Anxiety is an emotion that makes us feel human, but how do we support our kids when it affects their education? In this blog, Anna Finis, PsyD, Director of Child Mood & Anxiety Program at Compass Health Center- Chicago, breaks down what exactly anxiety is, how school refusal comes into play, how we can treat it, and quick and supportive tips for parents.
Racing thoughts, feeling “on edge,” disrupted sleep, butterflies in our stomachs, sweaty palms, racing hearts… we have all been there.
Anxiety is an emotion that makes us feel human. It is one of the human experiences which we can all undoubtedly say we have felt at one point or another. Considering that “28.3% of U.S. adults reported experiencing anxiety symptoms in late July 2022,” as reported by the Centers for Disease Control and Prevention, you are not alone. In fact, the World Health Organization stated that the COVID-19 pandemic triggered a “25% increase in prevalence of anxiety and depression worldwide.”
But what about our kids? While adults were impacted greatly by the COVID-19 pandemic, so were children and adolescents. Statistics consistently show that the pandemic has affected the mental health of young people at a disproportional rate as compared with adults.
In addition to stressors related to the pandemic, fall is historically a challenging time for most children and teens. Transitioning from a laxer summer schedule of sleeping-in and less homework to a more structured routine of early morning wakeups, afterschool activities, and homework, the start of the school year is never easy. Similarly, we've observed an increase in patterns of refusal after school breaks, as seen recently following winter holiday. It is estimated that five to 28% of children display school anxiety and refusal at some point in their life. to be hurdles for our children and teens.
What is Anxiety?
The key component to working with children who present with school refusal behaviors is targeting their anxiety around school. Anxiety is defined as a “current feeling of worry, nervousness, or unease due to the anticipation of future concern, danger, fear, or uncertainty.” From disrupted sleep, to perfectionism, to restlessness, irritability, and isolation, anxiety and worry can take on many forms. In general, those with anxiety tend to over-anticipate negative outcomes and find themselves thinking, “I cannot tolerate this” or “I know something bad is bound to happen.” When we over-anticipate negative outcomes, it’s easy to get in our head. We think, “I cannot handle this, so why try?” This is what happens with children who refuse school.
What is School Refusal?
“School refusal” is a term used to describe when our children refuse to attend school or enter the building but have difficulties remaining in class the entire day. School refusal is typically anxiety-based and can last for a brief period all the way to a more chronic timeline. If attending school for your child causes severe emotional distress, or your child has the desire to stay home because they feel home is “safe,” school refusal may be a challenge in your home.
The trickiest part about anxiety is that we tend to avoid things that make us anxious. An anxious child or teen will always choose the route of avoidance if it results in less anxiety. Thus, when our children stay home from school, they feel relief. While school refusal or avoidance can look like students missing full days of school, it can also look like students missing parts of the day, consistently arriving late, going home early, or spending much of the day outside of the classroom (e.g., in the nurses' office, counselors' office, etc.).
Children and teens may experience these thoughts when they are able to avoid school and thus also avoid their anxious symptoms:
- Deep breaths, I don’t need to see my scary teacher today…
- I don’t have the opportunity to run into my bully in the lunchroom...
- Thank goodness I am skipping gym so I won’t look like the worst athlete in my PE class...
This short-term relief, even if it only lasts one day, is strong enough to make our kids want to stay home tomorrow, and the day after that, and the day after that, and on and on.
My Child is Refusing School, Now What?
Research on anxiety teaches us that the only way to get over anxiety is to work through it. Anxiety only grows if we don’t face it head on. So, the best thing a caregiver or adult can do for a child with school anxiety is to hold their hand and move forward with anxiety. Anxiety doesn’t have to be a big, scary monster. Instead, let’s ask, how can we help our children understand that anxiety is normal, healthy, and can even sometimes be helpful?
