs to the parents; it is used as an attachment object to transfer emotional security from the parent to the child

say goodbye with a smile: try to say goodbye while the child is engaged in something positive; tell him briefly what you will be doing while you are apart, and give a return time

let your child walk away from you: for many children, it’s easier to leave than to watch a parent/caregiver retreat

try field trips: take trips together to reduce sensitivities and increase awareness of other people and life experiences

play therapy: a play therapist directs play to work through specific issues a child is having

For children with separation anxiety disorder, a common symptom is refusal to go to school. There are tips for both parents and teachers that may help reduce a child’s symptoms. Parents can try the following suggestions:

-help a child who has been absent from school return as quickly as possible: if a shorter day is necessary initially, symptoms may decrease once they discover they can handle the short separation upon return

-ask for late arrival accommodations: additional flexibility to talk and separate at a slower pace can help a child separate

-have a safe place: find a place at school where your child can go to reduce anxiety, perhaps the nurse’s office or the library

-allow contact with home: sometimes during times of stress, a brief phone call with family can reduce separation anxiety

-send notes for your child to read: a note in his lunch box can work wonders

-reward your child: every good effort deserves to be praised

Parents might also want to discuss the following classroom tips for dealing with separation anxiety with their child’s teacher.

-make sure the child is prepared ahead of time: be sure the child has a morning routine and knows what to expect, and knows an exact time a parent will pick her up

-be sure to share background information about your child with the teacher: share info about your child’s daily routine and how he copes with change, including methods for soothing

-consider providing a comfort item such as a stuffed animal or a laminated family photo

-provide distraction: picture books are good distractions; consider stories that explain how a parent comes back

-try a little extra TLC: sometimes a child just needs a bit more attention, whether it’s holding her close or just an extra hug or time to sit alone with the teacher

-engage the child: if a child is busy making a special art project for mommy or daddy, he will be distracted and excited to surprise them when he gets picked up

As your child moves through ages and stages, if you feel his/her separation anxiety is causing significant stress regarding daily activities, you should seek professional help. Your child’s pediatrician can refer you to professional specialists who can help your child and your family. Anxiety disorders can be effectively treated, and treatment should be based on a comprehensive evaluation of the child and family. Treatment often involves cognitive behavioral therapy for the child, focusing on helping the child learn skills to manage his anxiety and help him master situations that contribute to anxiety. Some children benefit from treatment with medication that helps them feel calmer. Family therapy and consultation with the child’s school may also be recommended.

Early detection and intervention can reduce the severity of the disorder, enhance the child’s normal growth and development and improve the quality of life experienced by children with separation anxiety disorder.


Note: The information in this article is for informational purposes only. It is not an attempt to diagnose or treat any medical condition. Always consult your child’s pediatrician with any specific medical questions. MKSA is also available to answer questions about child development. Contact us at 516-731-5588 or



Things to Look for When Choosing a Preschool

Choosing your child’s first school can be both exciting and overwhelming. If your child has special needs, it’s especially important to thoroughly explore different options. As space is sometimes limited, it’s best to start researching early and apply to several programs.

There are several things to look for as you begin to visit preschools. According to Harvard’s Graduate School of Education, look for the following:

Adults are talking to children in nurturing and encouraging ways. They address them by name, get down to their eye-level, listen and try to understand. A perfect example of this was a parent dropping off a recently potty-trained 3-year-old who wanted to wear his underwear backwards. The teacher understood that the little boy wanted to have the truck on the underwear in the front—where he could see it. And it wasn’t an issue.

Teachers focus on helping—not punishing—children who are behaving inappropriately. Good teachers help preschoolers develop social and emotional skills and self-regulation, with consistent routines, and strategies such as timers for turn-taking, and games for times a child needs to be physical.

Classrooms are joyful and fun. Teachers need to continually provide new activities and challenges in an environment focused on play.

Children are active. Artwork should cover walls, children should get lots of outdoor time, and they should not expected to sit for more than 20 minutes at a time.

Staff seem happy and are supported. It’s ok to ask about teacher turnover, and availability of regular professional development and planning time for teachers. Do they seem happy and excited—or bored? Teachers can make or break a child’s experience, so go with your instincts. If you feel good about the teachers, your child likely will as well.

