School Refusal

Kids Who Won't Go To School—

School refusal occurs when a student will not go to school or frequently experiences severe distress related to school attendance. Comprehensive treatment of school refusal, including psychiatric and medical evaluation when appropriate, is important because studies show that psychiatric disorders are the cause for up to 46% of students who fail to complete high school in the United States. Parents can do several things to help their child who refuses to attend school and treatment may be necessary. With treatment, the rate of remission is excellent; approximately 83% of children with school refusal who were treated with cognitive therapy were attending school at 1-year follow-up. School refusal is considered more of a symptom than a disorder and can have various causes.

Going to school is usually an exciting and enjoyable event for young kids. However, for some it can cause intense fear or panic. Parents should be concerned if their youngster regularly complains about feeling sick or often asks to stay home from school with minor physical complaints.

Not wanting to go to school may occur at anytime, but is most common in kids 5-7 and 11-14, times when kids are dealing with the new challenges of elementary and middle school. These kids may suffer from a paralyzing fear of leaving the safety of their parents and home. The youngster's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.

Refusal to go to school often begins following a period at home in which the youngster has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.

The youngster may complain of a headache, sore throat, or stomachache shortly before it is time to leave for school. The illness subsides after the youngster is allowed to stay home, only to reappear the next morning before school. In some cases the youngster may simply refuse to leave the house. Since the panic comes from leaving home rather than being in school, frequently the youngster is calm once in school.

Signs of a psychiatric disorder called separation anxiety disorder can include the following:

• Excessive reluctance to be alone at any time
• Excessive worry about losing a parent; excessive worry that a parent might be harmed
• Persistent refusal to go to sleep without a parent or other caretaker present
• Repeated complaints of physical symptoms whenever the child is about to leave a significant parental figure
• School refusal

These behaviors must begin before the child is aged 18 years, must last for 4 weeks or longer, and must cause serious problems with academic, social, or other functioning in order to be called a disorder.

Some commonly cited reasons for refusal to attend school include the following:

• A death in the family of a friend of the child
• A parent being ill (Surprisingly, school refusal can begin after the parent recovers.)
• Jealousy over a new brother or sister at home
• Moving from one house to another during the first years of elementary school
• Parents separating, having marital problems, or having frequent arguments
• Parents worrying about the child in some way (for example, poor health)

Other problems at school that can cause school refusal include feeling lost (especially in a new school), not having friends, being bullied by another child, or not getting along with a teacher or classmates.

Kids with an unreasonable fear of school may:

• display clinging behavior
• display excessive worry and fear about parents or about harm to themselves
• fear being alone in the dark, or
• feel unsafe staying in a room by themselves
• have difficulty going to sleep
• have exaggerated, unrealistic fears of animals, monster, burglars
• have nightmares
• have severe tantrums when forced to go to school
• shadow the mother or father around the house

Such symptoms and behaviors are common among kids with separation anxiety disorder. The potential long-term effects (anxiety and panic disorder as an adult) are serious for a youngster who has persistent separation anxiety and does not receive professional assistance. The youngster may also develop serious educational or social problems if their fears and anxiety keep them away from school and friends for an extended period of time.

When fears persist the parents and child should consult with a qualified mental health professional, who will work with them to develop a plan to immediately return the youngster to school and other activities. Refusal to go to school in the older youngster or adolescent is generally a more serious illness, and often requires more intensive treatment.

Excessive fears and panic about leaving home/parents and going to school can be successfully treated.

Although young kids usually find going to school fun and exciting, 1 in 4 kids may occasionally refuse to attend school. Such behavior becomes a routine problem in about 2% of children. Many kids with school refusal have an earlier history of separation anxiety, social anxiety, or depression. Undiagnosed learning disabilities or reading disorders may also play a significant role in the development of school refusal.

Parents or other caregivers can do several things to control school refusal before it becomes a routine, troublesome behavior.

• Firmly getting the kid to school regularly and on time will help. Not prolonging the goodbyes can help as well. Sometimes it works best if someone else can take the kid to school after the parent or caregiver says goodbye at home.

• It truly helps to believe that the kid will get over this problem; discuss this with the kid (the parent or caregiver needs to convince himself or herself of this before trying to convince the kid).
  

• Listening to the kid's actual concerns and fears of going to school is important. Some of the reasons for refusing to attend school may include another kid at school who is a bully, problems on the bus or carpool ride to school, or fears of inability to keep up with the other students in the classroom; these issues can be addressed if they are known. On the other hand, making too big a deal of school refusal may promote the kid's behavior to continue.
  

• Supportive counseling is often made available at school in these circumstances so as to minimize reinforcement of school avoidant behaviors and to prevent secondary gain from school refusal and should be encouraged for any student who wishes to have it. If the kid simply refuses to go to school, some parents have found that decreasing the reward for staying home helps, for example, do not allow video games or television, or find out what work is being done in the school and provide similar education at home, when possible. This is especially if the "illness" seems to disappear once the kid is allowed to stay at home.

• The parent or caregiver should reassure the kid that he or she will be there upon the kid's return from school; this should be repeated over and over, if necessary. Let the kid know that the parent or caregiver will be doing "boring stuff" at home during the school day. Always be on time to pick the kid up from school if you provide transportation rather than a school bus.
  

• Whenever events occur that could tend to cause students to miss school (for example, traumatic events such as terrorism, school shootings, or other traumas) all attempts should be made to help students return promptly to school and to help them to feel safe at school.
  

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