School refusal: Learn signs, causes and how to help your kid

Anxiety about something at school lies at the heart of child's reluctance

A teen school-age boy with a backpack looks downtrodden.
A teen school-age boy with a backpack looks downtrodden.

“I have a tummy ache.”

“You never want to hang out with me.”

“School is dumb.”

Three kids, three different statements. Ultimately, however, they could all be translated as:

“Something at school makes me anxious, and I don’t want to go back.”

That anxiety lies at the heart of “school refusal,” in which a child refuses to actively participate in his or her education, said Mathia Rall, a behavioral health specialist at Sanford Children’s Specialty Clinic in Sioux Falls, South Dakota.

Interpreting the widely varying signs of school refusal, and then figuring out how to help their child, might seem daunting to parents. But it’s worth it to catch the issue early, Rall said. Or even possibly prevent it.

“I always encourage families to be proactive rather than reactive. It’s much easier to manage when you’re proactive.”

Recognizing school refusal

Anxiety about social dynamics at school is one common cause of school refusal — kids might feel like they don’t have any friends, don’t fit in or have a connection with anyone at school, or another child is doing something to make them uncomfortable, Rall said.

Something in the routine might be causing anxiety — especially if it’s new, like the transition from elementary to middle school.

Feeling overwhelmed, incompetent or inferior in class — as though the other kids are smarter — can lead to school refusal.

And children with a medical condition, such as diabetes or allergies, might feel anxious anticipating other kids’ questions or reactions to it.

Younger children may give parents different clues than adolescents about their particular anxiety, Rall said. They might be more agitated than normal. They might seek more of a connection to the parent because they’re lacking a connection in school. So kids might follow a parent around, act needy, act less independent than before, want early childhood comfort items such as blankets and pacifiers again, have bathroom-related accidents, or say things like, “We never get to do anything together,” or, “How come I don’t get to decide anything?”

They may complain of a stomach ache or headache — and those complaints can be very real, manifested by the anxiety itself, Rall said.

Adolescents may be more blatant about how they feel: “I hate school.” They may eventually become more angry, aggressive and obstinate: “I’m not going, and you can’t make me.” But they may not be able to articulate any better than younger children the cause of their anxiety.

So Rall encourages parents to recognize the early signs. And then, “involve your village,” she said.

Advice for parents who detect school-refusal signs

“Ask for help, and do it sooner rather than later,” Rall recommends to parents. Reach out to friends and family, or find an online group to ask questions, or consult a therapist.

“I answer phone calls all day long from families that ask, ‘Do you think my child needs to be seen?’ ” Rall said. In a phone call, she’ll freely offer strategies for them to try for a couple of weeks, for a variety of issues. If those don’t work, then it might be time to schedule a visit with a therapist.

Contacting the school directly about the situation can be helpful, depending on the family’s relationship with the school. The school might send out a social worker or resource officer or staff member with a special connection to the child.

“Schools have gotten creative, and in my experience … a lot of schools are very helpful and will help assist you in getting your child to school,” Rall said. “And they have a lot more services at their disposal.”

She knows of one school staff member who had connected with a child having anxiety issues, and the staff member started providing a ride to school in the morning.

“What they’re really missing is a connection, and they just need to feel connected to someone,” Rall said.

Parents can work with the school to help their kids find connections, whether it’s to a person at the school, or in an after-school club that interests them. Even an off-site activity after school can help, if it’s something fun they can look forward to.

Effects of missing school

The consequences of missing school can vary as much as the reasons for avoiding school.

Falling behind academically is the most obvious effect. Catching up, even after just a few days away, is a lot harder and takes a lot longer than the actual absence, with grades declining in the meantime.

The same applies socially, Rall said. “The more time they spend away from the school, the more comfortable they are not engaging socially, and so it makes it harder and harder, with each day missed, to get them back to school.”

Anxiety could deepen to depression. Kids eventually could be more at risk to face alcohol and drug issues, poor compliance and poor coping skills and strategies, Rall said.

Rall thinks parents often overlook coping skills as something that needs to be taught along with skills such as toothbrushing, especially in an era when electronics and safety concerns may keep kids inside their home more, away from community interaction.

“We used to teach our children these skills by saying, ‘Go play outside.’ So when they skinned their knees, or this or that happened, they kind of started learning these coping skills, and other friends learned how to empathize,” Rall said.

Rall suggests parents now consciously teach their kids methods of coping with getting mad, sad, angry or frustrated. A few ideas might include taking deep breaths, screaming into a pillow, playing a verbal game to help focus and calm the child (“A is for apple, B is for _,” for example, and so on through the alphabet), or assigning chores and responsibilities to build self-esteem through a feeling of accomplishment.

Strategies for parents

Times of transition can trigger anxiety about school. Fortunately, parents may be able to ease some of that anxiety beforehand. In the summer before a move from elementary to middle school, for example, parents can walk the school grounds with the child. They can talk to the school about finding the child’s locker and practice opening it, or possibly meet the teacher beforehand. Or anything else that might help the child feel more comfortable there before school actually begins.

Moving to a new town can be another difficult transition, but enrolling kids in summer sports or programs to let them meet other kids and make friends before school starts will help them feel more comfortable, too.

“There’s different ways to involve your community, involve the child,” Rall said. “They talk about it taking a village to raise your child. This is the village that we talk about — how to connect them in and plug them in in different areas.”

Parents can help their kids at home, too, by delivering clear and consistent messages, whether the parents are together or apart. Rall also suggests that parents plan the week and set clear, stable routines for days off from school.

What if a child’s school anxiety leads a frustrated parent to anxiety as well? Rall’s advice is to ask for help.

“Get interventions and add another person to your team — add another person to your story. Because feeling exhausted, overwhelmed and at wits’ end is a lonely, desperate place to be. … Get more people on your team.”

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Posted In Back to School, Behavioral Health, Children's, Health Information

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