School Refusal – Dealing with severe anxiety

Wow!  It’s really that time of year again.  While there are a range of thoughts and feelings that students have about heading back to school, it is the students that have a true phobia about attending that I hope to reach in this post.  Hopefully, this will find its way to parents that have seen their child seriously resist school and it will provide other parents with good information so they recognize what they see if their child begins to truly resist school.

A preliminary study on children and adolescents that refuse school revealed that not only is this group more likely than their peers to suffer from an anxiety disorder, there is also a pattern in the way that they cope with their anxiety.  Researchers investigated something that psychologists call emotion regulation and they found that kids and teens that refuse school tend to have difficulty reframing safe situations as such and also hide their feelings about their fears from others.  These two phenomena are referred to as cognitive reappraisal and expressive suppression, respectively, and they both may contribute to a student’s ongoing school refusal.

The study took place in Australia and used a sample of children and adolescents in treatment at a school refusal clinic.  As opposed to truancy where students typically try to hide their absenteeism and also have behavior problems, this group of participants refused school for reasons of anxiety.  The study group was matched for age and sex to a same size group of peers that did not refuse school. 

As one might guess, the school refusal students had higher levels of anxiety when compared to their peers.  They met criteria for diagnoses such as generalized anxiety disorder, social phobia, and separation anxiety disorder.  Many of these students also had mood disorders (e.g., depression) and/or behavioral disorders (e.g., oppositional defiant disorder). 

The school refusal students were found to oftentimes view everyday situations as threatening in some way.   For example, something as routine as eating in the cafeteria or being called on in class could seriously overwhelm the students described in the study.  In addition, they were less able to reframe situations as safe.  In other words, they used cognitive reappraisal less frequently than their peers.  Also, the school refusal students hid their anxieties from others.  This expressive suppression is thought to serve two purposes.  One, the individual can avoid the uncomfortable emotion more easily.  Two, it can protect the individual from being ridiculed by others or other negative social consequences.

While the authors state that these results are just the beginning of understanding the possible role of emotion regulation in school refusal and that more research is needed in this area (including in the US), there are some takeaways worth noting.  First, school refusal in this study was closely linked to anxiety.  That anxiety was fueled further by an inability to reframe non-threatening situations as non-threatening.  Second, participants that refused school were also more likely to conceal their true feelings. 

Perhaps clinicians, parents, teachers, and others that encounter these students can bring some relief to them by working to increase a sense of emotional safety in the school environment as well as warmly and openly allow for honest discussion about the anxieties associated with attending school.  While this is where I would normally say more on recommendations, chronic school refusal problems would probably be best served by an experienced professional who is skilled at understanding and treating the underlying causes of school refusal.  This person could spend time getting to know your child as an individual and work directly with your child to help decrease anxiety, reframe the school experience in a more positive light, and promote effective emotional understanding, management, and communication.  Finally, he/she could work in conjunction with parents and school personnel and provide feedback and recommendations that can ease the transition back to regular school attendance.

Please bear in mind that this study is not describing the student that occasionally complains about going to school or wants to stay home now and then.  This post is addressing a much higher level of school refusal.  For any parent whose child is sometimes refusing school or tentative about going, however, looking at their worries about going may be a good place to start.

Thanks for reading.  -Anita

Source: Hughes, E. K., Gullone, E., Dudley, A., & Tonge, B. (2010). A Case-controlled Study of Emotion Regulation and School Refusal in Children and Adolescents, Journal of Early Adolescence, 301 (5), 691-706.

 

Good article on children who refuse to go to school due to problems with anxiety. There are some practical tips that I like to see from reviews of research too. The challenge is going to be getting schools to cooperate with things like making the child feel safer by spending time getting to know them better. In my experience, this is more based on the personalities of the teachers but most have overloaded schedules and unrealistic expectations put on them as educators already. I would suggest parents make an effort regardless to help their child manage their anxiety and have a successful school year.