Does my son/daughter have school refusal?
The answer to this question is in your gut. You know when things are getting out of hand or heading that way. If you are on this site, then you see signs that have led you here.
School Refusal is sometimes also referred to as school avoidance and school phobia. It describes a child's refusal to attend school. It can start as periodically missing school a day here and a day there. It can escalate into missing days of school at a time. It can also lead to children to refuse going to school altogether. Children may refuse school by crying, screaming, hiding or may complain of feeling sick. It is also challenging because the child may not be able to articulate why they are avoiding school School refusal is usually related to one or more emotional disorders. It is often seen in conjunction with anxiety, social phobia, depression, and obsessive compulsive disorder. Kids with school refusal are not refusing school to be defiant or get attention. There are usually underlying factors and emotional issues causing this behavior.
What to Do If Your Child Has School Refusal
You are dreading tomorrow morning. Not because you have to go to a job you may hate, but you are worried that you won’t be able to get your child out to school. It has happened a few times before and you don’t know when it will happen again. Possibly your child is in full blown school refusal and hasn’t been to school for consecutive days or weeks. I am sorry you are going through this because I have lived it and I know it is scary and all consuming. If this sounds like your current situation, then I would like to offer some suggestions on where to start getting help.
Call your school and let them know what is going on. Ask for the School Psychologist or a member of the Child Study Team. The child study team (CST) is usually made up of the school psychologist, a social worker, a case manager and sometimes a learning specialist. Their role is to assist children who qualify for special education. Don’t get confused with the term special education. Special Education also encompasses children who are diagnosed with an emotional disability (depression, general anxiety disorder, social anxiety, and obsessive-compulsive disorder). Of course, special education also includes children with learning disabilities, developmental disabilities, children on the spectrum and children who may have a physical disability. The CST is supposed to work with parents, students and teachers to help accommodate the student’s disability. Your child has the right to be able to access education as illustrated through the federal Special Education Law called the Individuals with Disabilities Act (IDEA). Your ultimate goal may be to get a 504 plan or an Individualized Education Plan (IEP) for your child. These plans can include; modifications of work, extended deadlines, study guides, audio/visual technologies, cooperative classes that have a special education teacher to assist the head teacher and/or visits to the school social worker or psychologist.
Schedule a meeting with them to see how they may help you. Afterwards you may want to request a psychiatric evaluation and/or psychological evaluation as well. This may be needed to start the ball rolling toward getting an IEP or 504 plans. When requesting anything like an evaluation, please put it in writing via email or mail so there is a time stamp. Special Education laws require school districts to respond to requests within specific time frames.
Try your hardest to get them into the school building. I really do hate to add this because of course you have tried to get your kid back to school! And when you hear a friend or family member say “Just get them to school” like it’s no big deal, it makes you just want to scream. The only reason I add this is because all the therapists and psychiatrists I have ever spoken to about this, say try whatever you can. The longer they stay away, the harder it is to return. Our middle school actually first sent the assistant principal and the school nurse to my house once to get my son out of the door. Another time they sent his guidance counselor and the last time they actually sent a policeman in uniform. All those situations broke my heart and made me sick to watch them try to coerce him. I question if it was worth it. They did get him to go with them those times, but it did not solve the problem. Long term school refusal soon kicked in. But if your child isn’t in crisis, and you have support from professionals at his school, being tough and determined may help get them back into the school building.
Find a qualified Psychologist and Psychiatrist. School Refusal in itself is not an emotional disorder but is a symptom of one. Your child needs help and support learning how to handle or overcome his emotional challenges. The most common causes of school refusal are General Anxiety Disorder, Social Anxiety Disorder, Depression, Obsessive Compulsive Disorder and Separation Anxiety. Be selective when searching for a therapist and psychiatrist. Make sure to include asking them what percentage of their practice has dealt with school refusal. Ask them what form of treatment they specialize in. You may choose to focus on a psychologist who practices Cognitive Behavioral Therapy. CBT works to solve current problems and change unhelpful thoughts and behaviors. CBT is often cited as the best therapy for anxiety and OCD. You may also want to consider a therapist who is trained in Exposure Response Therapy. ERP focuses on gradual exposures to anxiety inducing stimuli and situations. It is usually done in a hierarchy of least to most anxiety producing situations so the individual can build their strength and success.
You can also find free or low-cost mental health assistance through community resources. Sometimes this is offered from the county in which you live in or your state. I would try a google search like “(your county name here) mental health assistance” or “(your state name here mental health services, or mental health assistance).
