Q. My son is 14 and often refuses to go to school. Sometimes, I can convince him to get in the car, but then he’ll refuse to go inside. If I walk him into the school, later he’ll have a physical complaint such as a stomachache or headache, and I’ll get a call from the school nurse to pick him up. What can I do to help him?

A. Up to 5 percent of children have serious school refusal like that of your son. Many more children find school stressful and miss here and there, while others are tardy because the anxiety is so bad, it causes them to miss getting into the school on time.

There are stages when school refusal is more likely. It has been reported to occur more frequently from ages 5 to 6 and from 10 to 11, as well as when going into middle school and into high school. It sometimes occurs after a school vacation.

Possible underlying issues that can lead to school refusal include a fear of failing, bullying, fear of another student, thinking the teacher is mean, teasing by peers, stressful life events like separation or divorce of parents, moving, anxiety around perfectionism, taking on a heavy school or social schedule with scary required presentations and deadlines. Issues also include fear of going to the bathroom or showering in front of others. Some kids have social anxiety and are always concerned about being judged. They have anxiety about speaking up in class or presenting in school, and some have difficulty even eating in front of others. Some kids have generalized anxiety, which is excessive worry about many things. Children who have depression can also refuse to participate in school.

How can you help your son or any child who has school refusal?

  1. Get a physical checkup. Medical problems can cause depressed mood, which can trigger school refusal.
  2. Get a psychological evaluation.
  3. Have your child work with a therapist, who can discover maladaptive thought patterns and help him learn better ways of thinking and behaving, as well as confronting and working through fears.
  4. Be an active listener and talk with your child about feelings and fears in a loving, nonjudgmental way.
  5. Meet with your child’s teachers, school nurse and school counselor to devise a plan to keep your child in school. One idea is a peer buddy for less structured times like lunch, as anxiety can peak at this time. Or have him attend school for a short time and gradually increase the time in school.
  6. Encourage friendships in and out of school to build a support system.
  7. Work on relaxation techniques like breathing in for a count of six, holding the breath for four counts and breathing out for eight. Spend time periodically with your child practicing relaxation.
  8. Encourage hobbies and interests to distract and build self-confidence.
  9. Have predictable home routines for morning and evening. You might write these routines on a blackboard or a poster board. Anxious kids do better with predictable routines.
  10. Keep regular bedtimes even on the weekends and holidays to ensure sleep, because sleep deprivation increases symptoms of anxiety and depressed mood.
  11. Pour on lots of unconditional love.

School refusal is not something a child does deliberately to make their parents’ lives difficult. The child with school refusal needs help to learn how to deal with anxieties.

Betty Richardson, PhD, RNC, LPC, LMFT, is an Austin-based psychotherapist.

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