Once you have arranged to visit a school, asking questions can further help you assess the program and decide. Call in advance to arrange a tour and try to schedule a follow-up visit with your child to see how he/she reacts to the school. Below are some suggested questions to ask and points to consider, from’s pbsparents:

Ask yourself “What kind of school environment am I looking for?” Do you picture your child in a busy, active place with lots of other children, or are you looking for a small, nurturing environment with just a few kids? What specific needs does your child have: toilet training, napping, socializing?

Consider if this school is a good fit for your child—and you. How will he do socially in this environment? How does the school fit with your child’s disability, unique needs, strengths and personality?

Spend time observing. During tours, watch silently in the classroom and observe the interactions.

What is the educational philosophy? Some philosophies are play-based, some introduce reading and math earlier than others, and many schools incorporate multiple philosophies.

How large are the classes and what is the teacher-child ratio? The important thing to consider is how your child’s needs and your own will be met by this equation.

What is the look and feel of the school? Does it feel warm and inviting? Is it clean and organized, or messy and chaotic? Do they have a gym or play yard? How often do they use it? Is there a separate room for Speech, OT, PT and Psychologist services?

Is the atmosphere exciting? Do students seem happy? Do the teachers seem like they enjoy teaching here?

What kinds of activities are children doing? Are the projects controlled or open-ended, enabling children to do many different things with the same materials?

What is the focus on reading? Ask if it focuses on teaching early literacy skills and at what age. Does this approach seem right for you and your child?

Are children working all together or individually? Is everyone doing the same project or activity at the same time? Are individual interests being accommodated?

Organization. Are the classrooms organized? For children with Sensory Processing Disorder, are there visual and auditory organizers such as wall charts, schedules and timers to help minimize over- or under-stimulation?

How much do the children play? Both boys and girls need room to run around and time to do it, with plenty of opportunity for imaginative play.

How do parents get involved in the school? Is there an active parent’s organization? Can parents volunteer in the classroom?

How is information communicated to parents? Is there a newsletter? Can you e-mail the teachers?

How does the school address social-emotional issues? How does the staff help children resolve conflicts? How are issues like hitting, throwing, and biting addressed?

Food and mealtime. Where do students eat? In a classroom or lunchroom? How does the school handle special dietary requirements and how are food allergies handled?

What are the discipline policies? Are children punished for inappropriate behaviors? Ask for details about their discipline policies.

Is this school accredited? Public schools need to meet state and district requirements. Private schools get additional accreditation from organizations like the National Association for the Education of Young Children (NAEYC)and the National Association of Independent Schools. Accreditation standards vary, and some schools may meet standards without being accredited by outside organizations.

Specialists and therapies. What therapists visit the school and how often? Does the school have regular access to Speech Therapists, OTs, PTs and Psychologists? Does the school offer adaptive physical education? If your child has difficulties with speech and language, ask what method the school will use for communication. Do they have access to assistive technology? Are any extracurricular activities open to special needs students?

Paraprofessionals. If your child is going to need a para, ask what training is given to him/her. Will your child get the same para each day? Will the para be with your child at recess and lunch?

Request a copy of the class schedule. How is the day structured? Is it the right fit for your child’s intellectual, emotional and physical needs?

What are the medical policies? Is there a nurse on site full time? How are medications handled? How does the school handle injuries or illnesses? Can kids come to school with a cold but not a fever?

Is the space safe? Is it up to code? What evacuation plans are in place?

Can you get references from other parents whose children go to the school? If you haven’t been personally recommended, ask for some numbers of other parents who might answer more specific questions.

While there are many factors to consider when selecting a preschool, with some diligent exploration you’ll be able to find the right setting for your child—a nurturing yet stimulating environment that will positively shape his/her orientation toward learning for many years ahead. If you have any questions about your child’s development, reach out to us! You can call 516-731-5588 or contact us by email.

Note: The information in this article is for informational purposes only. It is not an attempt to diagnose or treat any medical condition. Always consult your child’s pediatrician with any specific medical questions. MKSA is also available to answer questions about child development. Contact us at 516-731-5588 or

 Sources:’s pbsparents
Child Mind Institute,

Back to School Tips for Families of Special Needs Children

As families and their children get ready for the back-to-school transition, there’s a lot to be done to get into a new schedule. The new school year means a new grade, new teachers, and even a new school. Back to school can be an anxiety-provoking time for parents under the best of circumstances. Making sure your kids have the right clothes and the right supplies can be overwhelming, but when you’re the parent of a child with special needs, you have to make sure they have the right program in place, too. Getting organized—both physically and mentally— before the year begins will go a long way toward creating and maintaining peace and success in the year ahead.

