the basics of school refusal

Getting through school refusal

With the beginning of a new school year, the OC Anxiety Center has seen more children with school refusal come in through our doors. “School refusal” is a general term with a myriad of causes. Is it a fear of embarrassing oneself in front of others, a dislike of academics, a bully at school, or panic disorder? These are just a few possible causes for being fearful of school, and to successfully treat school refusal, a base understanding of the issue needs to be completed before treatment begins.

Generally, the course of treatment of school refusal begins with an age-appropriate assessment. This can be accomplished by making the child feel comfortable in answering questions about a feared situation, includes the primary caretakers, and can be done either in office or at home. A knowledge of the child’s world (e.g., friends, school, hobbies, worldview) is often useful in relating with the child, as is communicating an understanding of the child’s fears.

Once the reason for refusing going to school has been established, a treatment plan is developed and explained to the family. Importantly, the parent(s) often plays a primary role in the treatment plan, as the homework assigned to the child often needs to be administered by the parent(s). To this end, the psychologist should explain fully to the parent(s) what needs to be done on a daily basis, and should be available during the week to answer questions.

Sometimes it is also necessary for the psychologist to accompany the child to school, just as in any exposure, and it is helpful to have the assistance of the school personnel, especially the teacher and school psychologist.As the child progresses through treatment, two common pitfalls include not being encouraging enough for each small positive step the child makes, and making sure the steps the child makes towards getting back into school are small enough that the child can achieve them. This may mean slow, steady change rather than a few large leaps. Typically, by the time help is sought parents are frustrated and want to see immediate change, which while understandable, often is not conducive to long term changes.

When working with an experienced psychologist, most children should be able to be back in school full time (and importantly, without fears or worries) in a relatively short time frame after assessing the reason for refusing to go to school and designing a successful treatment plan.