Landmark360

By Dr. Helene Dionne

Every year, school counselors hear from parents at their wit’s end as their child blatantly refuses to go to school. Other parents report their child is so sick in the morning, with stomach pain, headache, nausea, and/or panic attacks, that they cannot imagine insisting the student gets on the bus or in the car. Many of these kids create a great deal of turmoil in the home and angst for their parents as they melt down, cry, have angry outbursts, and generally beg not to be forced to attend school. 

What is going on? Very often, these behaviors are manifestations of anxiety. A rise in anxiety among students has been noticed for many years. Professionals in schools are now reporting a further increase in anxiety following the year of remote and hybrid learning due to COVID-19. So, how can a parent support a child in this situation? Here are some ideas that usually apply to students of all ages.

Take a deep breath and try to understand what may be happening

Explore the reasons behind your student's distress. Understanding what triggers the behaviors and where the feelings come from will give you a start. Problem solving with your child provides an opportunity for growth and presents the model of an adult who values reaching out for help when it is indicated. The following are some examples:  

Whenever possible, engage school personnel to help your student feel more at ease. For instance, a school counselor can welcome a younger child at the door for a short period of time, making the transition to class smoother. 

Ask a counselor to help your child develop new cognitive and behavioral strategies when facing stressful situations. Inquire about organizing group meetings to facilitate peer relationships.

Become your child’s advocate and work with the school administration to ensure that bullying issues or exclusion by friends/cliques are addressed in a constructive manner. 

Your child may experience significant performance anxiety, and that fear may be well founded. Learning disabilities may interfere with a student’s capacity to learn and reach their potential. You may decide to initiate a formal application for testing and access to an Individualized Educational Program (IEP) so that your child can receive appropriate school services to address those issues. 

Inquire about support available for homework and the development of organizational skills if your child is easily overwhelmed with homework and unable to stay on top of the workload. Difficulties with organization, possibly due to executive function problems, may contribute to these struggles.    

What if these attempts remain unsuccessful?

Oftentimes, the reason for the child’s distress remains vague or persists despite numerous interventions. Physical complaints continue, the scenes at home escalate, and the child’s school attendance worsens. Even though the cause remains amorphous, anxiety can be addressed and overcome. School refusal is a form of avoidance, and avoidance is a coping strategy that provides immediate relief to anxious students. Unfortunately, this relief is short lived, and contributes to making the problem bigger. Indeed, the more one avoids a task, the more difficult it becomes to accomplish that task. 

Dr. Aureen Pinto Wagner (2005) illustrates the anxiety experienced by a child who faces a dreaded situation as having to climb a “worry hill.” The student’s anxiety increases as the moment to be in school gets closer. At some point, the anxiety becomes so overwhelming that the student refuses to go, which allows a sudden escape and a drop from that worry hill. The next day, the student discovers that the hill has only become taller or steeper. If the student had been able to make it the previous day, even arriving late to school, the worry hill would typically be less tall the second or third morning. That process is called “habituation”: the more an individual practices, the easier the task becomes.

Following nearly two years of a disrupted school schedule due to COVID-19, many anxious children have lost the habit of tackling the worry hill. School, with its social and academic challenges, has become especially difficult for some. In order to be helpful, it is important for parents to maintain a stance that combines warm support with the clear expectation that the student has to attend school. Here are some concrete suggestions and recommendations:

Clarity and Consistency

Give a clear and consistent message that missing school is not allowed. Of course, this is easier said than done. It is painful to watch your child experience intense distress as you insist that they go to school. In cases where there are two parents or guardians, they may disagree on the strategies to accomplish that goal, and conflicts arise. A therapist or a school counselor can offer suggestions for a plan that both of you can agree on and are able to follow.

Collaboration

Invite your child to collaborate in the development of a plan for the morning routine, including a departure time. 

Strategies for anxiety

Help the child develop proactive calming strategies to face the morning stress.

A school counselor or therapist may be helpful in that process, but a supportive and understanding parent can make a difference, too. Together, you could learn breathing exercises similar to the ones athletes use prior to a competition or musicians before performances. Identify distraction techniques to be used on the way to school (music, conversations, video games…). You can provide a reminder of those strategies in times of crisis.

Change it up!

Consider having the parent typically less involved in the morning routine take over for a period of time. Sometimes, novelty facilitates the adoption of new behaviors.

Consequences

Implement a range of negative and positive consequences. Your child could choose something to earn with a number of successful school attendance days in a row. The reward does not have to be a present; it can be a meaningful experience with someone, for instance, or a pass from having to do chores. Over time, earning a reward needs to become increasingly more difficult. On the opposite side, limit entertaining activities  when your child stays home: no tv, computer games, chatting with friends online, or surfing the web during school hours. Could the child go to a parent’s workplace and do school work there? The more boring it is, the better. 

Is it an illness?

Be prepared for the student’s anxiety to express itself through physical symptoms such as headaches, stomach pain, nausea, shakiness, and sometimes full panic attacks. The pain experienced by the child is usually real, and should not be minimized. It also creates a dilemma, as you need to decide whether there is a legitimate reason to stay home. The rule of thumb is typically that the child has to go to school if there is no fever. Remember, if not connected to an illness, the symptoms tend to disappear once the student is actually in class and gets going with the day. This is because these symptoms are connected to the “anticipatory anxiety” (the fear of facing a dreaded situation) that gets stronger as the time to go to school approaches. It is often helpful to explain to the child that these symptoms will most likely and often disappear once they go to school.

Pattern

Be aware of a pattern often observed in children who struggle with school attendance. Sunday nights and Monday mornings tend to be more difficult, and the anxiety eases as the week goes on. This is especially true following long weekends or vacations. Awareness of that pattern can also help a child be less discouraged when anxiety raises its ugly head again—and be prepared for it. 

Less is More

Avoid getting into arguments with your child as best you can. You may have a couple of sentences that you repeat in response to challenges. For instance, you could reiterate “I know this is really hard, but we need to follow the plan,” or “It is terrible that you are feeling so much pain, but you have no fever, so you have to go to school.” Or “Hopefully, the pain will go away as the day goes on, as it does sometimes.” Stay away from words such as “always,” “never,”... or any incendiary expressions that lead to more conflicts. In many situations, silence or a simple “I know this is hard” may be your best option.

A final note 

In some cases, an evaluation by the pediatrician may be indicated and anti-anxiety medications considered, although such cases tend to be the exception.

As you begin to implement these strategies, be prepared for the mornings to become worse before they get better. Your child will likely be terrified not to be able to resort to avoidance and will push back as much as possible. It is during those times that it is especially important for parents to stick to the plan and provide the structure the child needs. Know that other parents have faced similar struggles, they managed to make it through, and have been able to experience pride as they watched their kid overcome adversity. In the process, they and their child learned coping skills worth mastering for the other obstacles that life will present. 

Reference:

Wagner, 2005. Worried No More: Help and Hope for Anxious Children

More resources about anxiety:

Huebner, 2005. What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety (What-to-Do Guides for Kids)

Recommended Website About Anxiety:

http://www.lynnlyonsnh.com/

Apps for Breathing/Mindfulness/Relaxation

https://www.calm.com/

https://www.stopbreathethink.com/

https://www.headspace.com/

Author

Dr. Helene Dionne has been the director of counseling services at Landmark School since 2003, after working for 25 years in the mental health world, in hospitals, outpatient clinics, and private practice.