Credit: Dr. Doug Newton, the Chief Medical Officer at SonderMind
School avoidance, or what some call school refusal, is definitely not a new phenomenon. As a practicing child psychiatrist, I saw this all the time. And, now in a post-COVID world it is even worse. In the past we would see school refusal peak in August or September, as the student was anticipating going back to school. It was the time I would work with families on prevention and early intervention techniques. But now, I am hearing school anxiety and avoidant behaviors are happening more often throughout the school year.
Child and teen school avoidance is almost always associated with anxiety and specifically social anxiety in teens and separation anxiety in younger kids. Though this association does not always hold true, the distinction matters because the thoughts, behaviors and solutions can be different. In teens, they often worry about what others think of them, easily embarrassed or feel singled out by their peers, even when it is not the reality. Larger groups and more public-school areas, like walking the hallways between class or eating lunch in the cafeteria, are the most anxiety provoking. In younger kids, they worry more about being away from the parent or caregiver. They think about the “what ifs.” What if something happens to them or someone they care about when away. What if something goes wrong at school and they feel they can’t see their parents, siblings or pet again. Unfortunately, these fears have become more real and amplified by the danger of gun violence in our schools. So, it is important to find out what your child may actually be worried about in order to help them feel more comfortable with the separation while at school.
For both younger kids and teens, the longer the student is out of school the harder it is to get them back in school. If your child is out more than a couple days, you should talk to your school principal, teacher and/or counselor to work on a “re-entry plan.” This usually involves exposing the student to school gradually, say coming to the school office or going in on a weekend or evening when fewer people are around. They can then work up to half days until finally the student feels they have mastered their fears and are more confident and competent to return full time. I have seen this gradual exposure technique work nearly 100% of the time, especially when coupled with support and rewards.
However, an ounce of prevention is often worth a pound of cure. If you know your child or teen has a pattern of high anxiety and school avoidance in the fall when the new school year starts, then work on an exposure and anxiety reduction plan 2-4 weeks ahead of the first day. I often recommend the child or teen go in and find their locker, see their classroom, meet a new teacher, or have lunch in the cafeteria ahead of the first day. You can work on a preemptive reward plan for getting to and staying in school. And, as needed, please consider a mental health professional that can help with the anxiety and with individualized planning.
Thank you,
Glenda Charlie and David Cates
