Transcription:
School Refusal, Why Doesn't Your Child Want To Go To School?

Melanie Cole (Host):   Does your child wake up complaining of an upset stomach or a headache and ask to stay home from school but once school starts, do they stop complaining and act normally or is there more going on? There might be many reasons. My guest today is Kristen Cole. She’s a Licensed Clinical Social Worker at Summit Medical Group. Welcome to the show, Kristen. School refusal—I mean, all kids, at some point, say, “Mom, I don’t want to go to school today.” Maybe it’s raining out. Maybe they say they have an upset stomach but when it becomes more common and they’re doing it more often, what is that? How is a parent supposed to take that kind of refusal?

Kristen Cole (Guest):   Well, I think the first thing is the real difference with school refusal is that it’s prolonged. So, it’s emotionally based school avoidance. So, it lasts repetitively and it’s initiated by the kid and it’s really due to severe emotional distress which could be coming from all types of things. I mean, it could be rooted in an anxiety disorder like generalized anxiety disorder or separation anxiety. Those are some of the most common. It also could be related to something that went wrong at school like bullying or maybe there’s a presentation coming up that they’re very anxious about which could be, but isn’t necessarily, social anxiety. So, I think that the issues for parents is to notice if it’s prolonged. It’s one thing for a kid to skip a day of school. When they start skipping school more than that, like more than a week, for example and they’re really expressing a great deal of emotional distress, that’s when you really want to come in and get some help.

Melanie:  I think every parent’s biggest question is do you let them? Even if they feel like they’re experiencing anxiety and stress, do you let them stay out of school or when does a parent intervene and call the school?

Kristen:  Well, I mean, that’s a great question, Melanie, and I would say you err on the side of sending them to school. One of the biggest issues with anxiety is accommodating the anxiety, so, unfortunately, sometimes even though we’re trying to maybe protect our kid, what we end up doing when we accommodate the anxiety is that we basically are saying, “Yes, it is kind of scary and you can’t handle it.” So, we really want to err on sending them to school. That said, I think the most important thing first is to really have a conversation with your kid. Acknowledge their experience. It’s very important to say, “I can see you’re really upset. I can see that you’re really scared. I can tell that you don’t want to go to school. Can you tell me what’s going on and what your brain is telling you? Why do you not want to go to school?” If it’s something that they’re perceiving danger from another kid, obviously, you want to go and intervene with the school staff and figure what the problem is but if it’s anxiety, then I really think you want to get them help for those fears.

Melanie:  Some kids say, “Oh, this teacher is mean.” Or, “I don’t like this class.” Or, “It’s too hard.” When it’s that kind of a situation, we’ve all come across mean teachers and we’ve all come across wonderful teachers that we loved and couldn’t wait to see again but when it is something like that, does a parent intervene?

Kristen:  Again, I would say it sort of depends. I mean, I think the first line, if they say their teacher is mean, I think you have to say, “Yeah? That’s too bad. I had a mean teacher once, too. Ick. I’m sorry you have to deal with that.” Maybe find out exactly how mean they are, obviously, but then I think it’s about sending them to school. The laws says you have to go to school. Be firm and committed to that. I think one of the things, again, that parents sometimes do is they start asking too many questions and worrying too much that their kid can’t really handle it and then they keep them home and then you have a whole problem that grows ever more serious. The longer they’re out of school, the worse the problem usually becomes.

Melanie:  So, are there some exams or tests to diagnose for excess school refusal?  Do you, as a counselor, are you able to assess the situation in some kind of means?

Kristen:  Yes. I mean, if people bring their kids in for an intake with our group, we do a whole battery of assessments on paper and then we do, obviously, a lot of questioning of the child and of the parent. You know, what we’re looking for is sort of the common anxiety disorders that lead to school refusal that I mentioned earlier. Separation anxiety is one. Generalized anxiety disorder is another. Sometimes kids have phobias related to school that are brought on by some sort of experience with alarms like fire alarms or something that they’re associating with the building. So, obviously, it makes a difference, right? We really want to know the root of their fear so that we can help them overcome it. I mean, the basic treatment approach, the heart of our approach, really, is to disconfirm the fear. We want to get them educated about fears and give them some ways to fight back the fear from the child’s perspective. From the parent’s perspective, we want the parent to know that they need to get their kid back to school as soon as possible. The other really important thing is not to make home attractive, right? So, if you stay home from school, you don’t want to let them be having fun while they’re home from school.

Melanie:  That’s absolutely a very good point. You don’t want it to be a more fun place than going to school. What about outside activities? Because sometimes kids who previously were athletic or that sort of thing, then all of a sudden decide they don’t want to do any of those things anymore. Is that along the same lines?

