School Refusal: A symptom of a much larger problem?

School Refusal: A symptom of a much larger problem?

school refusalSchool has started, extra curricular activities and after school sports are in full swing, homework is being assigned, social activities abound, and there is a chill in the air signaling the end of the summer season.

One problem: your child refuses to go to school. Not only that, but this refusal is causing severe emotional and behavioral dysregulation: claims of illness or recurrent physical symptoms, temper tantrums, fighting and, if your child has preexisting psychiatric diagnosis, a flare up of symptoms that may have lessened over the summer months.

Sound familiar? You aren’t alone.

According to aboutourkids.org, as many as 28% of school aged children refuse school at some point. School refusal behavior can take many forms. It can occur when children refuse to go to school and acquire an absence. It occurs when children get to school yet leave during the course of the school day, or it can be defined by the dysregulation that occurs in the mornings before school, even if your child ultimately gets there.

As frustrating and angering as it can be to have a child who does not go to school or causes a fight or behavioral escalation when told they have to go, it is key to remember that school refusal is a symptom of a much larger issue going on with your child.

School refusal can signify one or more of the following:

  • A response to major life changes (ie: starting a new school, problems within the home)
  • Underlying anxiety or depression, in particular: social anxiety, performance anxiety, health anxiety, or separation anxiety.
  • Peer and social issues or social isolation.
  • A conduct disorder.
  • Learning disabilities and/or poor academic performance.

What to do:

  1. Talk to your child, but NOT while the child is emotionally dysregulated or in acute distress.  Have a conversation and ask them if anything is happening at school that they want to talk about, or say, “I get that it is hard for you to go to school, and I want to help you.” It is important to validate the difficulty that your child is having, and show genuine concern.
  2. Reach out to the school. Teachers and guidance counselors are your eyes and ears: they may be witnessing a problem that your child is not communicating with you about. Or, they may have no idea your child is in distress around the idea of going to school and they need to know in order to help. Communication is key.
  3. Reach out to your pediatrician. If your child is perpetually claiming illness, rather than accusing them of “faking it”, take them to the doctor. This shows that their complaints are being taken seriously. It should be noted that your child may in fact be feeling ill. Symptoms of anxiety and depression can manifest physically: headaches, stomachaches, nausea, shaking and racing heart.
  4. Get professional help: a thorough diagnostic psychiatric evaluation when your child has school refusal is essential. Many psychiatric disorders could be contributing to your child’s distress, including but not limited to: Anxiety, Depression, ADD/ADHD, Separation Anxiety Disorder, Conduct Disorder and Social Anxiety or Social Phobias.
  5. Consult a therapist and get a professional treatment plan. Parents often cannot tackle school refusal alone. What may be needed is a solid and well organized treatment plan which may include: relaxation training, behavioral reinforcement such as contingencies or reinforcement, exposure therapies, coping strategies and a cope-ahead plan, CBT, and/or DBT, to help manage and control distress your child is feeling.

Some helpful resources to learn more about School Refusal and how to best help your child:

http://www.aboutourkids.org/articles/understanding_school_refusal

http://www.nasponline.org/families/schoolrefusal.pdf

http://www.adaa.org/living-with-anxiety/children/school-refusal

http://www.nytimes.com/2010/09/14/health/14klass.html?_r=1&&gwh=889B34C5C28F78CEB7DF2D6760083121&gwt=pay

http://www.childmind.org/en/posts/articles/2012-10-2-what-is-school-refusal

http://www.nytimes.com/2010/09/14/health/14klass.html?_r=0

-Jaime Gleicher, LMSW