School Refusal: Information for Educators

1 School refusal : Information forEducatorsBY MARY WIMMER, PHD,West Allis-West Milwaukee School District, WIEach year, approximately 2 5% of children refuse to come to School due to anxiety or referred to as School phobia, School refusalincludes kindergarten students with relatively mildseparation anxiety and more severe cases where a student misses weeks or months of School because ofdebilitating anxiety or depression. Because of the serious long-term social and educational consequencesassociated with missing School , the problem needs to be addressed promptly and aggressively with a teamapproach that includes teachers, parents, administrators, support staff, and, in some cases, communityagencies and refusal is not the same as truancy. Truant students hide their absences from their parents, do notexperience emotional difficulties associated with coming to School , andmay be involved in illegal activities orjust avoid School in order to engage in a more desired activity, such as playing video games or hanging outwith friends.

2 Other situations that are not considered School refusal arehomelessness and OF School REFUSALS chool refusal is often the result of separation anxiety, social anxiety,or performance anxiety ( , aboutspeaking in front of others), or anxiety related to test-taking, athleticcompetition, or academic may refuse to attend School to escape from a situation that causesanxiety or to gain attentionfrom a parent or other caregiver. Some students may feel that the School environment is cold andunwelcoming and a place where they experience failure. Consequently, they give up and just stop students feel unsafe at School due to bullying or gang activity, and experience emotional difficultiesassociated with coming to refusal has been found to occur more often after vacations, weekends, or at the beginning andend of the School year. Events that prompt School refusal include the deathof a loved one, a prolongedillness, moving or changing schools, entering kindergarten, and the transition from elementary to middleschool.

3 The problem is more severe in older children than younger OF STUDENTS WITH School REFUSALA nxiety, depression, and physical complaints are frequently associatedwith School with School refusal often exhibit separation, social/performance, or more generalized anxietyreactions as well as other anxiety 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 andother caregivers. They may cry, kick, or run away to avoid coming to young childrenexperience separation anxiety in preschool or when starting kindergarten. However, if the behaviorcontinues for weeks or even months, it is more serious and needs to be promptly with social/performance anxiety worry about what othersthink, are concerned about how they will be judged, and fear humiliation.

4 They may have intenseanticipatory anxiety about giving speeches, taking tests, or participating in anxiety with generalized anxiety disorder (GAD) have excessiveanxiety and worry about any number of situations and events. Their worry and anxiety is over and aboveHelping Children at Home and School III|S5H18 1what the situation calls for. These students areconcerned about their competence, unsure of them-selves, and perfectionist about their schoolwork. Theytend to perceive the world as threatening and mayexperience anxiety about situations such as war orcatastrophic events like tornados and hurricanes. Theiranxiety interferes with School performance and cancause fatigue, restlessness, difficulty concentrating,irritability, sleep disturbance, and muscle anxiety disorders, such as obsessive compulsive disorder (OCD), posttraumatic stress dis-order (PTSD), panic attacks, and agoraphobia, can beassociated with School may be the cause of School refusal behaviorfor some students.

5 Common characteristics of depres-sion in children and adolescents include depressedmood, lack of interest in activities, irritability, difficultygetting along with others, rebellious or risk-takingbehavior, sleep difficulties, physical complaints, fatigueor lethargy, feelings of inadequacy or excessive guilt,difficulty concentrating or indecisiveness, and thoughtsof death or suicide. For students who refuse to go toschool, the presence of depression is associated withmore severe symptoms than for those students withanxiety alone. Many students suffer from both anxietyand depression, two disorders that often occur ComplaintsSchool refusers frequently express physical complaints(headaches, stomachaches) without the presence of amedical condition. Some students ask to go to the nurse soffice on a daily basis with complaints about stomach-aches or headaches.

6 Sometimes an actual illness, likeasthma, contributes to a pattern of School refusal . Here, astudent s asthma may be the initial reason for schoolabsence. Later, anxiety about returning to School serves tomaintain the School avoidance, even after the studentrecovers physically. School staff should consult with thechild s physician to determine if there are any restrictionsfor the child at School . If there is no medical reason forstaying home, the child should be in Warning SignsIt is critical that both parents and Educators learn torecognize common warning signs of School refusal andrespond quickly. These include:NFrequent unexcused absences or tardinessNAbsences on significant days (tests, speeches, phys-ical education class)NFrequent requests to go to the nurse s office despiteno apparent signs of illnessNFrequent requests to call home or go home during thedayNMajor family event/trauma, sleep difficulties, dif-ficulty concentrating, depressed mood, or irritabilityNDifficulty or resistance to getting out of bed in themorning to go to School despite no apparent signs ofillnessKEY STRATEGIES FOR EDUCATORSWhen teachers or parents suspect that a student isrefusing to go to School due to emotional reasons, theyshould take immediate action.

7 A team approach toassessment and early intervention that involves family, Educators , and community providers increases theprobability of a successful solution. The team can includethe teacher, principal, School counselor, School psycho-logist, School social worker, School nurse, and commun-ity members working with the child (therapist orphysician), as well as the student s team assessment can include observation, interviews,a thorough review of medical and School records, andattendance history. Questionnaires may be used to gainan understanding of the student s emotional anddevelopmental status. Achievement testing may beneeded, particularly if the student is refusing to cometo School because of academic difficulties. An assess-ment can also include determining the antecedents andconsequences of the School refusal (what happensbefore and after).

8 Teams need to consider whether there is a parent-related reason for the student not coming to School , as inthe case of abuse or School withdrawal. Some parentsare dealing with their own mental health problems; inthese situations, treatment needs to start with theparent. School staff assessing the reasons for a student sabsences often find that refusal to attend School is theresult of a complex combination of goal of intervention is to increase the student sschool health students with anxietyand/or depression, intervention provided by a mentalhealth professional often includes cognitive behavioralapproaches that teach coping strategies such asrelaxation, problem solving, reducing negative self-talk,and increasing healthy self-talk. Other strategies mayinclude teaching about anxiety, rewards for schoolattendance, parent training, goal setting, and setting 2| School RefusalMedication may be used in combination withcognitive behavioral therapy for a student who has apsychiatric disorder such as severe anxiety or depres-sion.

9 School personnel should refer the parents to mentalhealth providers outside the School when the problem issevere and/or the student needs more help than can beprovided by School plan that addresses what steps willbe taken when the student refuses to come to schoolshould be developed in collaboration with the School attendance may be appropriate for youngerstudents or those with mild School refusal . A gradualreentry plan is often recommended for older students orstudents who are extremely anxious or reentry may start with having the studentarrive at School but not go inside on day one, enter and visitin the front office on day two, and identify which class ismost comfortable and stay just for that class on day student should be helped to identify the staffmembers with whom he or she feels safest and who cangreet the student and provide a safe harbor.

10 For olderstudents or those with significant anxiety or depression,allowing for progressive reentry over a 1 2 week periodmay be effective. Teams might also consider part-timeschooling, or they might temporarily allow a flexible schoolday for students with extended absences ( , over 2years) due to extreme levels of anxiety and depression andwhen other interventions have been Supportive StrategiesThere are many other steps that Educators can take tohelp support students and families dealing with schoolrefusal:NEncourage parents to set up regular evening andmorning routines, reinforce their child s positivebehaviors (participation efforts), and ignore negativebehaviors (crying, whining).NAssist parents in bringing a reluctant or acting-outchild into the School . Work with parents to effectivelyrespond to their child s complaints about School , whileclearly ensuring that the child attends with parents to monitor attendance, particularlyfor older the separation-anxious child when he or shearrives at School .