Are Morning Conflicts With Your Child Becoming More Common, But Only On School Days?

Does your child complain about headaches, dizziness, shakiness, chest pains, or abdominal pain almost every morning before school? Do they constantly convey worry about not getting enough sleep and being too tired to go to school?

Maybe you have noticed an increase in interpersonal difficulties, academic concerns, and frequent visits to the nurse or social worker. Or perhaps you are experiencing a very different child during the week than on the weekends, and you are not sure where to turn.

It Is About More Than School

School refusal, or school phobia, is not a diagnosis in the DSM, but it is a behavioral symptom of anxiety.

The reasons your child may not want to go to school can be different, and there are many conditions that might be at play. For example, they may want to go to school but are just not able to. Often, that indicates that an anxiety disorder or OCD might interfere with your child’s ability to get to school.

Together, you and a therapist can work to figure out what lies at the root of your child’s complaints of physical sensations and subsequent refusal to go to school and come up with a treatment plan for their phobia. School no longer has to be the enemy—anxiety is!

Missing A Few Days Is Normal, But School Refusal Indicates A Problem

Everyone misses the occasional day at school. A stomachache, a family vacation, a mental health day—these random and intermittent absences make sense. School refusal, though, is different.

The National Institute of Health reports that between 2%-5% of school-age children experience school refusal.* The School Avoidance Alliance, on the other hand, notes that school avoidance and refusal affect 5%-28% of children at some point in time.** While agencies might not agree on the number or prevalence, everyone can agree on the short- and long-term impact of school refusal from an intellectual, social, emotional, and behavioral lens.

School Refusal Serves Many Functions

Whenever a child does not attend school due to their fears, they learn that avoidance works—or at least, it works temporarily. By refusing to go to school, they don’t need to face negative emotions or feel physically uncomfortable, and they might even be escaping social situations that cause them anxiety.

In addition, when they get to stay home, they might receive extra attention from their parents or caregivers—a secondary benefit in their eyes. But there is a flipside. Staying home lowers negative arousal, which is negative reinforcement (more absence = more fear).

Fortunately, with help from a therapist, you can learn to break this cycle, as you begin to understand how to respond to your child and not accommodate their anxiety. With a targeted treatment plan and behavior goals to address your child’s phobia, the power struggle and number of conflicts over their refusal can be reduced, and your child can return to school.

School Phobia Treatment Can Help Regain Control From Anxiety

Society unfortunately oftentimes normalizes avoidance and unhealthy coping behaviors when something is difficult. It makes sense why this can be a go-to response, as it works well temporarily. Time away from school during the COVID pandemic has made it even more difficult for many children to return to school as they had months and even years when they were not there.

However, while we can normalize and even empathize with the difficult transition back, we know that allowing your child’s anxiety to make the decisions only leads to bigger consequences in the long run. A collaborative and sympathetic approach, on the other hand, can explore these fears and teach them that they can do hard things.

What To Expect From School Refusal Treatment Sessions

We will use a three-pronged approach, which includes working with parents, the school, and the child—all at the same time. Our goal is to create a treatment plan to quickly help your child get back into school, as we know the longer they are away, the harder it will be to overcome their phobia and go back. Oftentimes, we will set up treatment intensively at the beginning and cut down as we make progress.

First, treatment for school phobia will immediately involve parents in the process, teaching you about the anxiety cycle, what behaviors maintain your child’s anxiety, and how to reduce these behaviors. During treatment, we will teach you how to modify the environment and how to respond to anxiety when it arises so that your child can get to school. This may involve role-playing with you or even coming to your home in the morning to coach you while anxiety is happening.

With your permission, we will also work with the school to inform them about treatment and set up a reasonable plan for helping your child get back in class. For example, if your child has not been to school in weeks, it may be unreasonable to start with a full day back. Instead, we may suggest they start with attending one class or going to meet with the social worker. We will also advocate for whatever accommodations may be helpful in order to help your child succeed, and we’ll collaborate with school providers on how to respond when anxiety arises at school.

At the same time as we team up with you and the school, we will work with your child specifically on their fears related to attending school.

School Phobia Treatment Methods

At The OCD & Anxiety Center, we use Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) therapy to address school refusal, as they are the most effective treatments available, regardless of the type of anxiety or OCD that may be underlying your child’s phobia.

With the use of CBT, your child will learn to identify the fears and unhelpful thought patterns that are keeping them stuck. Their therapist will teach them to challenge and reframe many of these thoughts, while they gradually learn to face their fears.

Through ERP, and with time and repetition, your child will be able to see that what they fear is not as likely to happen as their anxiety is telling them and that they can handle it. And as they begin to go to school more consistently, they will see that it will get easier.

With support from a school refusal specialist and the right treatment plan, you and your child can learn that they can get back to school, face difficult situations, and reclaim their life from anxiety.

Perhaps You Are Considering School Phobia Treatment But Still Have Some Concerns…

What if my child does not want to participate in treatment?

While this may be a source of anxiety and frustration for you, there is a lot we can do just working with you and the school to help your child return to class without their participation in treatment. For example, we can teach you how to set up the environment, how to respond to your child’s anxiety, and how to motivate them—all factors that will help them return. And we can also make home visits, which sometimes help children to engage.

My child went to school all of last year. I don’t know what happened this year. Can treatment help?

Sometimes we do not know exactly what happened that led to a fear response, but other times we do. Regardless of what the reason is, we do know that avoidance only creates bigger problems, though it might seem like skipping school would reduce anxiety. If your child internalizes that avoidance is the best solution, this will impact them in more and more areas of their life.

Working together with you and the school, we can create a treatment plan to address any possible reasons or problems that might have led to anxiety in the first place, while not allowing anxiety to dictate the future outcome and next steps.

We have tried to talk to the school and nothing has helped.

Treatment requires a team approach. We are happy to reach out to the school and advocate for you and your child. To start, we can work with the school to create reasonable expectations and accommodations that may help. We have had great success working with schools and find that they are often willing and grateful for the skilled collaboration we provide.

Your Child Can Learn to Stand Up To School Anxiety

If constant battles with your child every morning regarding school attendance are becoming exhausting, treatment with The OCD & Anxiety Center can offer you the right tools to break the anxiety cycle and get your child back in school. To address further concerns or schedule an appointment, please call us at (630) 522-3124 or email us at info@theocdandanxietycenter.com.

If you would like additional information, please consider reading our newsletter or blog as well.

*https://www.ncbi.nlm.nih.gov/books/NBK534195/

**https://schoolavoidance.org/school-avoidance-facts/