Understanding School Refusal Behaviors

1 1/23/13 1 Understanding School Refusal Behaviors : Strategies for School - Based Staff & Parents Topics Covered 0 Who am I? 0 Goals of the Presentation 0 What are School Refusal Behaviors ? 0 Functions of School Refusal 0 Treatment Approaches 0 Challenges Faced by Staff and Treatment Providers 0 Treatment Options in HRM Who Am I? 0 Daniel Chorney, 0 Registered Clinical Psychologist 0 Owner/Psychologist @ Dr. Daniel Chorney & Associates 0 Dr.

2 Jason Chatman, Dr. Alissa Pencer, Dr. Tricia Beattie, Dr. Lindsay Uman 0 Former IWK Anxiety Team Leader & Community Mental Health staff psychologist 0 Previous research in anxiety development and expression across the lifespan 0 Education: 0 Psychology UBC 2004 0 Psychology West Virginia University 2006 0 Psychology West Virginia University 2009 0 Clinical Internship Brown University 2009 Goals 0 1. Basic Understanding of what constitutes School Refusal (aside from the obvious!)

3 0 2. Ability to identify why a child is avoiding School 0 3. Ability to develop a basic School - based behavioral plan to help reduce non- attendance 0 4. Ability to identify & refer complex/severe situations to appropriate services What IS Anxiety? 0 a feeling of worry, nervousness, or unease about something with an uncertain outcome Oxford English Dictionary Disclaimer! 0 Not all School Refusal is due to anxiety. 0 Not all School Refusal is due to anxiety.

4 0 Not all School Refusal is due to anxiety. 0 Not all School Refusal is due to anxiety. 0 Decinitely not all School Refusal is due to anxiety 0 Anxiety sometimes becomes the default when no one knows what to do 1/23/13 2 Decinitions 0 School Refusal Behavior(s) 0 Child- motivated Refusal to attend School and/or problems remaining in class for an entire day 0 Refers to a continuum of Behaviors (next slide) 0 An umbrella term that subsumes constructs such as.

5 0 truancy (unexcused, non- anxiety based absence) 0 School Refusal (anxiety- based due to separation, social, or generalized anxiety) 0 School phobia (older term rarely used now) School attendance with stress and pleas for non- attendance Repeated misbehaviors in the morning to avoid School Repeated tardiness in the morning followed by attendance Periodic absences or skipping of classes Repeated absences or skipping of classes mixed with attendance Complete absence from School during a certain period of time Complete absence from School for an extended period of time How Common Is It?

6 0 If including all Behaviors from previous graphics, prevalence can be as high as 28% (Kearney, 2001) 0 Difcicult to quantify due to heterogeneous nature (some children miss some School , some drop out entirely, etc) 0 Community studies suggest approximately 0 School Refusal and truancy, not including those who attended with distress 0 School Refusal behavior not closely linked to gender, race, or socioeconomic status 0 Typical age of onset is between ages 10- 13 (middle School entry) 0 Dropout rates are more common in.

7 0 Males 0 Ethnic minorities 0 Children/families of lower socioeconomic status 0 Children with disabilities Function Junction Four Primary Reasons ( Functions ) Children Refuse School 1. Avoid School - Related Stimuli That Provokes Negative Affectivity 2. Escape Aversive Social and/or Evaluative Situations 3. For Attention (Positive and/or Negative) 4. Tangible Rewards Outside of School Something bad Socially anxious Anxiety Parental Attention Fun Stuff at Home Rewards #1 Refusal Due to Anxiety 0 To avoid School - related School - related stress or stimuli that provoke negative affectivity (symptoms of dread, anxiety, depression, and somatic complaints that are negatively reinforced) 0 Translation: Something at School makes them mad, sad, scared, or upset 0 Examples.

8 Buses, cire alarms, gymnasia, playgrounds, hallways, classroom items, learning/academic issues 1/23/13 3 Characteristics #1 0 Most often younger children (5- 10 years old) 0 Often display difciculty with transitions due to fear 0 Can relax once in a place for extended time 0 Difciculty articulating what the source of fear is 0 Something bad will happen 0 Source is not actual/legitimate or reaction is excessive 0 , they are not avoiding due to true bullying or true threat 0 More concerned with NOT being in School than being at home (Function #4)

9 Common Behaviors 0 Difciculty concentrating due to distress 0 Excessive crying or tearfulness 0 Fear of a specicic School - related object or situation 0 Feigned illness to avoid School /class/projects 0 Irritability, restlessness, tense 0 Vague physical complaints head, stomach, nausea, fatigue 0 Sadness or withdrawal from peers and teachers 0 Shaky hands, voice, general nervousness/anxiety 0 Many of these Behaviors are seen throughout all 4 functions of School Behaviors (at times feigned) #2 - Refusal Due to Anxiety 0 To escape aversive social and/or evaluative situations at School (negatively reinforced) 0 Translation: Feeling judged, evaluated, or put in front of an audience or peers makes them excessively shy/anxious 0 Examples.

10 Interactions with teachers, principals, and verbally or physically aggressive peers, tests, recitals, athletic performances, speaking or writing in front of others, or walking into class with others present Characteristics #2 0 Typically slightly older (11- 17 years old) 0 May show heightened anxiety in relation to one class or section of the School day 0 , changing in front of others in PE, music class, drama, skips class on test/performance days, or when something is due 0 May have difciculty handing in assignments despite completing them 0 Pattern is often one of avoiding interactions with others 0 Eating lunch alone, escaping crowded places quickly.