What is School Refusal?
School refusal is not a recognized condition as identified by the official manual for diagnosing mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is simply a symptom and can be linked to various conditions such as social anxiety disorder, depression, oppositional defiant disorder, post-traumatic stress disorder, among others. In simpler terms, school refusal describes the situation when a child consistently refuses to go to school or faces difficulties remaining at school. These children may avoid school to deal with stress or fear. The reasons can be numerous and varied.
There are several ways to handle this issue. These include cognitive behavior therapy (which helps a child manage their problems by changing the way they think and behave), educational-support therapy, medication, and joint efforts between parents and teachers. In certain cases, extra emotional and educational support for the child and parents might also be considered. Monitoring any administered medications and seeking more intensive psychotherapy through professional consultation are also important.
School refusal presents a challenge for not only the children but also families and school staff. In the long run, consistent absence from school can have substantial effects on the child’s social, emotional, and academic growth. Hence, it’s crucial to detect issues early and tackle them to prevent any further problems. A cooperative approach is essential in handling school refusal, involving healthcare providers, parents, school personnel, and other mental health experts. While many children display physical symptoms, an evaluation by a physician is critical to eliminate chances of any underlying medical conditions. In many cases, children refusing school are often so fearful that they do not even wish to leave their house.
What Causes School Refusal?
It’s hard to tell how many children struggle with not wanting to go to school, often referred to as school refusal. Reports from groups that push for broader awareness of mental health issues suggest that between 2% to 5% of all children in school may experience this. Going back to school after being at home for a while, like after summer break, a vacation, or even a brief sickness, can sometimes bring out this problem. Even something stressful like moving to a new house or losing a pet or loved one can cause it.
When a child doesn’t want to go to school, they often say they’re feeling sick. They might complain of a headache, stomach ache, or sore throat in the mornings before school. If they’re allowed to stay home, these symptoms may disappear, only to return the next morning. In some cases, children may even start crying uncontrollably or having tantrums.
Risk Factors and Frequency for School Refusal
School refusal, also formerly known as “school phobia”, is something experienced by about 2% to 5% of all kids who are in school age. It’s important to note that both boys and girls can have this fear. It can happen at any age, but it’s more usual for 5 to 6-year-olds and 10 to 11-year-olds. The more days a child stays away from school, the more difficult it becomes for them to return. Interestingly, this condition has no connection to the child’s socioeconomic background.
Signs and Symptoms of School Refusal
Sometimes, a child’s reluctance to go to school is not a condition in itself. Instead, it may be a sign of an underlying emotional or behavioral disorder that is recognized in the DSM-5, a manual for mental health disorders. Being overly anxious about going to school or regularly skipping school altogether are signs rather than separate diagnoses.
Determining these issues typically relies on the child’s past behavior and experiences. Most of the time, regular physical exams don’t reveal any notable physical problems.
Testing for School Refusal
It can be a challenge to know precisely how many students skip school due to anxiety. This is because many times, their parents might call in to say they’re unwell. Especially when the anxiety shows itself physically as a headache or stomach pain, it’s easy to mistake it for a typical illness. High-stress situations can often lead to a child refusing to go to school. Some kids may even start their journey to school but end up feeling too anxious as they get nearer, to the point where they can’t carry on. Others may not even be able to leave their home. Signs of this can include getting extremely scared, having panic attack-like symptoms, crying a lot, throwing tantrums, threatening to hurt themselves, and physical symptoms that show up in the morning but get better if they stay home.
Here are some symptoms to watch out for, divided into a few categories. For the automatic part of the nervous system, you might notice muscle pain, dizziness, stomach and back pains, excessive sweating, joint pain, headaches, trembling, a racing heart, or chest pains. On the gastrointestinal side of things, your child might feel sick, vomit, or have diarrhea.
There could be several reasons why a child might refuse to go to school. It could be due to huge changes in their life, like moving houses or starting at a new school. They might also worry that something bad will happen to their parents while they’re at school, or they might be scared that they won’t do well academically. Fear of another student is also a possible reason.
