Friday, December 13, 2013

School Avoidance (Part 2 of 2)

As I mentioned in my previous blog, we have had an increase in calls to our Family Support Line related to children refusing to go to school.  If you did not read the previous blog, it would be a good place to start regarding general information on heading off school avoidance in children. 
What is school avoidance?  The website, Human Illnesses, defined school avoidance as “when children and teens repeatedly stay home from school or are repeatedly sent home from school, because of emotional problems or because of aches and pains that are caused by emotions or stress and not by medical illness”.  School avoidance, also referred to as school phobia or school refusal, occurs in approximately 2-5% of school age children.  It is most common in 5-6 year olds and 10-11 year olds. 
Typical behaviors for a child or teen that has school avoidance is for them to come up with reasons not to go to school, to complain of physical symptoms shortly before it is time to go to school, or to make repeated visits to the school nurse or counselor once at school, with similar physical complaints.  Often the complaints are vague or non-specific.  In more severe cases, such as school phobia, common physical complaints are aches and pains, headaches, stomach concerns, muscle tension, and dizziness.  In the most severe case of anxiety, students may complain of difficulty breathing and tightening in the chest, which can be an indicator of a panic attack.  The symptoms typically disappear once the child is allowed to go home and during the weekends or over school breaks.  In addition, when the physical complaints are evaluated by a doctor, there is no medical cause found.  
It should be noted that when children and teens complain of physical complaints it should always be assumed that the complaints are legitimate and a medical appointment should be completed to rule out medical issues.  In some severe cases of anxiety, people can develop ulcers and other health issues that should be addressed medically.    It is also important to note, that even if there is no medical problem, the physical complaints are not fake.  The child likely is experience physical discomfort due to emotional distress. 
Other symptoms that can develop in children with school avoidance is an increase in tantrums or tantrums that are not age-appropriate, separation anxiety, defiance, and in some cases other mental health concerns such as depression and obsessive behaviors. 
I often hear parents say that if it weren’t for the school avoidance they would not have any problems with their child.  They state that other than the avoidance the child follows the rules and does not cause problems in the home.  Most children with school avoidance are of average to above average intelligence.  They are often the children that were quiet and shy in school, but were well liked by adults due to the fact that they were not a disturbance in class and would do what they were told to do. 
Why do children/teens develop school avoidance?  Most parents’ initial response is to assume that there is an issue at school.  This may be the case, especially if there is bullying, conflict with a peer or teacher, existing learning disabilities, or fear of failure.  However, often times the avoidance has less to do with the school setting and more to do with the child’s coping skills and/or home environment. 
 In young children, the school avoidance can be due to fact that they are having some separation anxiety from parents and familiar environment.  With young children they are being introduced to a variety of new challenges, new people, and new environments.  In young children the avoidance may be related to concerns regarding potty training and/or using the bathroom in public.
Children of all ages, including teens, can develop avoidance behaviors when there is a major transition, such as change in the family structure (new siblings, older siblings moving out, separation/divorce, remarriage, military deployment, etc.), moves, or new schools.  Often the avoidance will appear when a student is moving from elementary school to middle school or from middle school to high school.
 It is also important to remember that the adult’s emotional stability can also be a factor.  If parent is stressed or depressed the children may pick up on this.  Children will often have avoidance behaviors if a family member has a serious illness as they are afraid something will happen to the loved one while they are away from the home.  This may also occur after a loved one dies.  The child may feel that they have to stay at home or someone else might die.  If there is domestic violence or substance abuse in the home the child may also feel that they need to be home to protect other family members or to help “keep the peace”. 
What can the adults do to help?  First, the adults need to find out what the underlying reason for the avoidance is.  Sometimes the child does not even know the underlying reason and needs help from the adults to figure this out.  Once the reason is determined then the adults can help the child to work on a plan to address the anxiety/fear of going to school.  It is very important to not allow the child to avoid school.  As with all types of anxiety, avoidance causes the problem to become worse, not better.  The longer a child is out of school, the harder it is to return.  A student may need to ease back into school, but they should be going at least a short time every day to start and the time should increase as the days or weeks go by.  Parents can enlist the help of the school to work out a plan for easing a child back into school.  Other professionals who can assist in the plan are the child’s pediatrician and/or mental health professionals.
Adults should not shame the child or make fun of the child for not attending school.  Adults can talk with the student on a regular basis about their feelings and fears as this helps to reduce the fears and stress.  Do not punish the child for avoiding school, but do not inadvertently reward them either.  If the child refuses school and the parent cannot get them there safely, the child should not be allowed to engage in fun activities while at home for the day.  There should be no television, video games, or special treats.  The home environment should be made to be as boring as possible so that it does not reinforce the child’s desire to stay home. 
For more suggestions on ways to address  school avoidance, additional ways to support your family and for other great parenting tips call the Family Support Line at 1-800-CHILDREN (800-244-5373) OR 1-866-Las-Familias (866-527-3264) for Spanish speakers. You can also e-mail with questions or concerns. Check us out on Facebook at Families First Colorado.  The Family Support Line offers parenting tips, resources and information only and does not serve as legal or mental health advice. We believe you are the paramount person to decide what is best for your family. Comments provided by non-Families First individuals are not the opinion of Families First.