Help!  I can’t get my teen to go to school.

The good news and the bad news is that this is not an unusual problem.  At least 5% of children refuse to attend school or remain in class an entire day and some studies show that some form of chronic absenteeism affects 28% of youth some time in their lives.

 

There is a range of such behaviors, as shown below:

  • Substantial distress while attending school, with pleas to parents for future nonattendance
  • Severe misbehavior in the morning in an attempt to miss school
  • Chronic tardiness to school
  • Skipping certain classes or periods of school during the school day
  • Lengthy absences from school

The last of these is severe enough for professionals to use the phrase “school refusal.”  But this is the extreme end of a series of behaviors that are best addressed at an earlier point—certainly once there is tardiness. Many children and adolescents with school refusal behavior show a wide range of constantly changing behaviors.

Suppose my teen is just sick a lot?

Common symptoms of school refusal behavior include:

  • anxiety,
  • depression,
  • withdrawal,
  • fatigue,
  • crying, and
  • physical complaints such as stomachaches and headaches.

More disruptive symptoms may include:

  • tantrums,
  • dawdling,
  • noncompliance,
  • arguing,
  • refusal to move,
  • running away from school or home, and
  • aggression.

The first step is to take your teen to his or her physician. If no problem or only a minor problem is found, school refusal must be considered. If the physician has no experience with this problem, he or she needs to refer your teen to a medical center.

What problems does this cause for my teen?

There are a number of problems caused by school refusal if it is not treated.  These include:

  • academic problems,
  • social alienation,
  • family conflict and stress,
  • school dropout,
  • delinquency, and
  • occupational and marital problems in adulthood.

 Why does this happen?

Youths refuse to go to school for one or more of the following reasons:

  1. to avoid school-related situations that cause substantial distress (for example bullying or a phobia),
  2. to escape painful social and/or evaluative school-related situations (for example performance anxiety, social anxiety, or an undiagnosed learning disorder),
  3. to gain attention from parents and others, and
  4. to pursue tangible rewards outside of school (such as getting to sleep late, watching TV or playing video games).

One study found that a clinical diagnosis could be made in 67% of children with school refusal. Of those, 66% had an anxiety disorder (with separation anxiety being the most common), with no other diagnosis being higher than 8%.

What can be done?

For a plan to be effective some or all of the following elements need to be included:

  • teaching him or her to reduce anxiety by using such techniques as muscle relaxation and breathing exercises
  • using “exposure-based practices” to gradually reintroduce the teen to school (the school will need to be cooperative by allowing the student to attend less than full time for a period of time)
  • the establishment of morning (to get going)  and evening rituals (to get enough sleep)
  • establishing firm rules about what conditions are acceptable for missing school (for example, vomiting, fever, or bleeding) and
  • escorting the child to school.

In addition, a plan that includes an anti-anxiety medication (for example Prozac or Zoloft) plus a form of therapy called cognitive behavioral therapy, plus the services of a social worker to work with the parent(s) and the school is generally needed to  resolve this difficult problem.