Disclaimer: The information contained in this article is for informational purposes only and is not a replacement for professional medical advice. Since each case of school refusal is unique, this article may not apply to your specific situation. Should you require medical advice, it is crucial to consult with a trained healthcare professional such as a psychiatrist, who can provide you with tailored recommendations.
Instances of children and teenagers refusing to attend school can place substantial stress on families, potentially leading to parent-child relationship conflicts and detrimental impacts on the young person's academic progress. Known as school refusal by school and mental health professionals, this issue can originate from various factors. This article will explore some of the common reasons behind school refusal, and examples of solutions to each.
Recognizing that there is no singular cause for school refusal is essential. Consequently, there isn't a universal solution that applies to every situation. The first step involves gaining an understanding of the young person's thoughts, feelings, and external circumstances that might contribute to school refusal. Often, this involves dedicating time for an open conversation with the child or teenager.
Discussions about school refusal within a family setting can be fraught with tension, potentially leading to unproductive arguments and strained relationships. It is advised for parents to approach the situation calmly and with curiosity. Validating the young person's feelings, irrespective of the appropriateness of their actions, can foster open communication. In cases where these strategies don't suffice or the young person struggles to articulate their thoughts, feelings, and experiences, seeking professional help is often necessary. If the young person doesn't have a psychiatrist or therapist, scheduling an appointment with their pediatrician can be a beneficial starting point.
Unraveling Common Reasons for School Refusal
School refusal can stem from a plethora of reasons, some of which we will discuss below.
1. School Environment: Situational issues within the school setting can often precipitate school refusal. For instance, a child experiencing bullying or a teenager feeling academically overwhelmed might understandably feel the urge to avoid school. It's essential to understand that these challenges can be situational, not necessarily indicative of a mental health problem. This is especially true in the San Francisco Bay Area, where school can be very competitive and academic pressure is high. Sometimes the expectations society places on our young people are not tolerable. Other times specific teachers may have rigid tendencies that create situations that feel unwinnable. Parents can often benefit from maintaining close communication with the school during such instances, with school counselors and teachers often serving as useful points of contact. Sometimes school refusal stops after the adverse situation is changed.
2. Mental Health Issues:
Anxiety Disorders: Various forms of anxiety disorders can lead to school refusal. For instance, a child with separation anxiety might worry excessively about being away from their parent or fear that something harmful will happen to the parent. A young person experiencing panic attacks may fear having another panic attack, making it difficult for them to leave their home. Teenagers with obsessive-compulsive disorder (OCD) might avoid school to evade touching something they perceive as unclean or contaminated, or due to fear that they might harm another person. Young people with social anxiety might worry about potential embarrassment, causing them to avoid these risks by staying home. Fortunately, treatments for anxiety disorders exist, such as psychotherapy. Medications that adjust the brain's serotonin activity can also be helpful, generally very well tolerated, and are non-addictive.
Post-Traumatic Stress Disorder (PTSD): PTSD can also result in school refusal. Particularly if the traumatic event occurred at school or if there are cues within the school environment reminding the child of the trauma. The primary treatment for PTSD in individuals under 18 involves trauma-focused therapies. Common examples include trauma-focused cognitive behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), and Seeking Safety (for those who also have challenges with substance use). (I am personally trained in cue-centered therapy, a newer evidence-based therapy developed at Stanford specifically for young people.) While medications aren't a first-line treatment for PTSD in children or teenagers, they can help manage commonly co-occurring problems like anxiety, depression, and sleep issues.
Neurodevelopmental Disorders: Children with neurodevelopmental disorders like attention deficit/hyperactivity disorder (ADHD) or autism often face challenges in a traditional classroom environment. This is because their thinking and behavior function differently from their neurotypical peers. They also frequently experience social rejection and ostracism from peers. When young people do not feel a sense of belonging or success at school they are at risk for developing anxiety disorders and school refusal. Supportive measures often involve formal requests for a 504 plan or individualized educational plan (IEP). ADHD can be treated with medications, which are often very effective.
- Depression: The lack of energy and motivation, characteristic of depressive disorders, can also lead to school refusal. Symptoms of depression may include persistent sadness, changes in sleep and appetite, loss of interest in previously enjoyed activities, and excessive feelings of guilt. Depending on its root cause, depression can be treated by addressing any underlying physical health issues, psychotherapy, or medications that enhance serotonin activity.
It's crucial to acknowledge that these are just a few of the potential mental health issues that can contribute to school refusal. Other disorders not covered here, such as substance use disorders, psychotic disorders, and oppositional defiant disorders, can also play a role.
In summary, addressing school refusal can be complex and often necessitates professional assistance. Since the solution can significantly vary based on the cause of the behavior, the first step involves gaining an understanding of the young person's experience.
This process may involve validating, warm, supportive conversations with the young person and open communication with the school. If mental health issues are suspected, parents are encouraged to seek a diagnostic evaluation from a trained professional, such as a psychiatrist or psychologist. By doing so, they can ensure their child receives the appropriate support tailored to their unique situation.
