By: Shelly-Anne Johnson LCSW
Families all over Georgia are struggling with the phenomenon of school refusal behavior. Ridgeview has a dedicated adolescent unit at each of our two locations and have seen firsthand the mental health blowback of this often overlooked issue. School refusal describes the disorder of a child who refuses to go to school on a regular basis, or has problems staying in school. Children may avoid school to cope with stress or fear for a vast number of reasons including mental health concerns like anxiety, phobias and/or depression, etc.
What does school refusal look like?
- Predictable of pleas for non-attendance with some regularity, (i.e., every Sunday night expect a fight with the child about the upcoming school week)
- Missing entire school days
- Missing parts of the day (i.e., leaving class or school during the course of a school day)
- Attending school but only after intense misbehaving at home in the morning
- Distress that is unusual which inevitably leads to pleas to not attend school in the future
School refusal behavior exists on a continuum that ranges from mild (clear cause & solution) to severe (long in duration [3 or more months] entrenched, student is at risk of dropping out) and can begin with complaints, leaving/skipping class to complete absences from school. This behavior also ranges in how it manifests at home (i.e., clinging to the parent, arguing in the car on the way to school, etc.)
Some common causes of school refusal include:
- Short term absences (i.e., during summer vacation, or a brief illness)
- A stressful event like the death of a pet or relative or moving to a new house
- Challenging classes/undiagnosed learning disability
- Teacher they don’t get along with
- Being bullied
- Mental health issue-diagnosed or undiagnosed
Warning signs to watch for:
- Frequent unexcused absences
- Going home before the end of the school day
- Asking to go to the nurse’s office often
- Skipping classes
Severe and prolonged school refusal jeopardizes the young person’s social, emotional and academic development, and may be associated with mental health problems in the future. When escape and avoidance behavior is reinforced by school refusal behavior that is allowed to continue, it teaches the child that when uncomfortable things happen in life, escaping and avoiding is the way to manage it. When this behavior is reinforced, it becomes a protective factor used at work and in social/love relationships well into adulthood. The future impact is far reaching and can include poverty and a life of crime.
What can parents do to help?
The first step is for parents and students to find out the function the school refusal behavior is serving for the child, and come up with a plan based on alleviating the distressing symptoms of that function. Chris Kearney and others posit that school refusal behavior is typically mediated by two things: avoidance or escape behavior- negative reinforcement (seen in students with anxiety and other mental health concerns like depression and phobias) OR students who are driven by positive reinforcement -they are in pursuit of attention from caregivers or tangible reinforcement outside of school (typically seen in students with conduct disorders but could have its base in anxiety).
For students whose school refusal is driven by the need to avoid or escape the parents should consider:
- Psychoeducation for the child and for themselves to understand what is really going on underneath the behavior.
- Somatic management skills-to teach them to manage unpleasant symptoms (i.e., anxiety symptoms, sleeplessness, etc.) and helping them learning how to soothe themselves
- Systemic desensitization & exposure
- Gradual exposure to increasing demands-exposing them to things that make them uncomfortable while teaching them how to manage these situations.
- Self-reinforcement/self-efficacy focus-the goal of all this is to have them start feeling better about themselves and gaining confidence as they accomplish these systematic goals. Help them to correct the things they have been struggling with in school and helping them to move forward.
For students whose school refusal is driven by the need for caregiver attention or for pursuing tangible reinforcers (rewards) outside of school the parents should consider:
- Establishing a fixed routine
- Learning how to negotiate and problem solve as a family
- Defining behavior problems and designing and implementing child-parent contracts (Contingency contracting-set realistic goals)
- Setting up positive and negative consequences
- Communication skills training
Parents will also need to form an alliance with a team at the school to formulate a re-entry plan. Do not attempt to go this alone. The bottom line is therapeutic intervention must begin with education and an understanding of the function that is driving the school refusal behavior. This can be used as a starting point from which to formulate a plan for school re-entry. Find resources in the area and reach out for therapeutic support if the behavior cannot be managed at home. Ridgeview has dedicated adolescent units for both inpatient and outpatient care, with compassionate staff trained in providing the specialized care that adolescents need. Call us or stop by one of our campuses for a no cost assessment to see the best level of care for your child.