Anxiety & School Refusal: Conquering the “Jitters”
The start of another school year is just around the corner! Many children eagerly anticipate the excitement of filling up their book bag with school supplies, wearing new back-to-school clothes, and re-connecting with friends, but other children meet this time of year with dread, shame, and worry. School-based anxiety is a common issue facing children, adolescents, and their families. Parents should be mindful of signs and symptoms to determine if their child suffers from an anxiety-based disorder that exceeds typical first-day-of-school “jitters”.
What is school-based anxiety and school refusal?
Anxiety disorders are one of the most common problems among children and adolescents with rates varying from 10% to 20%. While a little worrying is normal, anxiety is defined as excessive worrying that is irrational or out of proportion to the feared stimulus. Symptoms of anxiety can interfere with everyday functioning as well as interpersonal relationships and school achievement. School can be an especially daunting place for children with anxiety because of the enormous interpersonal and academic demands. School-based anxiety is defined as a developmentally inappropriate reaction to the perceived consequences associated with school (e.g., failing a class, fears of getting picked on). School refusal behavior, also known as school phobia, occurs when the anxiety becomes so distressing that children and adolescents miss days, weeks, or months of school. The most common age of school refusal is 10 to 13 years, but can occur at any point in development. Parents are also more likely to see anxiety and avoidance behaviors occur during transition years (e.g., from elementary to middle school).
How does anxiety and school refusal impact youth?
Children with excessive anxiety present with a range of behaviors. Some children withdrawal from social activities or avoid difficult tasks for fear of failing or being embarrassed. They may appear inattentive, forgetful or unmotivated to engage in classroom discussions. Academic performance starts to suffer and teachers may interpret their behavior as defiant, disorganized or lazy. Socially, children may isolate themselves to avoid participation in peer interactions. They may have a poor self-concept and believe they lack the skills to initiate and sustain a friendship, which leads to further worries about being rejected by peers. Over time, children are more likely to develop sadness and develop a stable pattern of anxious thinking. Avoiding school or minimizing academic and social activities offer youth effective, short-term relief to reduce anxious feelings, but over time have serious negative consequences. Additionally, families are affected by this problem. Parents often feel blamed by the school given the common misperception that the issue is simply a matter of discipline. In reality, parents struggle to manage conflicting feelings around empathic desire to comfort their children and exasperation associated with the battle to get them to school.
Warning Signs and Symptoms
Some warning signs that your child might be experiencing increased anxiety or school refusal include:
- Excessive reassurance-seeking behavior
- Clinging to an adult
- Temper tantrums, crying
- Sleep difficulties
- Depressed mood, irritability
- Difficulty concentrating
- Complaints of physical problems that are absent on weekends or breaks
- Frequent tardiness or absences
- Absent on important days (tests, presentations)
- Frequent trips to the nurse’s office
- Frequent requests to call or go home
- Refusal to get out of bed or go to school
- Running away from home or school
What You Can Do
If you are concerned that your child is experiencing an increase in stress and anxiety or you have observed changes in his/her behavior that lead to school-based problems, it’s important to take steps to indentify the problem and develop an intervention plan. Parents may wish to consider one or more of the following actions:
Medical and Psychological Evaluation
Having a routine medical check-up might be a good place to start, especially if you child is complaining of physical problems (e.g., headaches, stomach aches). Many of the symptoms commonly seen in children with anxiety can also have a medical explanation. Ruling out physical problems is critical before taking further action. On a related note, there are also a number of psychological conditions that could better explain the kinds of problems associated with school refusal. For example, a mood disorder such as depression may also cause a child to withdraw from school or lack motivation to go to school. Also, conduct problems, attention deficits and learning disabilities might manifest as school refusal and poor classroom connectedness. Finally, many children are unfortunately the targets of bullying, which can make school very unpleasant and lead to unwillingness to attend. In these cases, intervention efforts would take a different form. A comprehensive psychological evaluation would identify these or other potential contributors to your child’s school difficulties as well as guide treatment decisions.
School-Based Interventions
Parents are strongly encouraged to work closely with the school in developing an intervention plan. In order to be successful, the plan should start with a school refusal assessment that identifies the target behaviors, as well as antecedents and consequences (i.e., what happens before and after the behavior) at home and school. For example, if the child’s refusal seems to occur on days when there are tests, the school might implement a plan providing accommodations and support around test taking. Other common school-based interventions include structured behavior plans with rewards and consequences, social work support, reduced time spent at school, reduced or modified work expectations, or a systematic re-entry plan.
Home-Based Interventions
Parents play an important role in their children’s treatment plan. Successful interventions will include ongoing, consistent communication with the school and specific ways of handling anxiety and school refusal at home. Parents may be guided on how to respond to children’s complaints of feeling sick or temper tantrums. Forcing your child to go to school when the child is having a meltdown is one of the hardest things parents face. The result is feelings of guilt and frustration; parents may feel compelled to let the child stay home. This response inadvertently reinforces the anxiety and makes the problem worse. Establishing a contingency plan that involves the school will be helpful in guiding your decisions during these intense moments.
There are a number of other things parents can do to support anxious children, in general. Being supportive and consistent in discipline as well as providing a structured, predictable routine can alleviate anxiety symptoms. Be patient and avoid being overly critical or punitive. Praise effort over outcomes and be prepared to listen and encourage expression of feelings. Also, be mindful of your own anxiety and make efforts to model relaxation strategies such as positive self-talk and deep breathing
Other Considerations
Seeking outside help is strongly recommended if the problem persists and continues to impact the child’s ability to attend school or engage in daily activities. Individual or family therapy can be very helpful to reduce anxiety and support parents. Cognitive-Behavioral Therapy is a well-supported treatment approach that teaches children to manage anxiety using a combination of physiological, behavioral and thinking strategies. For extreme cases, parents may consider enrolling their children in partial- or full-hospitalization programs designed specifically to treat school refusal. Also, anti-anxiety or anti-depressant medication may also be a component of treatment.
If you have concerns about your child experiencing anxiety or school refusal and would like an evaluation and/or treatment through our Stress and Anxiety Clinic, please call 847–933-9339 to schedule an appointment.