I have been seeing an increasing number of school refusal cases in my clinical practice. I have yet to read any studies that provide empirically based findings as to why this challenging set of behaviors is on the rise, but I do have a few (unsubstantiated) theories:
1. Children and adolescents have access to too many enjoyable activities when they stay home. When I was a child, if I were to stay home from school, I would be bored out of my mind. Unless I could have quickly caught up with the story line of “General Hospital,” there would be nothing to distract me from the long, drawn-out day, where I was lacking in social interactions. Today, the average home has TVs hooked up to cable, computers, iPads and smartphones galore and gaming systems, etc. Who would not want to stay home and “play” with their gadgets, in contrast to engaging in the challenging curriculum and unchartered social relations of an average day at school? I am always shocked when I hear how the children and adolescents who are too “emotionally ill” to go to school are allowed to be home, having access to technology. IF you are too sick to go to school, then you need to be engaging in a behavior that as closely as possible approximates the behaviors one would engage in at school. As long as your kid does not go to a school for programmers and gamers, chances are their school day does not entail being locked into technology. So they should not be allowed to do that if they are engaging in school refusal behaviors.
2. Parents fail to see the dangerous waters their child is entering when they engage in school refusal behaviors. When your child is little and screaming about not wanting to go to the doctor, what do you do? Do you negotiate? Do you wait until they are ready to obtain their annual checkup? Going to school is as mission-critical to survival as obtaining appropriate medical care. I always tell parents who meet with me that we need to treat school refusal as a psychiatric emergency. Children not showing up for school is equivalent to adults not showing up for work and not caring for their families’ needs.
3. It is unclear why the child is refusing to attend school. In treating school refusal, it is critical to first conduct a functional analysis to determine why a child is refusing to go to school. School refusal is not a diagnosis; it is a symptom of a disorder. Is a child refusing to go to school because he is being bullied? Is she refusing to go to school because she is having panic attacks in the cafeteria? Is he refusing to go to school because he fears he will not make straight A’s and his rigid, perfectionistic thinking is getting in his way? It is critical to figure out why a child is having a difficult time going to school in order to develop an effective treatment plan, to assist your child in reintegrating back into school.
It is also critical to have the support and the assistance of your child’s school. It can assist you in creating an appropriate action plan to get your child back to school. That plan may entail a school staff member temporarily coming over to escort your child to school in the mornings (nothing quite as effective at getting a kid up and out as a school security guard entering the home). The plan may also entail accommodations such as your child being able to take a break from class if he or she feels a panic attack coming on. There are many creative strategies to assist a child in more effectively managing distress and obtaining the tools and skills necessary to handle life’s challenging moments. What is most important is for children to learn that quitting, avoiding, or running away from problems is not a viable long-term solution. As we adults have all learned the hard way, it just leads to digging ourselves deeper into the pain and suffering.
If your child is struggling with school refusal or school anxiety, I recommend you contact a mental health professional trained in cognitive-behavioral therapy (CBT) or pharmacotherapies or both. You can search for a therapist in your area on the Anxiety and Depression Association of American (ADAA) website to help you with this challenging, but very important work.
Worries are a fact of life. We all have thoughts like these: “Am I going to be late for a meeting?” “Should I accept this job offer?” “Did I eat too much?” “Is Mary angry with me?” “Am I on track for getting an A in this class?” and “Did I plan enough time for my husband and I to spend together on our trip?”
The fact is that worrying can be a useful activity: A student who worries about doing well on an exam is more likely to study than a student who doesn’t worry at all. Worries indicate you are invested in something, and they can motivate you to work toward your goal. Fortunately for most people, when worrying is unhelpful or interferes with their lives, they can usually put it aside.
But some people have worries that are incessant, pervasive, intrusive, unproductive — and difficult to turn off. Their worries are present from the moment they wake up until last minute of their day. This type of chronic worrying can negatively affect their daily functioning.
When this happens, it may be a disorder called GAD, or generalized anxiety disorder. Their worrying persists even when there is very little or no cause for worry. Many chronic worriers also suffer from irritable bowel syndrome, insomnia, hypertension, back pain, and other physical symptoms.
If chronic worrying is a problem for you, here are three things you can do to cope outside of your therapist’s office:
1. Train yourself to worry about a one thing at a specific time each day. If your worries pop up at any other time, gently remind yourself, “I’ll think about this at 4:30 p.m.” When that time arrives, think about your one worry.
2. Determine if your worry is productive or unproductive. Ask yourself if there is anything you can do in the next hour (or the next few hours, the next day) to address it. If so, great! If not, make a conscious effort to put it on the shelf. If you find yourself worrying about an exam you already took, put your worry aside. Tell yourself that you can’t do anything about it so worrying isn’t helpful right now. Then decide what you can do instead that will be more useful. Go for a walk, go to the gym, call a friend, etc.
You should know that your worry will jump from the shelf into your lap over and over again. Just don’t let it lie there; make yourself put it on the shelf again and again.
3. Learn mindfulness meditation and practice it daily. It will allow you to develop a different relationship to your thoughts and worries. Rather than reacting to worries as if they are reality, you will observe and be aware of them without letting the emotional content suck you in. Take five minutes each day to focus on something neutral such as your breathing or sounds, while staying aware of the worries that tug at your concentration. If your awareness drifts away from your “anchor,” notice where it goes and gently redirect your awareness back to the breathing or sounds. This trains your mind to remain aware when your worries begin to creep in and to let them go.
If you treat your worries as habits that you can train or as activities to limit, you can “get out of your head” and live your life more fully. Learn more about the symptoms of GAD, as well as treatment options or how to locate a therapist on the website of the Anxiety and Depression Association of America (ADAA): visit www.adaa.org.
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