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Deborah Howell (Host): Hello, I’m Deborah Howell, the host of School Refusal, a special podcast series from Rogers Behavioral Health. This is episode one of our four part series where we’ll look at some common questions around school refusal. I’d like to welcome Dr. Heather Jones, a psychologist at Rogers Behavioral Health where she provides clinical assessments, consultation, and supervision of behavioral specialists working in the adolescent center for OCD and anxiety. It is such important work. Welcome Dr. Jones.
Dr. Heather Jones (Guest): Thank you.
Host: What is school refusal?
Dr. Jones: School refusal describes a set of behaviors associated when children either refuse to go to school on a regular basis or have difficultly staying in school throughout the week when they’re actually there. An important differentiation between school refusal and truancy, so the literature really differentiates these two things that school refusal is associated typically with anxiety or depression where truant students tend to maybe hide their absences from their parents and do not experience that anxiety or depression that is associated with coming to school, and so those are two important distinctions so we’re really talking about students who have difficulty being in school or staying in school because of pretty severe anxiety or depression.
Host: That must be just so heartbreaking for the parents. How prevalent is school refusal?
Dr. Jones: 2% to 5% of school aged children are struggling with staying in school. Typically they’re between the ages of 5 and 6 and 10 or 11 and the reason that we’re seeing these spikes in ages are because these are times of transition either entering school for the first time. So think going to kindergarten, how scary if we can remember that was or entering – transitioning from elementary to middle school or even that transition between middle and high school. Typically these children actually have average or above average intelligences and they are really struggling with staying in school or getting to school when their typical aged peers are able to do that without as much difficulty.
Host: And when do school refusal behaviors generally begin to occur?
Dr. Jones: So again during those transitional times. Other prompting events can be stressful life events. So moving, starting a new school, it could be even an unrelated life event like a death of a loved one or a prolonged illness. So there could be experiences in a child’s life that have taken them out of school based on medical necessity for example, and then they have a difficult time transitioning back into school. Kind of that idea that if we avoid something long enough, we actually build a sense of fear about re-engaging in that activity and having some anxiety about what it means to go back into school, and the problem as you can imagine is much more severe in older children than younger children. The impact is much less on younger children, and I think more age appropriate or socially accepted if you think about a child that is transitioning into kindergarten, it’s pretty typical that you’d except them to be – children at that age to be apprehensive. It’s really when we get into the middle and high school years that these behaviors become really a more significant problem.
Host: I see, yeah because we were all scared to death about going to kindergarten, excited but scared. Now doctor what are some behaviors associated with school refusal that educators and parents should watch for?
Dr. Jones: So the challenging thing with school refusal is there’s really heterogeneity in the presentation. What I mean by that is it can really look very different for one child versus another child. Some things that we might see in younger children when it’s time to go to school, having tantrums or even running away, like no I’m not going to go to school, I’d rather run away from you just in the house or, heaven forbid, just run down the streets when the bus comes; certainly tearfulness before going to school. Something that we see really commonly with younger children and older children are somatic complaints, so stomach aches, headaches, this can even translate into having – going to see a gastroenterologist because of chronic stomach aches associated with going to school, being in school, and then it could be – if we sort of look at the continuum of symptoms and things to look out for, just starting to see in your child hesitation about going to school or maybe persistent negative thoughts or statements about school where they didn’t otherwise exist – so I hate school or I’m not good at school, even verbal worry. So what if something bad happens when I’m at school? What if I get bullied? What if I fail this exam? Another common behavior is reassurance seeking from parents or teachers. So these are sort of precursors for anxiety disorders, asking is everything going to be okay? Just that overall apprehension about being at school.
Host: So those are the early triggers that parents might see?
Dr. Jones: Yes, that’s correct. Bullying is just one of those factors, and I think over the last 10 years we’ve really seen a transition in bullying to an electronic form, so it’s not just that face to face bullying but maybe I am a child who has no problem going to school but has recently seen something said about me on social media and so now I have apprehension about going into school, being there, being present with my peers, certainly those factors that we’re learning how to deal with now present unique challenges.
Host: Your kid has a tantrum, what do you do?
Dr. Jones: That’s a great question. We’re going to talk about sort of behaviors, parental behavior that either maintain or reinforce school avoidance. So inadvertently we – you see your child have a tantrum or say to you as a parent, I don’t want to go to school or it’s scary, or I don’t like it and it’s hard – it’s hard as a parent to force your child or ask your child to do something that’s really uncomfortable or that’s causing them emotional distress. So I think we need to look at single behaviors. So one bad day at school, one time I don’t really want to go, this is terrible and then it sort of subsides, and they go to school and that’s not an issue and I think most parents would be able to manage that with just basic parenting, supportive parenting. When it starts to become chronic and we’re seeing week after week or day after day of having difficultly going to school that’s when we’re going to want to make sure that if they – we really want to encourage them to continue to go, even though it’s hard, even though they might be crying, or they’re having a hard time, we know that being in school is better than not being in school even if it’s anxiety provoking.
Host: I look forward to continuing our conversation about school refusal with you in part two of this four part series. Thank you so much for joining us for part one Dr. Jones.
Dr. Jones: Thank you for having me.
Host: Rogers Behavioral Health is working each day to ensure those with mental health challenges have access to the highest quality of care and most effective treatment available today. To learn more about the many ways Rogers can help children, teens, families, and schools, please visit rogersbh.org today, that’s rogersbh.org. I’m Deborah Howell. Thank you so much for tuning in.