Try to remember that there is hope that you child will get back to a school setting. There are resources and professionals to help, you just have to be determined and unrelenting to find the best help for your child.
School Refusal is often accompanied by one or more of the following:
Anxiety (General Anxiety Disorder, Social Anxiety Disorder, Separation Anxiety)
Obsessive Compulsive Disorder
Mary B. Wimmer, PhD School Psychologist from Wisconsin and School Refusal Expert goes on further to explain the “CHARACTERISTICS OF STUDENTS WITH SCHOOL REFUSAL”
“Anxiety, depression, and physical complaints are frequently associated with school refusal. Anxiety Students with school refusal often exhibit separation, social/performance, or more generalized anxiety reactions as well as other anxiety disorders. Separation anxiety. Students with separation anxiety, which is most common in younger children, become preoccupied with thoughts of harm befalling a loved one and are overly dependent on parents and other caregivers. They may cry, kick, or run away to avoid coming to school. Many young children experience separation anxiety in preschool or when starting kindergarten. However, if the behavior continues for weeks or even months, it is more serious and needs to be promptly addressed.
Social/performance anxiety. Students with social/performance anxiety worry about what others think, are concerned about how they will be judged, and fear humiliation. They may have intense anticipatory anxiety about giving speeches, taking tests, or participating in sports.
Generalized anxiety disorder. Students with generalized anxiety disorder (GAD) have excessive anxiety and worry about any number of situations and events. These students are concerned about their competence, unsure of themselves, and perfectionist about their schoolwork. They tend to perceive the world as threatening and may experience anxiety about situations such as war or catastrophic events like tornados and hurricanes. Their anxiety interferes with school performance and can cause fatigue, restlessness, difficulty concentrating, irritability, sleep disturbance, and muscle tension.
Other anxiety disorders, such as obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic attacks, and agoraphobia, can be associated with school refusal.
Depression may be the cause of school refusal behavior for some students. Common characteristics of depression in children and adolescents include depressed mood, lack of interest in activities, irritability, difficulty getting along with others, rebellious or risk-taking behavior, sleep difficulties, physical complaints, fatigue or lethargy, feelings of inadequacy or excessive guilt, difficulty concentrating or indecisiveness, and thoughts of death or suicide. For students who refuse to go to school, the presence of depression is associated with more severe symptoms than for those students with anxiety alone. Many students suffer from both anxiety and depression, two disorders that often occur together”
Dr Chris Kearny from UNLV is a leading researcher and author on school refusal. He devised the following categories to illustrate school avoidance causes.
School Refusal: Categorical-Dimensional Approach Based on Function
• to avoid school-based stimuli that provoke a sense of negative affectivity, or combined anxiety and depression; examples of key stimuli include teachers, peers, bus, cafeteria, classroom, and transitions between classes
• to escape aversive social or evaluative situations such as conversing or otherwise interacting with others or performing before others as in class presentations
• to pursue attention from significant others, such as wanting to stay home or go to work with parents
• to pursue tangible reinforcers outside of school, such as sleeping late, watching television, playing with friends, or engaging
The following is the School Refusal Assessment Scale-Revised (SRAS-R), developed by Christopher Kearney and Wendy Silverman. It is a psychological assessment tool designed to evaluate school refusal disorder symptoms in children and identify their reasons for avoiding school.
Scoring and interpretation of the SRAS-R
Scoring the SRAS-R is based on a 0-6 scale, with each question being scored as follows based on participant response:
0 points: 0, meaning “never”
1 point: 1, meaning “seldom”
2 points: 2, meaning “sometimes”
3 points: 3, meaning “half the time”
4 points: 4, meaning “usually”
5 points: 5, meaning “almost always”
6 points: 6, meaning “always”
Each item in the question set contributes to a different function which may be contributing to the child's school refusal behavior. Total scores may be computed by adding the scores of each of four functions on both the parent and child versions. These function scores are each divided by 6 (the number of scores in each set). Parent and child function scores are then summed and divided by 2 to determine the mean function score. The function with the highest mean score is considered the primary cause of the child’s school avoidance. The function divisions are as follows:
Function one ("avoidance of stimuli provoking negative affectivity"): items 1, 5, 9, 13, 17, and 21
Function two ("escape from aversive social and/or evaluative situations"): items 2, 6, 10, 14, 18, and 22
Function three ("attention seeking"): items 3, 7, 11, 15, 19, and 23
Function four ("tangible rewards": items 4, 8, 12, 16, 20, and 24
Scores within 0.50 points of one another are considered equivalent.