School refusal is defined as refusal to attend or difficulty in staying in school for the full day.
It’s a nightmare for parents and chronic school refusal has serious implications for a child’s long term education, social and emotional wellbeing.
It needs to be dealt with immediately. Go to the school principal and the GP in the first instance who will make a referral to local child and adolescence mental health services (CAMHS). School refusal is seen as a priority by these services.
Underlying school refusal is an anxiety about something. The challenge is to find out where the anxiety is coming from – eg internal; - learning disorders, poor social skills, or poor problem solving strategies; external – bullying, peer pressure, or conflict with teachers.
This involves the family working with a member of CAMHS and the school to learn how to manage anxiety and return the child school quickly.
A psychologist from CAMHS will assess the child’s anxiety, examine the broader relevant issues, and develop an intervention program, typically involving:
• Cognitive Behavioural Therapy (CBT) for anxiety management
• Parent training
• Collaboration with the school
• Tips for parents and teachers to manage refusal
The longer a child is allowed to refuse to attend, the deeper the avoidance behaviour becomes and the more difficult to change.
It may be necessary initially to allow some ‘slack’ in relation to what is expected of the child when at school as long as they attend (the goal then becomes to increase active participation in expected school activities).
If a child has a tantrum or panic attack when entering school, it is best to calmly deal with this without taking the child home. This may take hours, however if an anxiety attack results in going home the child is learning that the only way to decrease their anxiety is to flee.
If the child can feel their anxiety decreasing whilst staying at school, the need to flee decreases over time.
how to calm a child
If a child is highly anxious and distressed (above a 5/10 on the anxiety scale):
• DO NOT attempt to reason with them or talk them through it – their brain is in no state to process such information, the anxious brain has little capacity to use reasoning, logic or rational thinking.
Instead use calming strategies – this is much easier if the child has learnt calming techniques or if the parent/teachers know what the child finds calming.
• DO NOT over power the child or force them. Lack of control increases anxiety, give them space and time. Communicate in a calm, clear and supportive way (“I can see you are upset. Let’s move over here and sit down for a bit”). Take things one small step at a time.
Only when the child is calmer (under a 5/10 on the anxiety scale) can you can use reasoning, logic and rational thinking.
• DO NOT tell the child to calm down, instead help the child to be calm, e.g. remove them from the ‘fuss’ and chaos of early mornings at school, speak in a low voice, move slowly around them, appear like you know what to do and that it’s all good.
• DO NOT provide re-assurances such as ‘everything will be fine’ ‘you’ll be okay’, instead (if anything) provide support and confidence ‘this is hard for you, we will find a way to make it okay’ ‘it’s okay for this to take a bit of time’
It is crucial that the reasons for the child feeling anxious about school are understood so that they can be appropriately addressed.