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School Refusal

School Refusal

The estimated prevalence rates of school refusal vary from 1-8 percent with about one quarter of American children refusing to go to school at one point. Refusing to go to school is almost always  a form of anxiety. Children who won't go to school  are often stressed  at school because of: bullying or peer stress,  academics and their challenges, discord with teachers,  general anxiety and other mental health problems, worry  about being separated from their parents (separation anxiety). This page will mostly deal with school phobia. 

It’s important to identify and quickly work on school refusal because consequences include:

  •         lowered self esteem
  •         trouble with peers,
  •         academic difficulty
  •         depression 

Some children who have severe school avoidance can continue on later to be unsuccessful at graduating.

It's important to know that school refusal rarely comes from the desire to engage in bad behavior and be truant, and almost always is resulting from the avoidance of something that is making a child or adolescent anxious. A child who is avoiding and refusing to go to school isn't necessarily avoiding school, but is avoiding something that they feel and experience while at school.

School Refusal in Children versus Teens

School refusal is somewhat different in teens than young children

In teens school refusal is more likely to become depression because it severely hinders their independence. Additionally, when approaching treatment with teens we need their buy in more than we do with younger children.

How Does school Refusal  Start?

School refusal related to anxiety often starts with a specific trigger. Something happens in school such as a teacher embarrasses them; they are humiliated or bullied by another student, they fall in school or vomit, or are stressed in some other way. From that develops and intense desire to avoid school, which reinforces the anxiety and exacerbates the phobia or refusal. School refusal can also be a part of separation anxiety, so if your child is exhibiting school refusal, it is important when they are calm to get a good sense of why they are not wanting to go to school. If they give you information that leads you to believe it relates to being separated from you, especially if they are fearful of something happening to you, we may be dealing with separation anxiety. You can learn more about this here. If a child or teen is exhibiting school refusal, and it is an anxiety disorder, it is likely school phobia, separation anxiety or social phobia. 

How do Students Who have School Refusal Act?

Students who have school refusal related to school phobia  will describe that they feel physically ill, physiologically overwhelmed,  that they have thoughts of something terrible happening at school, or that they somehow won’t be able to make it through. They will often avoid school at all costs, feigning illness, becoming aggressive, crying and begging their parents not to make them go. I have had school phobic children kick out the windshield of their parent’s car on the way to school  while in a fight or flight mode .

What Should I do if my Child is Exhibiting School Refusal Related to School Phobia ?

If you have a child exhibiting school refusal it's important to immediately and firmly encourage them to go back to school.  Depending on the length of time that has transpired, you may need professional help.

Professional Help with young children

Younger children benefit from a calm reassuring and patient attitude from the parents and school. If they have been absent from school for a long time, they may require 

  • A safe person at school
  • Someone to help with getting out of the car or bus
  • A place at school that is quiet they can go to  when they become overwhelmed
  • A gradual plan to visit the school ( exposure)
  •  Partial days at the school

Professional help with older children

If your child is older, you will likely be less successful and need their buy in and definitely need professional help( teen) as well a an  assessment for depression. For older children Cognitive Behavioral Therapy ( CBT) is recommended and selective serotonin reuptake inhibitors (SSRIs) may be indicated along with therapy. Older children will also need a similar plan where the school and parents are involved. 

In both of these cases the family will need therapy to understand how they may be accommodating  the child's behavior. Often when a child has anxiety, in an attempt to relieve it we mistakenly reinforce the cycle of anxiety. We call this accommodation. Therapy includes helping parents to change this cycle. 

School phobia in College age Children: Emerging adults

While research shows school anxiety appears to peak between ages 5 and 6 and 14 and 15 during times of transition, young adults entering into college appear to be a group that is at growing risk. Transition is always a trigger for kids who have anxiety, and this is one of the biggest transitions of all. Eighty  percent of kids who are in college report that they are stressed, One third  have a depressive episode and Forty percent don't finish within 6 years!  Depression is the most common reason for withdrawal but anxiety is a gateway to depression ( 2014  ADAA ). Many kids will first begin to experience anxiety, begin a pattern of avoidance of class and work, and then start to experience depression. 

So what can you do about your kid that has anxiety to prevent or help with this? 

If you have anxiety in your family it's important to recognize that your child is at risk, and if you yourself have anxiety, it's important to recognize that you are at risk for passing those patterns to your children.  Get your child help early, several years before they might be going to college, to ensure that they are learning strategies of problem solving, emotional regulation, stress management, assertiveness, and relaxation. Get yourself help so that you can ensure you are managing your anxiety as appropriately as possible. Prevention is the best way to avoid your child being a statistic.  

 

How to Create a Supportive School Environment for Anxious Students and School Refusing Students

Local therapists are almost always willing to do presentations for schools to educate them about school refusal.These inservice trainings can be very beneficial educating school personnel on child anxiety.

Teachers can also make their classes anxiety friendly, and understand what certain accommodations can benefit their anxious students in the classroom. Below are some accommodations that are helpful to use in the classroom for anxious students

1. Create a consistent daily routine. For younger students create a consistent schedule and routine that is posted in the classroom, preferably one that is visual. For older students, the same is important, regular feedback on grades and timeliness with grading procedures, and an easily updated and accessible calendar where students are notified of any changes and important dates would be important for students with anxiety. Good organization and clear expectations will help the anxious students the most.

2. Create a task focused environment where competition between students is minimized. Encourage individual goal setting rather than comparisons.

3. Enable small group activities: Initiating positive peer interactions can be very beneficial for students with anxiety, especially those with social anxiety. Small group activities help to challenge children with anxiety, decrease their isolation, and build a sense of mastery.

4. Allow students to have a classroom pass to help them leave in times of high anxiety and got to a counselor or a school nurse to practice coping skills or relaxation techniques until they feel calm enough to return. This can be available to all students.

5. Where an anxious student sits can have an impact on their anxiety. They may not want to sit in the front of the class and have their back to everyone, or they may need to feel like they want to sit by the door in the event that they become extremely anxious and need to have get the pass to leave for a break.

6. Extra time on tests and a flexible test taking environment can help decrease anxiety and improve test results.

7. There may be particular assignments that cause students to feel anxious and withdraw avoid and refuse to come to school. A socially anxious student will frequently feel unable to do oral presentations and avoid school. Accommodations for anxious students include taping the presentation for the teacher or doing the presentation with the teacher alone.

8. Copies of notes and a class buddy should the anxious kid miss class or assignments: These strategies can help if a child is absent because of anxiety from school or class.

These are some suggestions for accommodations and classroom strategies but are by no means the only strategies. Keep in mind that anxiety is a disability like any other disability. Your child, teen OR COLLEGE STUDENT is entitled to accommodations and a 504 plan.

I hope this page has been helpful in giving you some information about school refusal.

References

ADAA. ( Producer) ( 2014) Getting Ready How to Help your Child Overcome School Refusal or School Phobia. Retrieved from https://adaa.org/webinar/consumer/getting-ready-how-help-your-child-overcome-school-refusal-or-school-phobia

Moran, K. (2015). Anxiety in the classroom: Implications for middle school teachers. Middle School Journal, 47(1), 27-32. doi:10.1080/00940771.2016.1059727 Thanks for visiting!

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