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Easing separation anxiety in a 4 year old with autism

“When my aunt is at work, I take care of my 4-year-old cousin who has autism. Her doctor says that developmentally she’s like an 18 month old. I’m writing because she has really bad separation anxiety. Every few minutes she asks when her mommy is coming. Do you have any suggestions on how I can help her feel more comfortable?”

This week’s “Got Questions?” answer is from child psychologist Michelle Spader, of Ohio’s Nationwide Children’s Hospital, a member of the Autism Speaks Autism Treatment Network.

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Thanks for your question. It’s helpful to know that your cousin is developmentally like an 18 to 24 month old. Children at this stage often have separation anxiety. So your cousin seems to be going through something that’s both common and normal. Sometimes separation anxiety eases over time. Meanwhile, here are some suggestions to help her through the day:

Talk with her autism therapy team
Hopefully your young cousin is receiving autism-related therapy. So first and foremost, I encourage you and your aunt to enlist the members of her therapy team in addressing her separation anxiety. A speech therapist, for example, can help her learn language related to understanding past, present and future. An understanding of “future,” in particular, can help her grasp that her mommy will come for her. Her behavioral therapist or psychologist can help your young cousin develop coping strategies.

Say it with pictures and stories
Children with autism or other developmental delays often do better with visual supports than repeated verbal explanations. For example, you can create a “Where is Mommy?” page. On the paper, paste a picture of her mom at her workplace. Next to it, have a picture of your young cousin with you in your home. When she asks if her mommy is coming, point to the picture of her mom and say, “Mommy is at work right now.” Then point to the picture of the two of you in your home and say, “She’s coming here to pick you up this evening.” (Learn more about visual supports and download the AS-ATN/AIR-P Visual Supports Guide here.)

Similarly, you might try writing and illustrating a simple social story. Social stories are short narratives designed to help those with autism understand a situation. Your social story might be about a little girl who goes to stay with her older cousin while her mother is at work. Have it illustrate how the little girl misses her mother but comes to understand that her mom always comes to get her at the end of the day. (Click here for an example of a simple social story. Click here for more detailed directions for writing social stories.)

Create a daily schedule
Many individuals with autism crave predictable routines. Consider making a daily schedule that illustrates the order of your young cousin’s day. Start with the first thing that happens – perhaps “Say goodbye to mommy. Give her a kiss.” Include a photo or drawing.

The next picture should illustrate what she does next while in your care. Eat breakfast? Watch Sesame Street? Continue, in order, with the day’s predictable events (a snack, going outside to play, going to the store, etc.) The last picture will be of her mother walking into the door.

Now when your little cousin asks when mommy is coming, you can show her in the context of the day’s events.

Establish a separation routine
When your aunt leaves in the morning, it may help if she and her daughter have a simple, consistent and cheerful routine. This might be a kiss and saying, “See you later. I love you!” Please caution your aunt against sneaking out of the house when her daughter isn’t looking. In the short term, that may avoid tears. But it can backfire by causing greater anxiety.

I hope these tips prove helpful. Please let us know at

Need personal guidance?
Members of the Autism Speaks Autism Response Team are trained to connect individuals and families with information and resources.
Call (888) 288-4762│En Español (888) 772-9050│ or email


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The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.