By Madhurani Khare, M.D. Princeton HealthCare System
Any parent of a school- age child has probably heard, at one time or another: “I don’t want to go to school.” In fact, they probably uttered those exact same words to their parents when they were kids.
While occasional complaints about having to go to school are normal, daily refusals are not. Adamantly refusing to go to school on a daily basis may be a symptom of an underlying problem such as anxiety or depression that needs to be addressed before it worsens.
School refusal affects between 2 percent and 5 percent of school-age children, according to the Anxiety Disorders Association of America. The behavior typically peaks between ages 5 to 7, and then again at ages 11 to 14, when transitions to middle school or high school occur.
Often, children who are anxious or depressed will complain of physical ailments such as headaches or stomachaches as a reason to stay home from school. The symptoms then quickly disappear until the next day. Other signs include:
• Crying every morning or evening.
• Inability to sleep.
• Frequent trips to the nurse’s office.
• Slacking off on work, resulting in falling grades.
Initially, a parent might not recognize these signals as school refusal, but if they last longer than a week or so, they shouldn’t waste time getting help. Consider that numerous studies have established links between excessive absenteeism and educational underachievement, psychiatric problems, delinquency and substance abuse.
From being teased on the bus to feeling overwhelmed with schoolwork, a variety of psychological factors are behind school refusal, including:
• Separation anxiety, especially when a home environment is chaotic and the child is concerned about what may transpire when he or she is not there.
• Generalized anxiety disorder.
• Social anxiety.
• Depression.
• Desire to receive attention from parents outside of school or receive “rewards” by not attending school, such as playing video games or watching TV.
• Undiagnosed learning or reading disabilities that may surface as schoolwork becomes more difficult.
• Bullying by classmates and peers.
• Alcohol and drug abuse.
Whatever the reason, the worst thing a parent can do is give in and let their child stay home. Letting children miss school because they don’t want to go only reinforces the behavior and makes it that much more difficult to send them to school the next day.
Instead, parents should seek professional assistance to help their child identify and cope with the stress and reinforce the importance of going to school.
When treating children for school refusal, therapists at Princeton House Behavioral Health typically begin with an evaluation to spot any medical, psychological and social issues at play.
Occasionally, children are referred to neurologists, nutritionists, pulmonologists or other specialists to further evaluate potential medical problems that may be causing their symptoms.
In most cases, however, children participate in behavioral therapy to help them develop skills to overcome anxiety and depression.
Children learn to recognize what triggers their anxiety and are taught healthy techniques for dealing with those triggers. They learn tangible coping skills such as deep breathing and progressive muscle relaxation to relieve anxiety.
Therapists encourage children to slowly reintegrate into school, steadily increasing the time spent in the classroom and helping them realize there is nothing to fear.
For many children, the very prospect of returning to school after an extended absence is a significant source of anxiety. Often, they anticipate being ridiculed by peers or judged by teachers. Therapists encourage children to get together with their friends prior to going back to school to help ease the transition.
In severe cases, children may participate in a full-day program at Princeton House that provides an environment similar to the structure of the school day, but less stressful and anxiety provoking. Half- day programs are available for children who have returned to school, but still need support.
If necessary, doctors also prescribe anti-anxiety or anti- depressant medication to help children overcome their symptoms.
The ultimate success of any treatment program for school refusal largely depends on the close coordination of parents, physicians, school officials and mental health professionals.
Children who need to catch up on missed schoolwork might be eligible for special school services through an individualized education plan. Therapists typically work with schools and parents to develop a plan, which describes goals for the student and outlines the school’s role in helping the student achieve these goals.
Therapists also work with schools to develop plans that spell out modifications and accommodations that the school agrees to make to help the student.
Seeking professional assistance is the best way to handle school refusal. But in addition, the Anxiety Disorders Association of America offers the following tips to help parents and children develop coping strategies for school anxieties and other stressful situations:
• Talk with your child about feelings and fears, which helps reduce them.
• Emphasize the positive aspects of going to school.
• Encourage hobbies and interests. Fun is relaxation, and hobbies are good distractions that help children build self-confidence.
• Help your child establish a support system. A variety of people should be in your child’s life — other children, as well as family members or teachers who are willing to talk with your child should the occasion arise.
For more information about Princeton House Behavioral Health, call 800-242-2550 or visit www.princetonhcs.org/ princetonhouse.
Madhurani Khare, M.D., is board-certified in child and adolescent psychiatry, as well as general psychiatry. She is the medical director of the Hamilton site of Princeton House Behavioral Health. Princeton House Behavioral Health, a unit of Princeton HealthCare System, is a leading provider of highly skilled and compassionate behavioral health care.