Kristen:  Yes, I think that when – it’s an interesting question – I’m thinking about my cases of school refusal. I don’t know that they were doing-- I think they sort of just once they stayed home, they stayed home. They weren’t staying home from school and then going to soccer practice. I don’t think parents would fall for that, exactly. If you’re going to stay home from school because you’re sick, you’re not going to then go to soccer practice.

Melanie:  Well, sure, that’s the old age adage. If you stayed home, you can’t go out and play or whatever it is. So, then, what is a parent to do, when does it become something that they bring their child in for that assessment?

Kristen:  I would say, again, the question is how prolonged it is, right? One or two days out of school, I don’t think that’s such a big deal. I do think it’s worth noticing if there’s a lot of emotional distress and fear associated with going to school in the morning. Once it becomes more than a week, I think it’s time to come in and get help. Cognitive behavioral therapy is one of the more effective approaches for helping kids with school anxiety.

Melanie:  That was going to be my next question. What do you do for them? After you’ve assessed them and tried to figure out what the reason is, how do you get them to not be afraid and go back to school?

Kristen:  The first thing we want to do is really teach them about fears and worries so that they can sort of better understand what they’re up against, right? You can’t really manage things if you don’t even know that they’re going on. The first thing we do is really teach them about our therapy and then we teach them about anxiety. We basically are trying to help them get better by realizing that the scary thing isn’t that bad and that they can handle it. It’s not easy because their anxiety is usually pretty acute for them to be staying home from school in a consistent way, but we try to get them to understand that the anxiety is tricking them into exaggerating the danger associated with school and underestimating their ability to handle it. There’s a lot of thinking interventions that we do in terms of helping them understand that their thoughts lead to feelings. Then, the big piece of it is behavior. We’ve got to get them back into the building as quickly as possible. Sometimes, we have to do that in a step-wise manner,  in a gradual way. Maybe first we’ll go to the building and you can be in the counselor’s office, then the next day you’ll go to the building and you’ll go to some of your classes – your favorite classes, maybe. And then, the next day you’ll stay for the whole day. It’s really important to be firm, from the parents’ perspective, to be firm and to keep pushing, reinforcing the behaviors.

Melanie:  Could this signal a future phobia?

Kristen:  It is, unfortunately, related to future mental health challenges, but not always. It’s really hard to say; it depends. But, definitely, there is research that shows that it’s related to future mental health challenges.

Melanie:  In your opinion, Kristen, in what you’ve seen doing what you do, how do the schools react to this? And, have they been generally helpful and do they help ease the student back in?

Kristen:  Yes, I would say so. I’ve had very good experiences working with schools, from the principals and teachers to the guidance staff and child study team and nurses. Nurses are pretty good about noticing the frequent flyers and the kids who are kind of excusing themselves from classes with stomachaches and headaches on a regular basis. They’ll often reach out to the parents and say, “You know, I think that there might be something going on here with anxiety. This isn’t probably a medical issue or maybe it is and you want to get that checked out.” But, in terms of working with the school, I’d say yes, I feel like the schools are kind of pretty well acquainted with this problem and they are willing to collaborate. They’ll come out and meet you at your car. So, if the mom is having a hard time getting the kid out of the car, the guidance counselor will come out and help. They’re willing to have the students-- their basic goal also is to get the kid back to school as soon as possible, so they’re willing to do lots of things to make that possible.

Melanie:  Then, wrap it up for us, Kristen. It’s such great information for parents. Tell parents what you tell them every day about this type of topic, what you can do to help them and why they should come to Summit Medical Group for their care.

Kristen:  Well, I think the first thing and my first tip for parents would be to have a positive attitude and believe that your child is going to get over this problem and let them know that you believe that they can handle it. I think the second thing I said earlier is really, I think it’s very important to start out with acknowledging their distress. Sometimes we as parents kind of want to, in our zeal to fix it and make it better , we sometimes immediately say, “No, you shouldn’t feel that way.” I think it’s really important to say, “I’m sorry you’re feeling that way; that sounds scary.” I think another important point is that we’re not really trying to eliminate anxiety; we’re trying to help kids manage their anxiety. It’s really all about small steps and avoiding avoidance, basically, because avoidance may make things better in the short run but it only reinforces anxiety in the long run. I guess, finally, I would say to parents you really want to have simple, clear expectations for rewards and consequences, and not keep asking leading questions like, “Are you scared? Are you worried? Do you think you can go to school?” Rather, I think it should be, “I know that you’re scared. It’s okay. I’m going to help you through it.” Treatment, I think, as I said, is really indicated for sure when it’s prolonged. In my view, that’s more than three or four days. Then, finally, I would say that from the parents’ perspective, again, you really don’t want your kid to be allowed to do anything during the school day that they wouldn’t be allowed to do at school because sometimes that will reinforce their staying home.

Melanie:  That is just absolutely great advice, Kristen. Thank you so much. You’re listening to SMG Radio. For more information you can go to www.summitmedicalgroup.com. That’s www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.