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School Refusal

Skipping school isn’t always playing hooky—it isn’t really “playing” at all and may actually indicate a more serious issue. As parents, your first step is to pay attention to your children’s school-related concerns and take seriously behaviors such as refusing to attend school.

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School Refusal—A Key Symptom

Depression and anxiety disorders are common psychiatric problems that cause children and adolescents to miss school. Both depression and anxiety appear in as many as 50 percent of children and teens who frequently refuse school. As with any illness, these symptoms demand treatment.

What You Need to Know About School Refusal

Review these questions and answers to help you and your family understand the issues behind school refusal, find a way to address the issues and get your child or teen back into school and reaching for success.

Some children or teens may refuse school as a result of peer pressure or just to get a day off. Refusal that’s only occasional may not be serious, but as parents, you should pay attention. Because at least 50 percent of children who regularly skip school deal with depression and/or anxiety disorder, they may feel fearful, helpless, hopeless and overwhelmed at the prospect of going to school. They may not even be able to explain what they’re feeling.

No. Most children enjoy and attend school regularly, enjoying the social activities and, usually, the work that goes with it. Children who don’t go to school may be unhappy or fearful. Regardless, the problem of skipping school must be addressed.

School is the work of children and teens. If adults weren’t able to get up and off to work each day, family members and coworkers would become concerned and intervene if the behavior continued. Yet, parents may feel at a loss for what to do if children stay home for days, weeks or months at a time. Parents must recognize when a problem exists and take action to prevent small concerns from turning into critical issues.

The only sure way to determine if an adolescent experiences anxiety, depression or a less serious behavioral problem affecting school attendance is to rule out depression and anxiety disorders. Contact a professional to evaluate your teen and determine if the issue is rooted in anxiety and/or depression. If not, school refusal may be treated as a simpler behavioral problem.

Depression and anxiety may be difficult to detect.

Childhood depression symptoms often appear differently than those of adult depression. Depressed adults may isolate themselves, but children may or may not withdraw from others. To a casual observer, some depressed adolescents may seem hyperactive. Depression may also emerge as irritability, inability to concentrate, changes in sleep and eating patterns or low self-esteem. More seriously, depressed children may have thoughts of suicide and even make attempts on their lives. They may steal, run away or get into fights.

Anxiety disorders in children and teens may display as fear of being away from home or being away from parents, even for short periods. At school, youngsters may be fearful of talking in class, refuse to raise their hands to answer questions, worry excessively about things that happened in the past or things they anticipate happening in the future. Sometimes, symptoms of anxiety disappear on weekends and school breaks because stressors—talking in class, going to certain classes—that trigger fearful feelings are absent.

Remember, with evaluation by a qualified mental health professional, anxiety and depression are the two most treatable psychiatric disorders.

While it may be related to a life event, such as a death in the family or other trauma, depression is often unrelated to such factors and may be caused by a neurochemical deficiency in the brain. If symptoms last more than two weeks, get an evaluation and consider treatment.

Some children and teens with depression may benefit from antidepressant medication. Medication should only be used after a thorough psychiatric evaluation and should be continually monitored by a psychiatrist.

Sometimes, depression and anxiety abate over time. Other situations require treatment to help shorten the course of these disorders. Delaying treatment for teens results in unnecessary distress and school failure and avoidance. Parents must intervene before school failure becomes difficult to overcome.

You should always understand why your child or teen misses school. Persistent physical symptoms that prevent a child from going to school need medical attention. So, too, the first signs of children making up reasons to miss school or avoid school for unexplained reasons, fearfulness or withdrawal should get your attention. Seek help immediately.

Children may use the word ‘bored’ to express low energy and lethargy—symptoms of depression—because ‘bored’ comes closest to describing what they feel at the time.

Intelligence, as such, has little to do with disorders of anxiety and depression. Very intelligent and talented people experience anxiety and depression. If your child is clinically depressed, intelligence will not necessarily make it easier—and may make it more difficult—to resolve those feelings. Parents, teachers or friends might find it hard to understand why such children, who are so smart with so much going for them, don’t just pull themselves together and go to school.

Remember, intelligence and emotions are separate. When children have trouble with grades, you may consider using a tutor; when children experience anxiety or depression, consider seeking help from a mental health professional.

Guidance counselors, school social workers and psychologists, attendance officers, principals and assistant principals are professionals who work with children who refuse school and their parents. Collaborate closely with these valuable resource people to get your child back in school.

Consider consulting private mental health treatment providers or mental health professionals at Dominion Hospital or your local community mental health center to work with your family and your child’s school.

Because school refusal is often a stubborn problem, the support of many people can make finding a solution easier.

Additional pressure may not be the answer for children in this situation. However, letting your child know that refusing school is against the law may motivate the acceptance of help. In many regions of the country, court systems increasingly recognize children who refuse school may have underlying mental health problems and support parents in getting children the help they need.

Homebound instruction will not resolve school refusal for several reasons.

  • The extra attention of a teacher coming to your home may make staying at home even more attractive.
  • Homebound instruction may mask your child’s anxiety, but it doesn’t get rid of the triggers or causes.
  • Just when children need friends and peers, homebound instruction creates social isolation.
  • Returning to school may be harder.

Actually, drug and alcohol abuse more commonly result in school refusal than school refusal resulting in drug abuse. Children or teens frequently miss school after getting involved with drugs or alcohol because they:

  • Aren’t ‘available’ for classwork
  • Skip class to get high

Parents should have children evaluated quickly—before experimentation with drugs or alcohol becomes a pattern that leads to home, school and social difficulties.

Refusing help is not uncommon for children and teens who avoid school because of depression. Avoiding school may lessen feelings of helplessness and fear that also make it difficult for them to find ways to create healthy changes.

But parents shouldn’t take ‘no’ for an answer. Setting firm limits is appropriate when your child’s well-being is at stake. Contact the guidance counselor at your child’s school or a mental health professional for suggestions or assistance in overcoming opposition.

How We Can Help

At Dominion Hospital, we work with school-avoidant children and adolescents. In addition, our Partial Program—an intensive, therapeutic, day-treatment option—and our inpatient hospitalization program include mental health and chemical dependency services as an element of treatment for dual diagnosis (psychiatric illness with substance abuse).

Get a free screening to help understand the choices to assist your child. We’ll work with you to overcome your child’s resistance. And we provide information for parents, teachers and mental health professionals about school-avoidant behavior, symptoms and treatments.

Review mental health topics and special information about child and teen health issues in our online Health Library.