BY: Elizabeth Wassenaar, MS, MD, Lindner Center of HOPE, Staff Psychiatrist and Medical Director of Williams House
Life can be overwhelming and we all would like to take a day off every once in a while. Likely, as helping professionals, we don’t take mental health days as often as we could actually benefit from them. This is one of the reasons why, when a child or adolescent refuses to go to school, we may be initially sympathetic. Maybe a day or two off will help, we may think. In too many cases, however, we see that a day or two off turns into something much more problematic as parents and professionals struggle to get a school avoider back to school. Homework piles up, grades start to fall, and friends wonder what has happened to their classmate. Parents try many different tactics to try to get their child back to school; bribing, negotiating, punishing, or even carrying a child through the school door.
Children want to not go to school for many reasonable causes: kids can be cruel; learning can be difficult; anxiety about performance can be overwhelming; health concerns can require special privileges that feel too identifying; and getting up early in the morning is harder for some more than others. Furthermore, mental illness can make school attendance difficult for many additional reasons. There are good reasons to keep children home from school – physical illnesses can be contagious, some stages of mental illness are better treated with mental rest, and in some cases of bullying the safest way to deal with an unsafe situation is to remove the child.
Nevertheless, school refusal is avoidance, and anxiety loves avoidance. Nothing is more reinforcing that one cannot handle something than not doing it. So, after one has checked on physical health and for other explanations, how can professionals support parents to keep their children in school or break the cycle of school avoidance and school refusal?
- Help parents identify the behaviors of avoidance and link that to anxiety.
Avoidance is a coping mechanism for dealing with anxiety, which can become maladaptive when avoidance becomes the only options. Avoidance can look a lot of different ways –tantrums, tearfulness, vague physical symptoms, negotiation (more on that later), chaos, and so on. Parents may not be able to recognize all of the forms avoidance can take. Helping them objectify avoidance will help them strategize on how to deal with it.
- We have to truly believe that avoiding school will not make it better.
It can be tempting to collude with anxiety that the precipitant needs to be avoided for all the reasons laid out in this article and we need to be internally convinced that anxiety is not correctly assessing the situation. As difficult as school can be, school occupies a unique place in a child’s life. It is the place of work, play, and love. Learning and playing are the main jobs of childhood. Playing looks both like playing at recess and like experimenting in relationships with both friendship and love. Identity is formed and reformed through our work, play, and love. When a child is not in school for an extended length of time, they are abrupting their opportunity for this developmental process to proceed.
- Negotiation is another way of avoiding and is a dangerous game.
Many of my patients have used a variety of negotiating tactics with their parent: “Let me go in later and then I’ll go, I promise” or “Let me catch up on my work today and I’ll go in tomorrow”. Small avoidances add up to large avoidance and are not moving towards your goal. Reverse the negotiation and set up conditions that will allow an out as long one starts the day at school. Often, once anxiety has lost its argument that one cannot handle going to school, staying in school through the day is easier to manage.
- Encourage parents to work with the school
Parents and school are on the same side of this concern – both parties want the child to be successful in school. For parents, this may be the first time dealing with school refusal, but it is most certainly not the first time the school has dealt with school refusal. Most schools have a variety of plans to help keep a child in school. Have parents reach out to the school and let them know what is going on.
- Set small goals that lead to the victory
The ultimate goal of full school participation is an overwhelming prospect. Depending on how severe the school refusal is, reintroducing school can be an extended process of gradually introducing larger and larger challenges. Perhaps, on the first day, one can only walk through the school doors. Maybe a student will be able to be in the school building, but not in classes. Parents can engage trusted friends to provide motivation and encouragement through social interaction and distraction while at school.
- School has many different forms
Many families choose alternative school arrangements including home schooling, virtual schooling, and others, for a variety of reasons and this article is not meant to convict choices that do not have a child in a classroom every day. There are many viable options for school that provide an environment that promote healthy development. When a family is making a decision to change the way school is delivered, help them examine what factors are involved in their decision. If they are making the decision from a place of believing that the anxiety that drives school avoidance cannot be defeated then, help them with all the ways described above.
School is a venerable and sometimes dreaded rite of passage. A great deal rides on academic and social success in school which increases anxiety and can lead to school refusal. As a team, parents, professionals, and schools can help keep children and adolescents in school and accomplishing their goals.
