School refusal — it exists, and is when a child refuses to go to school because of emotional distress. However, this is different from another type of refusal called truancy. Truancy is associated with skipping school because of defiance and doing so in deceptive ways.
School refusal is associated with anxiety disorder and often occurs in children who are typically well-behaved and compliant in other aspects of their life. “Many youths demonstrate some aspect of school refusal behavior, making it one of the most common childhood behavior problems. In addition, extended school refusal behavior can lead to serious short-term and long-term consequences if left unaddressed,” says Christopher A Kearney, Ph.D. in a report for the University of Nevada.
Most times, school refusal occurs when a child is around five to six years old or 10 to 11 years old, according to a Special Health Report from Harvard Medical School. Typical triggers include the start of a new school year, especially during transitional grades, such as beginning first grade or entering middle school, according to Harvard Health. It is associated with separation anxiety, social anxiety disorder and generalized anxiety disorder.
Children might complain of stomach aches, headaches or other illnesses and, especially in young children, they might feel sick. Anxiety often causes physical symptoms such as these. Other children might cry, scream or plead until parents give in and allow them to stay home. Some children might miss days, weeks or even months of school because of anxiety. The longer they stay away from school, however, the more difficult it is to go back.
What parents can do
The first step is often to take your child to the doctor. If your child is consistently complaining of stomachaches, headaches or other ailments, it is best to have him evaluated by a doctor to rule out physical causes.
Request an evaluation from a mental health provider, preferably one who specializes in childhood anxiety. School refusal isn’t a diagnosis, it is a symptom. While many anxiety treatments are similar — for example, cognitive behavioral therapy is used to treat different anxiety disorders — it is best to have an accurate evaluation and a professional who specializes in treating children.
Talk to your child’s teacher to find out what is going on at school. There could be situations, such as bullying or academic difficulties, that are triggering or worsening your child’s anxiety. Ask the teacher about social situations, how your child seems when he is at school, who he spends time with during recess and how his academic progress is. This can help you find ways to help your child manage his feelings of anxiety.
Keep an ongoing dialog with your child about what is going on in his life. Ask about homework, what he thinks of his teacher, how he gets along with classmates. Ask about friends and suggest inviting friends to your home. You don’t want to interrogate your child or judge his behavior, but you do want to show you are interested.
Set ground rules for staying home from school. Your goal is for your child to go to school. Staying home shouldn’t be a day to play and have fun. Set rules on what your child can and cannot do if he doesn’t feel well enough to go to school — for example, rest in bed, read books, no television, no video games. Offer minimal attention. (This is when ruling out a physical cause helps, because you won’t feel guilty for not paying attention to your child’s health.) Make sure staying home isn’t a treat.
Decide before the school year begins what constitutes being sick enough to stay home. A fever? Throwing up? If your child already knows what you expect, your answer is, “I know you aren’t feeling well this morning but you don’t have a fever, so you are well enough to go to school.” Again, if you have brought your child to the doctor to rule out physical causes, you can safely send them to school. If by chance he is ill, let him know that he can go to the nurse and if she determines he is sick, you will pick him up.
Enlist the help of a relative, friend or neighbor to get your child out the door and off to school. Children often won’t put up a fight for someone other than a parent.
Arrange a one-on-one meeting with the teacher. This is helpful if your child is starting a new school or going through a transitional year. Ask if the teacher would be willing to meet with your child after school (you can be present) so he can get to know and feel more comfortable with the teacher.
Focus on the positive aspects of going to school. What does your child most enjoy? Is it being with friends? Art class? Learning about science? Remind him that he needs to go to school to experience the good parts of the school day.
Seek help. Look for a counselor or therapist who has experience working with children. Cognitive behavioral therapy helps kids get more comfortable with feeling anxiety, manage anxious thoughts and face their fears.
It’s important to find ways to help early. The longer a child misses school the harder it is to get back into the routine. Staying out of school for one day might seem like a good idea, but it reinforces the anxiety and makes the fear more real in your child’s mind.
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Eileen Bailey is a freelance health writer. She is the author of What Went Right: Reframe Your Thinking for a Happier Now, Idiot’s Guide to Adult ADHD, Idiot’s Guide to Cognitive Behavioral Therapy, Essential Guide to Overcoming Obsessive Love, and Essential Guide to Asperger’s Syndrome. She can be found on Twitter @eileenmbailey and on Facebook at eileenmbailey.