When parents/guardians, school professionals and outside providers are dealing with school refusal, it's critical to first understand what the child or adolescent is trying to communicate. Once this message is decoded, the adults can then take charge through a proactive, yet sensitive approach.
This post is intended to provide practical insight, indicators and interventions to effectively address school refusal, once and for all.
School refusal in children and adolescents is a growing issue that impacts not only the student but the entire family, school personnel, and mental health professionals working with the student. Although school refusal may appear to be a very simple or concrete issue to resolve, it is often misunderstood and consequently minimized or mistreated. Without proper intervention, the student’s attendance will further deteriorate, his or her anxiety will further increase, and this cycle is then perpetuated. If left unchecked, school refusal can become a chronic struggle and also present a significant obstacle to a child’s healthy development.
Many school refusal issues stem from strong feelings related to the process of separation/individuation. Frequently, the school avoidant child has anxiety about separating from his parent(s) and is intensely worried about peer/social relationships at school. In other cases, the child is afraid to separate from the parents due to concerns about the parent’s own feelings about separation. Unfortunately, the feelings that lead to school refusal are not often discussed, understood, or fully identified by either the child or the parents. These can be overt feelings of anxiety or other underlying feelings such as abandonment, disappointment, guilt, worry, shame, embarrassment, etc. These unexpressed and unaddressed feelings can become key precursors to school refusal.
Although it is difficult to recognize feelings that have not been expressed, there are early (and often subtle) indicators prior to the onset of school refusal that parents and school personnel are advised to address before the situation intensifies. The following are some of the common early warning signs of a child’s increasing anxiety that lead to school refusal:
Increasing/excessive tardiness to school
Monday and post-holiday absences
Increase of vague somatic complaints in the morning
Unspecified illnesses or sickness in the morning
Frequent visits to the nurse’s office and/or bathroom
Unsubstantiated complaints about peers and teachers
Refusal/withdrawal of school-related activities, such as sports, clubs, etc.
Crying and/or tantrums when topic of school is brought up
Irrational excuses by the child about why he or she cannot go to school on a particular day (e.g. “I’m already late and can’t walk in during the middle of a class”)
Fantasy-like communication by the child related to his or her absenteeism (e.g. repeatedly promising to go to school tomorrow and then not going)
It is essential to recognize these signs at an early stage rather than assume that the child will just start feeling better on his or her own and return to school. The reality is that the child’s emotional state will not improve when he or she is at home if interventions are not employed to address the behavior. It must be emphasized that while the child may indicate that he or she is feeling better during a school day spent at home, these feelings are very temporary; they provide relief for the child in the moment. The underlying feelings will continue to resurface the next morning when the anxiety returns about separating and going to school for the day.
Treatment professionals may need to help the child’s parents take charge, provide firm expectations, and make decisions rather than allow the child to dictate the appropriate course of action. At times, there may be some underlying parental ambivalence about their child going to school against his or her own will. The parents will understandably need support to recognize and work through these feelings in order to diminish the likelihood of unintentionally hindering the student’s return to school. It is essential that the parents realize this by ensuring that they make staying home feel more uncomfortable for the child if he or she resists going to school.
An effective short-term means to help the child move out their front door and into the school door is to consistently implement incremental consequences and school-driven interventions. Parents and school personnel can be equally conflicted about enforcing consequences in school refusal situations because of various concerns including:
The child’s fragility and/or unpredictability in reaction to consequences
A lack of clarity about how, when, and where to apply consequences
The idea that consequences in general are a “waste of time” and “don’t work”
While parents often worry that taking a stance to facilitate their child doing something that he or she doesn’t want to do will only make the situation worse, the current situation will only continue to deteriorate in the absence of clear expectations and an incremental use of consequences. Yes, the child will be momentarily upset when receiving the message about incremental consequences, this reaction is quite normal and an appropriate response to the situation. Additionally, it is important to appreciate that deep parental concerns about the child’s reaction to consequences may also provide a critically helpful indicator of a child’s possible need for more intensive psychiatric care than initially understood.
The most applicable consequences for school avoidant behavior generally involve the limiting/removing of a short-term, daily pleasurable activity or privilege that the parent can easily monitor (e.g., taking away the child’s cell phone, not allowing the child to go out with friends, or curtailing the use of video games or other forms of entertainment). The school avoidant child will often try to bargain about the situation in a way that will only continue to maintain the existing dynamic (i.e. “If you let me have my phone . . . or use of computer . . . or go out with my friends, I will go to school tomorrow”). It is important that this order be reversed—the child needs to go to school before the privileges are given.
If a child knows what consequences to expect in advance and can have a new opportunity to regain his or her privileges on a daily basis by going to school, the child is more likely to respond positively to them. Although consequences from parents are frequently very effective when appropriately implemented, it is important to also emphasize that school refusal requires a team effort among parents, school personnel and any outside providers involved. School personnel (as well as outside providers) can often assist in the process by offering the following interventions:
Making it as easy as possible for the student to go to school by meeting him or her at a different school entrance door and/or letting the student go to an emotionally safe place when arriving at school (e.g., CST, guidance, nurse’s office, etc.) rather than going to class immediately.
Helping the student develop a step-by-step plan to both get to school and to map out the school day. This gives the student some control in the situation and can increase his or her investment in the process.
Empowering the parents to talk with the student to anticipate and resolve potential school refusal issues each night before bed rather than reactively discussing them all in the morning.
Communicating with the student and family daily to discuss attendance issues as well as making it clear to the student that he or she can reach out by phone when at home.
Facilitating a multi-disciplinary meeting at school with school personnel, child, family and providers.
Coordinating care with outside providers, agencies, etc.
Conducting a home visit after multiple tardies or absences.
Early detection and intervention will allow the best opportunity for the school avoidant student to remain in his or her current school setting. It should also be noted that treatment should always be implemented at a commensurate level of care (school counseling, CST member, outpatient therapy, partial hospitalization, inpatient hospitalization, etc.) based on level of need. Additionally, an expanded circle of people who have meaningful relationships with the child should also be considered as resources in helping to remedy this situation (e.g. extended family, mentors, coaches, peers, etc.). When school refusal can be addressed through ongoing intensive collaboration between student, parents, school personnel, outside providers and other pertinent caring individuals, the collective team can work together to effectively take charge and navigate all of the challenges that arise.
For additional information about understanding and addressing school refusal, please click on the link below to listen to my free one hour webinar:
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