School refusal may be due to a combination of intrapersonal and interpersonal mechanisms while emphasizing scrutiny of interaction between the child, family and school, says Consultant Psychologist Dr Sangeetha Madhu.
Anand 14 years old was the only child of his parents. He had been a little reluctant to attend school at age of 5 years but had transferred to another school when he was 8 without any difficulty. When he shifted to a new school at 14 years, his attendance broke down quickly. His family doctor arranged for extensive investigation of the abdominal pains of which he complained each morning. No abnormality was found. The morning battles continued and eventually, Anand refused to attend school altogether.
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Going to school usually is an exciting, enjoyable event for young children. But for some, it brings fear and panic. Parents have cause for concern when their child regularly feels sick from tension, or with minor physical complaints wishes to stay from school.
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School Refusal
School refusal became an issue of concern in the 60’s, began to decline in the 80’s but began to increase rapidly in the 1990’s. Earlier school refusal was categorized as a type of neurosis or a mental disorder. However, recent studies have conceptualized this problem as a product of an imbalance between school, family and social environment.
What can we do for this increasing trend of school refusal among children? This is a good time to think about this critical problem especially in the Indian setting where educational concerns are becoming more prominent.
Development and Aetiology
The child develops a pattern of predictable behavior. The child may begin the day complaining he is too sick (e.g. headache, sore throat, stomach ache). When he stays at home, he begins to feel better, by next morning the symptoms are back in full intensity. When the child repeats this pattern on a chronic, consistent basis school refusal has evolved.
When it is related to separation anxiety disorder, the child will also avoid other school related activities. Children with school refusal may feel unsafe staying alone in a room, display clinging behavior, display worries about parents, have difficulty going to sleep / nightmares, have unrealistic fears, fear of being alone in dark, severe tantrums when forced to go to school.
When does school refusal begin to show in a child?
Refusal to go to school may begin following stresses – the birth of a sibling, the death of family member, friend or pet; change in school; new teacher; changes in the family; divorce, remarriage. It may also follow summer vacation, hospitalization or holiday break.
Almost every child will display behavior to avoid school for academic / social reasons at some point of their school career. When school refusal becomes a chronic pattern and left untreated the child may develop social, academic problem, poor peer relationships, school or legal conflicts, work or college avoidance, panic attacks, agoraphobia, and adult psychological disorders.
School refusal may be due to a combination of intrapersonal and interpersonal mechanisms while emphasizing scrutiny of interaction between the child, family, and school.
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Treatment
- If complaints of illness are the excuse for not attending school, have the child checked by the family medical provider. If there is no medical reason, the child should be at school. The parent should attempt to discover if there is a specific problem causing the refusal.
- Sometimes the child gets a relief by just expressing concerns about friends or school expectations. If the child is able to pinpoint a specific concern (such as worry about tests, teasing, etc.), then the parent should immediately talk to the child’s teacher about developing an appropriate plan to solve the problem.
- If the child does stay at home then rewards such as snacking, TV, toys, or parental attention should be eliminated. A school schedule may be duplicated at home.
- However, if the child is extremely upset, if the child needs to be forced to attend school, if there is significant family stress, or if the refusal to attend school is becoming habitual, the family should not hesitate in asking for assistance from the school psychologist, school counselor, or other mental health professionals.
- Parents and the school need to work together to identify what is causing or maintaining this behavior and to develop a comprehensive plan of intervention. A key to success is rapid intervention; the longer the behavior occurs, the harder it is to treat.
Treatment depends upon the causes, which can be difficult to determine. Many children may have started to avoid school for one reason (e.g., fear of being disciplined by a teacher, feeling socially inadequate) but are now staying home for another reason (e.g., access to video games, lack of academic pressure, etc.). Several treatment plans may need to be tried. Helping the child to relax, develop better coping skills, improve social skills, using a contract, and helping the parents with parenting or family issues are all examples of possible treatments.
Resources to provide systematic and molecular solutions are imperative. Unfortunately, school administrators, psychologists, educators, pediatricians and mental health professionals often employ one set of criteria for problematic absenteeism, which prevents social activism. The heterogeneity of school refusal and varied family dynamics emphasize the need for assessment and treat school-refusing refusing children and their families.
Pic courtesy: theconversation.com