School refusal: When a child won't go to school

The transition back to school each fall is challenging for many families. But some children and teens feel so much emotional distress that they may repeatedly balk at attending school or staying there - a problem known as school refusal, or school avoidance if it occurs consistently. Ways to identify school refusal and tips on responding to it quickly are described below.

What is school refusal?

Shifting from a more relaxed summer routine to early wake-ups, hours in class, and dreaded homework makes many students feel mildly anxious or cranky during the early weeks of a new school year. For some students, however, school feels so difficult and overwhelming that they experience significant, distressing anxiety around attending and staying in school. To relieve this anxiety, a child or teen may begin to avoid school.

School refusal can take many forms. It can include behaviors like frequently struggling to arrive at school on time, leaving before the school day ends, or not attending school at all. Headaches, fatigue, stomachaches, and other physical symptoms of anxiety may make it hard to get off to school in the morning or make it feel necessary to leave early.

School avoidance allows a child or teen to escape distressing aspects of the school day, which provides immediate short-term relief. However, when a student continues to miss school, returning can feel harder and harder as she falls behind academically and starts to feel socially disconnected from classmates and teachers. Additionally, the child doesn't get the chance to learn that it's possible to handle school-related anxiety and cope with any challenges the school day brings. This can keep her stuck in a vicious cycle of school avoidance.

What can parents do to help stop the cycle of school refusal?

• Step in quickly. Missed schoolwork and social experiences snowball, making school avoidance a problem that grows larger and more difficult to control as it rolls along. Be on the lookout for any difficulties your child might have around attending school on time and staying for the full day. If the problem lasts more than a day or two, step in.
• Help identify issues. Try to find out why your child is avoiding school. Gently ask, "What is making school feel hard?" Is your child struggling socially or being bullied? Afraid of having a panic attack in the classroom? Worried about his academic performance or public speaking? Fearful of being separated from her parents for a full day?
• Communicate and collaborate. Your child's school is a key partner in combating school avoidance. Contact the school guidance counselor, psychologist, or social worker to share what you know about why your child is struggling to attend school. The more information the school has about why school avoidance is occurring, the better they will be able to help you. Collaboratively problem-solve with your child and the school by identifying small steps that can help your child gradually face what he is avoiding at school. Let's say fear about speaking in front of the class is a problem. A child might be permitted to give speeches one-on-one to a teacher, then to his teacher and a few peers, and gradually work up to speaking in front of the class.
• Be firm about school. Be empathetic but firm that your child or teen must attend school. Tell her you are confident she can face her fears. Let your child know that while physical symptoms of anxiety, such as stomachaches, headaches, and fatigue, are certainly unpleasant, they are not dangerous. Generally, children should only stay home from school for fever (at least 100.4° F), vomiting, or a few other reasons. It's important for anxious children and teens to learn that they can persevere and do what they need to do even when experiencing physical anxiety, just as adults must in their own jobs. Physical symptoms often ease up as the school day progresses and children face their fears. Learning this firsthand can empower a child.
• Make staying home boring. Is there anything about the out-of-school environment that makes it extra tempting to stay home? Make home as school-like as possible. No unfettered access to screens of any kind and no sleeping or lounging in bed unless genuinely sick. Be clear that if your child or teen does not attend school, you will be collecting all screens and/or turning off data and home wifi. Then follow through! Ask the school to send work for your child to complete during the day or to provide a tutor at home.

School avoidance is a serious problem that can worsen rapidly. Work closely with your child's school. It's also a good idea to consult with a licensed mental health professional who specializes in child anxiety and can support you in helping your child or teen re-engage in school. Ask the school guidance counselor or your pediatrician to refer you to an expert. The Association for Behavioral and Cognitive Therapies and the American Psychological Association also have online search tools. Additionally, your pediatrician may want to schedule a visit to rule out health problems.

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