We’ve listed below some areas to address in preparing for the school year, along with 50 Tips for School Year Success:

Schedule a special back-to-school meet-and-greet/tour for your child prior to the first day of school
Many children with special needs need prior exposure to new experiences to help ease their anxiety. If this sounds like your child, we recommend reaching out to the school to request a special meeting and/or tour with your child’s teacher. For elementary students, try meeting with teachers, the principal and the school nurse. For middle and high school students, you’ll want to meet with the guidance counselor as well. For many children this is necessary even if they are just moving up a grade into a new classroom, but it is especially important if s/he is undergoing a significant transition. As with the back-to school IEP meeting, it is recommended that you include this special meeting/tour in your child’s IEP accommodations in their IEP every year.

Review your child’s IEP
For children with IEPs, it is important to refamiliarize yourself with the services and accommodations your child will receive in the upcoming school year. The IEP is the cornerstone of your child’s educational program, so it’s important that you have a clear understanding of it. Note when it expires and if your child is up for reevaluation this year. Most importantly, check to make sure that the IEP still reflects your child’s needs.

Meet your child’s new teachers
Special Education Advisor points out that many kids with special needs have some quirks that teachers ought to know about. But your child also has wonderful things about him that the teacher should know as well. Make an appointment to sit down with or schedule a conference call with your child’s new teachers to tell them the good things and the not-so-good things they need to know about your child. Reading a child’s file isn’t the same as learning about him from someone who knows him.

Set up transportation
Special transportation is frequently a service on an IEP, meaning the school will provide transportation other than the regular bus to get your child to her school or special education program. If you haven’t heard yet, check in with the bus company or special education office to get the details about where and when your child will be picked up. Then you can do a “run-through” to make sure your child understands the routine.

Organize all that paperwork
In the world of special education, there are lots of meetings, paperwork, and documentation to keep track of. Try to keep a family calendar of school events, special education meetings, conferences, etc. Setting up a binder or folder to keep your child’s special education documentation, meeting notices, and IEPs in sequential order can also help you stay organized.

Start a communication log
Keeping track of all phone calls, e-mails, notes home, meetings, and conferences is important. Create a “communication log” for yourself in a notebook that is easily accessible. Be sure to note the person you spoke with, dates, times, and nature of the communications you have. It might be useful to send a communication notebook to and from school with your child to help him/her and the teachers keep on top of what’s happening. It’s also a great way to stop playing phone tag with the school and let them know if your child is having a rough day.

Talk and prepare
Just talking about the upcoming year and changes can help reduce some of that back-to-school anxiety! Talk to your child about exciting new classes, activities, and events that they can participate in during the new school year. Children pick up on your mood, expectations, frustrations, and disappointments. Of course, they also pick up on your excitement, pleasure, anticipation, and gratitude. Be sure you are starting the year off in a positive manner. If attending a new school, try to schedule a visit before the first day. With older students, it is sometimes helpful to explain the services and accommodations in their IEP so that they know what to expect when school begins.

Attend school events
Take advantage of Open Houses, Back-to-School Nights, and parent-teacher conferences to help you and your child get a feel for the school and meet the teachers, other staff, students, and families. Share the positives about working with your child, and let the teacher know about changes, events, or IEP concerns that should be considered for your child.

Clothing and weight/compression
Is your child a sensory seeker, or in need of special clothing? Be sure clothing is soft, comfortable, and provides pressure if needed to calm and comfort. Tagless shirts, compression vests, and other sensory-savvy clothing items can help kids adjust and perform at their best. By applying compression to the joints, a compression shirt or garment can provide an all-day hug to calm, engage, and help with focus. If your child has a hard time sitting still, try a wiggle seat, weighted vest, or lap pad. Your student might also like a wiggle cushion or ball chair for school or during homework at home. Sensory filters such as weight and movement can really help children transition well to school and not lose touch with their physical needs.

Behavior and Rules
Talk to your child about school expectations—and yours as well. Be sure your kids know the rules. Have them repeat those rules back to you, so you are clear that they are aware and understand. Give them space to voice any concerns as well. If your child needs assistance with emotional intelligence, regulation, or social communication, be sure to discuss this with the teacher and to give your child ample opportunity to express himself or herself.

