Case Study: Dawn is 14 and starting high school. Transitions have always been difficult for her. Ever since she received her notification for freshman orientation she has been unable to fall asleep. Dawn worries. Her parents fondly refer to her as their worry child. Dawn wonders if she will make friends at the new school, if people will make fun of her. She worries if she will have someone to sit with at lunch and if her mother will be okay without her. Her most intense concern is if she will embarrass herself and throw up on the bus. The day arrives for orientation and Dawn adamantly refuses to get into the car with her parents and bursts into hysterical weeping.

School Refusal
School starts in a few weeks. For most children and teens starting a new school year is generally anticipated with excitement, maybe a slight tinge of anxiety, or sometimes with older teen’s indifference. For some children and their families it is a time of stress, dread, confrontation eventually moving into a crisis mode every morning.

School refusal can occur at any age but more commonly occurs in children age 5-7 years old and in youngsters 10-13 and 14-15. Children and adolescents are more vulnerable during transition times such as starting school or changing schools.

Oftentimes, it occurs after a period at home like after summer vacation or staying home following an illness. It can also occur in response to a stressful event (i.e. death of important figure in child’s life, divorce), and in younger children although it can occur at any age, separation fears and concerns about leaving their parents or the safety of their homes. With older children and adolescents social concerns (peer issues, presenting in front of a class, low self esteem) and performance issues and worries can be contributing factors toward the problem. In America as many of 28 percent of school aged children refuse school attendance at some point. The child or adolescent experiences considerable distress over attending school and are embarrassed and shamed about their inability to attend.

The continuum of school refusal can vary from the child who is ill every morning but under parental duress or cajoling attends .The child who attends school but is at the nurse’s office every day with symptoms (stomachache, nausea) begging to go home. To the youngster who flatly refuses to attend school and can exhibit either anxiety, panic, somatic concerns, tantrum or combination of some or all of the above.

So what can a parent do?

Step 1. Listen to your child. Sit down and have a discussion with them on the issue during a non-crisis time. Communicate using active listening to elicit information regarding reality based stressors (peer bullying, teacher issues ect. unrealistic worries or excessively high self expectations.

Step 2. Develop a plan with your child to help them navigate the problem with positive and negative reinforcers. Set the boundaries of expected age level behavior. Attending and mastering academic information at school is a major development task for school age children and adolescents.

Step 3. Work/collaborate with school personnel to intervene swiftly in the problem. Seek professional assessment for your child to understand the factors creating and impacting the school refusal and to determine if there are any co-morbid mental health diagnoses or medical conditions that require treatment.

If you have additional questions, please contact the Lakewood Hospital Teen Health Center at 216.391.TEEN (8336).

The Teen Health Center is proudly celebrating their 10th anniversary this year. They are located at 15644 Madison Avenue, Suite 108, in Lakewood. Learn more about the Lakewood Hospital Teen Health Center.