For many families the first days of school are met with excited anticipation of new friends, new teachers, and new experiences. However as many as 5% of school aged children refuse to attend school based on fears and anxiety. Emotional meltdowns and anxiety may occur at school, in the car on the way to school, when getting out of bed in the morning or even the night before school. A common scenario is parents desperately attempting to get their fearful, emotionally distraught child out of the house, into the car or out of the car and into the school. Psychologists call this by various names including separation anxiety, school refusal or an anxiety disorder.
What is School Refusal?
In young children, in order to understand school refusal it is important to first understand the nature of anxiety. Anxiety is another word for fear and is thought of as a response involving thoughts, behaviors, and physical responses. The thoughts that accompany anxiety have to do with anticipation of something terrible that is about to occur. For younger children they may be worried that something terrible may happen to their parents while they are at school. For children that are somewhat older they may anticipate something terrible happening to themselves while at school. A better understanding of school refusal occurs when we have a clear picture of the thoughts that occur when the anxiety or fear is highest. The physical reactions that occur with anxiety are what is commonly known as a “fight or flight” response. This includes a rapid heart beat, breathing changes, muscular tightness and sweating. The behavior that naturally accompanies this response is avoidance or in this case school refusal.
The early signs of childhood anxiety which can often result in school refusal include: a reluctance to fall asleep without being near parents, nightmares, extreme homesickness, as well as physical symptoms such as stomach pain and rapid heart-rate.
Family history and parenting style are extremely important components to school refusal. It is relatively easy for a parent to inadvertently strengthen a child’s anxiety by not gently requiring the child to overcome the distress and challenge their avoidance of school.
- Practical Tips for Handing School Refusal
- Initiate a consistent bedtime and daily awakening schedule for her two weeks before the first day of school.
- Replace summer evening TV watching with reading.
- Have breakfast together and then go to school regularly before the first day and walk to the classroom.
- Meet briefly with your daughters’ new teacher or some other helpful staff member a few days before the start of school (call ahead to schedule this). This is a good time for you to meet, and have your daughter get comfortable with, the school staff.
- Speak with your daughter about these experiences, help her challenge any negative thoughts or fears she may be having and tell her how confident you are in her ability to overcome stomachaches, headaches or other physical complaints she may have and assure her when she goes to school she will have fun and make friends.
If on the first days of school your daughter does become anxious and resistant it is very important that you stay calm and do not over-react. Your daughters’ Kindergarten teacher will have experience with this problem and will help your child settle in. It is important that you do not stay and wait for your daughter to calm down. Instead leave quickly and assure her you will be there to pick her up. Staying to long with your daughter may reinforce her anxiety and perpetuate the problem.
What to Do If the Situation Does Not Improve?
If these steps do not solve the problem within the first weeks of school your daughter could have a Separation Anxiety Disorder. Separation Anxiety Disorder affects approximately 4% of children (Anxiety Disorders Association of America). With Separation Anxiety Disorder, a child experiences excessive anxiety when away from home or separated from parents or caregivers. While separated, it is not uncommon for these children to have fears and worries regarding the health and safety of their parents.
Evidence suggests that cognitive behavioral therapy (CBT) is effective in the treatment of childhood anxiety disorders. If your daughter’s fears and worries continue your teacher or school psychologist may be able to refer you to a psychologist who specializes in cognitive behavioral therapy for children.
How Cognitive Behavioral Therapy Can Help
Anxiety disorders have been shown to be highly responsive to cognitive behavioral therapy. School refusal can be addressed with CBT anxiety protocols such as exposure and response prevention (ERP). ERP is a treatment method available for a variety of anxiety disorders. The intervention is based on the idea that a child/adolescent is exposed to their fears and through repetitive exposure they learn to overcome their avoidance. In doing so the thoughts/cognitions associated with the fear are altered and the fear and avoidance lessens and ultimately is extinguished.