Treatment Options for School Refusal
There are various options available to help manage school refusal, which is when a child refuses to go to school due to fear or anxiety. These can include cognitive behavior therapy, educational support, medication, or interventions involving both parents and teachers.
Cognitive behavior therapy (CBT) is a structured method where a therapist gives specific instructions to gradually expose the child to the school environment. The child is encouraged to face their fears and taught how to change their negative thoughts. CBT helps address present concerns and provides tools to modify unhelpful thoughts and behaviors.
Another therapy is exposure-response therapy (ERP). This focuses on slowly exposing the child to things or situations that make them anxious. ERP is usually performed in the most anxiety-inducing situations to boost the child’s confidence.
Dialectical behavior therapy (DBT) is another useful technique. It includes two sets of skills that encourage acceptance (mindfulness and distress tolerance) and two sets of skills that promote change (emotion regulation and interpersonal effectiveness). DBT can manage other mental health problems and family issues that might contribute to the child refusing to go to school.
If a child displays physical symptoms due to school refusal, the healthcare provider should explain that these can be signs of emotional distress rather than physical illness. It’s also crucial for a team of professionals — like the physician, parents, school staff, and other mental health experts — to work together to support the child. Unless a child has a valid medical reason, physicians should avoid providing notes to excuse them from attending school.
Certain kinds of medication can also be used as part of the treatment. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety disorders in children. SSRIs have shown to be effective and safe for treating childhood anxiety symptoms, including school refusal. Also, for severe cases, benzodiazepines may be prescribed for short-term use. However, since benzodiazepines have potential side effects and can lead to addiction, they should only be used for a few weeks.
Managing school refusal requires a multi-faceted approach that might include a combination of therapy, supportive educational measures, and sometimes medication. An individual plan that caters to each child’s specific needs often yields the best results.
What else can School Refusal be?
When it comes to understanding whether a child is experiencing school refusal or truancy, the following criteria can help differentiate between these two behaviors:
School Refusal
- The child often exhibits strong emotional reactions, such as anxiety, temper tantrums, depression, or physical complaints, when it comes to attending school.
- The child’s parents are aware that their child is not attending school. In fact, the child often tries to convince the parents to allow him or her to stay at home.
- Unlike truancy, antisocial behaviors are not typically associated with school refusal.
- During school hours, the children often stay at home.
Truancy
- With truancy, children typically do not show significant anxiety or fear about going to school. They also often try to hide their absences from their parents.
- Antisocial behaviors, such as lying, stealing, and disruptive activities, especially with antisocial peers, are often seen in kids with truancy.
- Truant children are frequently not found staying at home during school hours.
- It’s necessary to note that anxious school refusal and truancy do not mutually exclude each other. They also significantly correlate with mental health problems and adverse experiences at home and school.
What to expect with School Refusal
Often, the issue of school refusal tends to naturally improve as children grow older, causing no lasting problems. So, typically, there’s a good outcome. However, it’s important to note that it can sometimes signal upcoming mental health difficulties.
Possible Complications When Diagnosed with School Refusal
Taking long absences from school can cause delays in a child’s cognitive, emotional, and social development. Additionally, if the refusal to go to school isn’t a standalone issue but is part of a more severe illness, it can lead to even more serious consequences.
Key Points to Remember:
- Long absences from school can hinder cognitive, emotional, and social growth
- The refusal to attend school can be a sign of a more serious illness
- More severe problems may occur if the underlying issues aren’t addressed
Preventing School Refusal
School refusal is not a mental illness in and of itself, but it can be a sign of an anxiety disorder. Figuring out what’s causing the school refusal and addressing it usually involves teamwork. It may need the involvement of a healthcare provider (like a doctor or nurse), parents, school staff members, and mental health professionals, such as psychologists or psychiatrists. All these individuals work together to ensure the child’s well-being.
