How to recognize what's called '#school refusal' and how to get #kids back in class

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Writer: Rachel Busman, PsyD, ABPP

Clinical Expert: Rachel Busman, PsyD

Most #kids don’t want to go to #school once in a while. But #kids with what experts call “#school refusal” have a lot of very extreme #anxiety about going to #school. Your #child may have #school refusal if they often try very hard to avoid school and get extremely upset about going. #Kids with #school refusal may also feel sick a lot and regularly visit the #nurse.  

Sometimes #kids may be anxious about going back after being home sick or after a #school vacation. For these #kids, it is important not to let them stay home. They need to get back in the swing of things as fast as possible.  

If #school refusal goes on for weeks or months, it’s time to take action. It’s possible that your #child is being bullied or having a hard time with a #teacher. If you think that might be the case, talk to your child, their #teachers and other #adults in their life to find out if anything is going on. #School refusal usually goes along with disorders like #separationanxiety, #depression or #panicdisorder. An evaluation from a professional can tell you if your #child needs treatment. #Cognitivebehavioraltherapy (#CBT) and exposure therapy are used to treat #school refusal. These therapies help kids manage anxious thoughts and face their fears little by little.

The term “#school refusal” used to be more or less synonymous with truancy, invoking a picture of #kids hanging out on the street corner, or holed up in their bedrooms playing video games.

While it is true that some game-playing might well be involved, it’s important to understand that #school refusal is not the same as playing hooky. It isn’t driven by the allure of having fun outside of #school, but rather by an aversion to #school itself.

Problematic patterns

Everyone resists going to #school once in a while, but #school refusal #behavior is an extreme pattern of avoiding #school that causes real problems for a child. School refusal is distinguished from normal avoidance by a number of factors:

- How long a #child has been avoiding #school

- How much distress they associate with attending #school

- How strongly they resists

- How much their resistance is interfering with their (and their family’s) life

Including all these aspects is important, because a #child can still have #school refusal even if they attend #school most days. I’ve worked with #kids who have missed only a day or two of #school, but they’ve been tardy 30 times because their #anxiety is so extreme it keeps them from getting to #school on time. #Kids with #school refusal might also have a habit of leaving early, spending a lot of time visiting the #nurse, or texting #parents throughout the day.

Suspicious sick days

Often #kids with #school refusal will start reporting unexplained symptoms like headaches or stomachaches. #Anxiety does manifest in physical ways, so their symptoms could be indicative of that. As a #parent, the first thing you want to do in this situation is get your #child checked out by a #pediatrician; you don’t want to overlook a medical problem. But it may be that going to #school is their problem.

Sometimes resistance to attending #school is just a little blip on the radar, and it can be easily remedied. Maybe your #child had the flu and was out for a good amount of time, and now they are having a hard time making the transition back to #school. Suddenly they’re getting clingy and anxious about all the homework they missed.

In this scenario, it is important not to prolong time at home. Instead, you want to have a conversation with the #teacher and with your #child. You want to be able to tell them, “We’ve talked to your #teacher, and he knows you were sick. I know you’re worried, but he understands. It’s time to get back to #school.” Then they return to #school and often things go relatively smoothly.

Similarly, some #kids in #school experience blips of #anxiety after vacations. The key point is to get #children back in #school as soon as possible.

More serious concerns

When #school refusal starts to become a bigger problem—it’s going on for numerous days, weeks or even months—you should reach out and ask for help. This includes #kids who go to #school but only attend partial days because they are spending a lot of time in the nurse’s office and getting sent home early from #school.

Understanding the problem

For more serious cases of #school refusal, the first step in treatment is getting a comprehensive diagnostic assessment. While #school refusal is not a diagnosable disorder, it often accompanies disorders like #separationanxiety, #socialanxiety, #depression or #panicdisorder. A complete assessment helps treatment professionals understand what is underlying #school refusal, allowing them to tailor therapy to your child’s particular situation.

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Listen up

It’s also possible that something specific is happening at #school, like #bullying or a difficult class. This doesn’t mean you should immediately jump in and ask your #child who doesn’t want to go to #school, “Who’s #bullying you?” But it is important to know what is going on in your child’s life. You should expect to hear what their #teacher is like and how homework is going. You should also have a sense of the #kids your #child is hanging out with. These are all things that should come up in everyday conversation. And if your #child mentions that something happened that day, perk your ears and put down whatever you were doing and listen in a nonjudgmental way, because it could be important.

Reaching out

Treatment providers working with #kids who have #school refusal will often use #cognitivebehavioraltherapy, which helps #kids learn to manage their anxious thoughts and face their fears. While #kids who are anxious might disagree, the best way to get over #anxiety is actually to get more comfortable with feeling anxious. #Kids need the chance to see that they can attend #school and their worst fears won’t happen. Exposure therapy, which reintroduces #kids to the #school environment gradually, is very effective at this. In the very beginning of treatment, this might mean driving by the #school or walking through its empty halls on the weekend. From there #kids can work up to attending one or two classes and then eventually attending a full day towards the end of treatment.

It’s best to be proactive and catch #school refusal as soon as you can. Unfortunately, the longer a #child misses #school, the harder it is to get back in the routine, because being absent is very reinforcing. I have worked with families that describe getting ready for #school like it’s a battle complete with huge tantrums. Sometimes the morning gets so challenging and exhausting that mom and dad just give up and say, “Fine, stay home; I’ll go pick up your homework.” It’s a very understandable situation, but again, letting it continue puts #kids one day further from being back at #school. It is important for #parents to know that the sooner the #child gets back to #school the better, and reaching out for help is an important first step.

Rachel Busman, PsyD, ABPP

Rachel Busman, PsyD, ABPP is a licensed clinical #psychologist and the senior director of the #Child & #Adolescent #Anxiety and Related … Read Bio

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