Eat Well
Providing a healthy breakfast, lunch, and snack can have a huge impact on how kids perform, as well as on how they feel as they manage their day. Be sure to stock up on easy-to-access fruits and vegetables. In addition to edibles, some students can benefit from a chewy or fidget to have throughout the day to help ease stress.

50 Tips for School Year Success
For some specific strategies to help you and your children get, and stay organized, take a look at these tips:

  1. Set your kids’ sleep schedules back to “School Time” two weeks before the first day.
  2. Get your kids involved in programs that they can do after school to keep them active.
  3. Reacquaint your kids with the calendar schedule they’ll use to manage their activities.
  4. Set up weekly meetings to review your kids’ schedules for the week(s) ahead.
  5. Create a family calendarthat tracks everyone’s activities and commitments.
  6. Refresh your rules about screen time for the school year. What’s allowed and when?
  7. Establish a set “Family Time,” whether it’s during dinner or before bed.
  8. Use an egg timer to get your kids used to focusing for specific periods of time.
  9. Teach your kids to prioritize their assignments by making to-do lists with deadlines.
  10. Set a regular alarm each day that signals the start of homework time.
  11. Discuss what your kids can expect on the first day so they feel more prepared.
  12. Visit the school with your kids so they can get familiar with their new environments.
  13. Include your kids in back-to-school shopping by letting them pick out their items.
  14. Create a dedicated space for your kids to store their school supplies and technology.
  15. Establish a specific space like the family office as the official “homework area.”
  16. Remove distractions like TVs and video game consoles from homework areas.
  17. Repurpose and relabel plastic tubs to organize all school supplies.
  18. Help your kids develop a filing system for organizing their documents for each class.
  19. Set–and enforce–regular weekday and weekend
  20. Set–and enforce–regular weekdayand weekend wake-up alarms.
  21. Keep track of existing extracurricular activities to prevent over-scheduling.
  22. Create a list of fun after-school activities and gamesto keep your kids entertained.
  23. Touch base with teachers early on to troubleshoot any issues your kids may be having.
  24. Create an after-school schedule that allows time for snack, relaxation, play and study.
  25. Establish regular bedtime routines for elementary school kids and preschoolers.
  26. Carve out blocks of fun time for your kids, whether it’s through sports or playdates.
  27. Encourage your kids to lay out their school clothes the night before.
  28. Have your kids pack their school bags before they go to sleep that night.
  29. Have your kids also pack their gym bags the night before and leave them by the door.
  30. If your kids bring their own lunch, pack their lunch boxes before going to bed.
  31. Establish rules for where they should put lunchboxes, etc. when they come home.
  32. Go through your kids’ schoolwork once a month to toss the things you don’t want.
  33. Create an inbox for kids to leave things that need your attention, like permission slips.
  34. Get copies of school menus in advance to discuss lunch choices.
  35. Get your kids involved in creating and preparing their daily lunch menus.
  36. Buy reusable sports bottles to increase their water consumption during the day.
  37. Keep a small emergency allowance in your kids’ bags, just in case.
  38. Use sticky notes to flag important items in kids’ folders that they should pay attention to.
  39. Set your clocks forward 10 minutes. This makes it easier to be on time.
  40. Use positive phrasing, such as “You can go outside after your homework is done,” rather than “You’re not going outside until this is finished.”
  41. Make sure your kids (and you!) have an effective wake-up alarm that works for them.
  42. Set an alarm or notification 30 minutes before bedtime.
  43. Remove mobile devices from kids’ bedrooms to focus them on sleeping.
  44. Set up the breakfast table before you go to bed.
  45. Set up a hanging organizer with five boxes for clothes for each day of the week.
  46. Dedicate a rack in the garage, basement or entry way for sports equipment.
  47. Schedule study blocks on the weekends before big tests, mid-terms and finals.
  48. Talk openly with your kids about their feelings about returning to school.
  49. Do something fun to diffuse this stressful time of year for all of you.
  50. Take a breath!

Your child’s well-being is the most important back-to-school preparation. Addressing sensory, physical, and psychological needs as kids head back to school can help ensure that everyone has a great back-to-school experience. Be sure to address your own as well!


Note: The information in this article is for informational purposes only. It is not an attempt to diagnose or treat any medical condition. If you have any specific questions regarding your child and his/her needs at school, consult your primary care physician.


Ilana Danneman at
LizAlton at    
Lara Cleary at 
Amanda Morin at