School Refusal: Information for Educators
BY MARY WIMMER, PHD, West Allis-West Milwaukee School District, WI
Each year, approximately 2–5% of children refuse to come to school due to anxiety or depression. Previously referred to as school phobia, school refusal includes kindergarten students with relatively mild separation anxiety and more severe cases where a student misses weeks or months of school because of debilitating anxiety or depression. Because of the serious long-term social and educational consequences associated with missing school, the problem needs to be addressed promptly and aggressively with a team approach that includes teachers, parents, administrators, support staff, and, in some cases, community agencies and physicians.
School refusal is not the same as truancy. Truant students hide their absences from their parents, do not experience emotional difficulties associated with coming to school, and may be involved in illegal activities or just avoid school in order to engage in a more desired activity, such as playing video games or hanging out with friends. Other situations that are not considered school refusal are homelessness and pregnancy.
DEVELOPMENT OF SCHOOL REFUSAL
School refusal is often the result of separation anxiety, social anxiety, or performance anxiety (e.g., about speaking in front of others), or anxiety related to test-taking, athletic competition, or academic difficulties. Students may refuse to attend school to escape from a situation that causes anxiety or to gain attention from a parent or other caregiver. Some students may feel that the school environment is cold and unwelcoming and a place where they experience failure. Consequently, they give up and just stop coming. Some students feel unsafe at school due to bullying or gang activity, and experience emotional difficulties associated with coming to school.
School refusal has been found to occur more often after vacations, weekends, or at the beginning and end of the school year. Events that prompt school refusal include the death of a loved one, a prolonged illness, moving or changing schools, entering kindergarten, and the transition from elementary to middle school. The problem is more severe in older children than younger children.
CHARACTERISTICS OF STUDENTS WITH SCHOOL REFUSAL
Anxiety, depression, and physical complaints are frequently associated with school refusal.
Anxiety
Students with school refusal often exhibit separation, social/performance, or more generalized anxiety reactions as well as other anxiety disorders.
Separation anxiety. Students with separation anxiety, which is most common in younger children, become preoccupied with thoughts of harm befalling a loved one and are overly dependent on parents and other caregivers. They may cry, kick, or run away to avoid coming to school. Many young children experience separation anxiety in preschool or when starting kindergarten. However, if the behavior continues for weeks or even months, it is more serious and needs to be promptly addressed.
Social/performance anxiety. Students with social/performance anxiety worry about what others think, are concerned about how they will be judged, and fear humiliation. They may have intense anticipatory anxiety about giving speeches, taking tests, or participating in sports.
Generalized anxiety disorder. Students with generalized anxiety disorder (GAD) have excessive anxiety and worry about any number of situations and events. Their worry and anxiety is over and above what the situation calls for. These students are concerned about their competence, unsure of themselves, and perfectionist about their schoolwork. They tend to perceive the world as threatening and may experience anxiety about situations such as war or catastrophic events like tornados and hurricanes. Their anxiety interferes with school performance and can cause fatigue, restlessness, difficulty concentrating, irritability, sleep disturbance, and muscle tension. Other anxiety disorders, such as obsessive– compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic attacks, and agoraphobia, can be associated with school refusal.
Depression
Depression may be the cause of school refusal behavior for some students. Common characteristics of depression in children and adolescents include depressed mood, lack of interest in activities, irritability, difficulty getting along with others, rebellious or risk-taking behavior, sleep difficulties, physical complaints, fatigue or lethargy, feelings of inadequacy or excessive guilt, difficulty concentrating or indecisiveness, and thoughts of death or suicide. For students who refuse to go to school, the presence of depression is associated with more severe symptoms than for those students with anxiety alone. Many students suffer from both anxiety and depression, two disorders that often occur together.
Physical Complaints
School refusers frequently express physical complaints (headaches, stomachaches) without the presence of a medical condition. Some students ask to go to the nurse’s office on a daily basis with complaints about stomachaches or headaches. Sometimes an actual illness, like asthma, contributes to a pattern of school refusal. Here, a student’s asthma may be the initial reason for school absence. Later, anxiety about returning to school serves to maintain the school avoidance, even after the student recovers physically. School staff should consult with the child’s physician to determine if there are any restrictions for the child at school. If there is no medical reason for staying home, the child should be in school.
Common Warning Signs
It is critical that both parents and educators learn to recognize common warning signs of school refusal and respond quickly. These include:
KEY STRATEGIES FOR EDUCATORS
When teachers or parents suspect that a student is refusing to go to school due to emotional reasons, they should take immediate action. A team approach to assessment and early intervention that involves family, educators, and community providers increases the probability of a successful solution. The team can include the teacher, principal, school counselor, school psychologist, school social worker, school nurse, and community members working with the child (therapist or physician), as well as the student’s parents.
Interventions
The goal of intervention is to increase the student’s school attendance.
Mental health services.
For students with anxiety and/or depression, intervention provided by a mental health professional often includes cognitive–behavioral approaches that teach coping strategies such as relaxation, problem solving, reducing negative self-talk, and increasing healthy self-talk. Other strategies may include teaching about anxiety, rewards for school a attendance, parent training, goal setting, and setting up contracts.
Other Supportive Strategies
There are many other steps that educators can take to help support students and families dealing with school refusal:
SUMMARY
Successful intervention for students with emotionally based school refusal is attainable by using a team approach, employing best practices such as those outlined in this handout, and maintaining patience and persistence.
RECOMMENDED RESOURCES
Csoti, M. (2003). School phobia, panic attacks, and anxiety in children. New York: Jessica Kingsley Publishers.
Kearney, C. A. (2007). Getting your child to say ‘‘yes’’ to school. New York: Oxford University Press.
Kearney, C. A. (2008). Helping school refusing children & their parents: A guide for school-based professionals. New York: Oxford University Press.
Wimmer, M. B. (2003). School refusal: Assessment and intervention within school settings. Bethesda, MD: National Association of School Psychologists.
Online
Anxiety Disorder Association of America, Anxiety disorders in children and adolescents, school refusal or avoidance: http://www.adaa.org/GettingHelp/FocusOn/ children&Adolescents/sra.asp
National Institute of Mental Health: http://www.nimh. nih.gov
Mary Wimmer, PhD, is a school psychologist with the West Allis-West Milwaukee School District, WI. E
2010 National Association of School Psychologists, 4340 East West Highway, Suite 402,