By Christine Brady, M.A.,
Intern of Marriage & Family Therapy
What parent among us has not experienced the plaintive pleas of little ones, their little voices crying out, “I don’t want to go to school!” Sometimes these requests are due to vague physical complaints such as, “I don’t feel good”, or “My tummy hurts”. Other times, the range of reasons can vary from mean teachers to lack of friends, or perhaps an exam is scheduled for that day. For a lot of children these occurrences are few and far between. For others, this is a pattern which seems to happen almost daily, increasing family stress, and causing harried parents to count down the days until graduation (a daunting task if your child is in elementary school). School refusal, if left unchecked, this pattern can escalate lead to chronic lateness, repeated absences, and consequences from truancy officials at school.
Consistently truant children often attempt to conceal their absence from parents and spend their day away from home while children typically termed as school refusers tend to stay home during all or part of the day with parental knowledge. School refusing children commonly become upset at the prospect of going to school and may show signs of fearfulness, crying, temper tantrums, unexplained physical symptoms, or other behaviors, such as stalling, missing the bus, or oversleeping. Children who are refusing to attend school may be attempting to avoid a fearful experience. Being bullied, the structure and discipline of the school setting are common reasons for avoidance. Another motivation for school refusal could be pursuing a positive experience like staying at home with access to video games, access to the internet, or gaining parental concern or attention.
School refusers can have anxiety around specific situations such as the bus ride, cafeteria, restrooms, or locker rooms thereby increasing the desire to avoid school. A child may or may not be able to identify their specific fear, only knowing that they don’t want to be at school because it makes them feel awful. Another group of school refusers may find the social or performance aspects of school such as interactions with peers, writing on the board, being called on in class, tests, or performance classes such as PE make the prospect of attending school frighteningly unbearable. Some children experience school as a place where they are constantly reminded that they are not good enough to achieve at a normal level, let alone, excel.
Dr. Haarman further relates in his book, School Refusal Behaviors, that the most important factor in increasing the likelihood of success with children who can’t or won’t go to school is to return to school as soon as possible. The longer the child avoids a normal school day routine, the more difficult and traumatic it will be to return to school. A viable starting point for the effective exposure therapy of the child returning to regular school attendance may be to build tolerance to the anxiety provoking activity by attending some portion of the school day whether attending particular classes for a limited time period, or certain days until the child’s anxiety returns to near normal levels. This may require cooperation of school administration, such as a modified schedule change, a teacher change, or allowing the child to arrive late or leave early.
Treatment of School Refusal
|This chart is adapted from research conducted by Kearney and Albano, identifies a number of possible intervention strategies most suited for each of the four types of school refusers.|
|(crying, nausea, distress, sadness, and various phobias, i.e. bathrooms, cafeteria, teachers, bullies, etc.)||Somatic control exercises such as breathing retraining and muscle relaxation
Gradual re-exposure to school
Reduce physical symptoms and anticipatory anxiety
Self-reinforcement, self-talk, self-esteem
|To escape aversive social and evaluative situations (social phobia, test anxiety, shyness, lack of social skills)||Role play restructuring of negative self-talk
Gradual exposure to real life situations
Social skills training and reduction of social anxiety
Coping strategy templates
|To get attention (tantrums, crying, clinging, separation anxiety)||Parent training in contingency management
Clear parental messages
Evening and morning routines
Use of consequences for compliance/noncompliance
|For positive tangible reinforcement (lack of structure or rules, free access to reinforcement, avoidance of limits)||Family contingency contracting to increase rewards for attending school and decrease the rewards for missing school
Curtail social and other activities for nonattendance
Alternative problem solving
References and Further Reading:
Albano, A.M., Chorpita, B.F., & Barlow, D.H. (2003). Childhood anxiety disorders. In E. Marsh and R. Barkley (Eds.), Child psychopathology (279-330).New York, NY: The Guilford Press.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Washington, DC, American Psychiatric Association, 2013.
Berg, I. (1996). School avoidance, school phobia, and truancy. In: M. Lewis (ed.), Child and Adolescent Psychiatry. Baltimore, MD: Williams and Wilkins.
Berg, I. (1997). School refusal and truancy. Archives of Disease in Childhood, 76, 90-91
Bernstein, G.A., Helter, J.M., Burckhardt C.M., & McMillan, M.H. (2001). Treatment of school refusal: one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 206–213.
Broadwin, I.T. (1932). A contribution to the study of Truancy. American Journal of Orthopsychiatry, 2, 253-259.
Coolidge, J.C., Hahn, P.B., & Peck, A.L. (1957). School Phobia: Neurotic crisis or way of life? American Journal of Orthopsychiatry, 27,296-306.
Dube, S.R. & Orpinas, P. (2009). Understanding excessive school absenteeism as school refusal behavior. Children and Schools, 31(2) 87-95.
Duckworth, K. & deBug, J. (1989). Inhibiting class cutting among high school students. High School Journal, 72, 188-195.
Evans, L.D. (2000). Functional School Refusal Subtypes: Anxiety, avoidance, and malingering. Psychology in the Schools, Vol. 37(2), 183-191.
Fremont, W. P. (2003). School refusal in children and adolescents. American Family Physician, 68, 8, 1555-1560.
Haarman, G.B. (2012). School Refusal: Children who Can’t or Won’t go to School, Foundations: Education and Consultation Press. Louiseville, KY.