You are probably thinking, “Well, how do we do that?!” You are right; this is a big feat. It is not easy to tell a child with school anxiety and refusal that they need to go to school. However, research consistently tells us that, “The number one factor increasing the likelihood of success with children who can’t or won’t go to school is an early return to the physical environment of school. Quickly returning to attending some portion of the school day is the most effective intervention in almost all situations.” (Kearney, 2018). If we know our anxious children are not in a place to make this decision on their own, sometimes we as adults need to make it for them. As parents, you do not need to do this alone. There are behavioral health programs, like Compass Health Center’s School Anxiety & Refusal Partial Hospitalization Programs (PHP), offered both in-person & virtually, that can help you.
How Do Behavioral Health PHP and IOP level Programs Work?
The first step in treating any form of school anxiety and refusal is working with a team to determine why your child is refusing to go to school. There are 4 functions of school refusal: missing school to avoid feeling uncomfortable emotions, missing school to avoid social pressures, missing school to stay home and earn more tangible reinforcements (screen time, sleep, etc.) or missing school to gain more time with preferred adults at home (caregiver, grandparent, neighbor, sibling, etc.). Once a clinical team determines what is maintaining your child’s school refusal behavior, they can specifically tailor their treatment to ensure appropriate goals are set.
For example, if your child is refusing school to avoid social pressures, judgement, or scrutiny, perhaps the therapist will begin to work with them on distress tolerance, social skills training, and social-related exposure exercises.
Maybe your child is refusing school to stay home and obtain attention. These children may show less distress about attending school overall but put up much larger fights in the morning when you are trying to get them out of the door. In this case, a behavior plan to help the child understand the expectations, rewards, and consequences of going versus not going to school is crucial.
In All Cases, Coping Skills Training is Necessary
When a child is faced with anxiety, we need them to learn skills to tolerate this on their own. Oftentimes, it is the parents themselves who end up becoming the coping mechanism for children with anxiety. Of course, we want to be there for our child in distress. This is biology! It is naturally hardwired into our brains as caregivers to monitor our child’s emotional state and soothe, protect, and care for them when we see them in distress. However, this becomes problematic when involving ourselves ends up limiting the child’s opportunity to use their own coping skills. As a result, the child can grow less resilient in the face of anxiety.
Our goal is to set expectations for children that help prepare them for the real world. This means understanding and internalizing that they can do hard things; that they can go to school even if they don’t feel 100% that day; and that they can be anxious and go to school. Setting these expectations shows your children that it is possible for them to cope with anxiety in healthy ways, as opposed to avoidance and refusal, which are unhelpful coping strategies. As they start to experience that they can tolerate the anxiety, the anxiety, in turn, decreases over time.
Quick Tips for Parents
Focus on one day at a time. Validate your child’s emotions. You can try saying, “I know you are anxious about school tomorrow” and remind them that they can be anxious and follow through… “and we are still going to go to school.” Try not to negotiate. Instead, plan to insert small rewards throughout the week, such as, “I know Mondays are hard, so if you can get to school today, you can pick out the tv show we watch as a family after dinner tonight.”
Most importantly, lean on a team of trusted adults. Pull your school team in, let them know how difficult your mornings are, and ask how they can become involved. Lean on your friends, fellow family members, and neighbors, if you feel comfortable. This is not easy work! Ask for help.
Also, find a therapist. Anxiety is a contagious emotion! When you are in the thick of it with your child, it can be hard to think clearly, make a plan, and execute it. It can be tremendously helpful to pull in another adult to help support you. Work with a therapist to make a “cope ahead plan” for difficult mornings.
We Can Do Hard Things Together
Getting a child with anxiety to school, when getting to school is the last thing they want to do, is not an easy task. As adults, we know the importance of getting a child to school each day. School is a training ground for the real world. It is healthy to share our emotions when things get hard, and it is healthy to ask for help. So, ask for help. Reach out to your therapist or Compass Health Center to guide your family through these difficult moments.
At Compass Health Center, we specialize in School Anxiety & Refusal treatment through comprehensive group, individual, and family therapy, psychiatry, and medication management. We also provide immediate mental health assessments, ensuring families can schedule an assessment for their child within 24 hours of placing their first phone call and begin treatment as soon as the next day.
Let’s teach our kids that we can all do hard things and that we are resilient in the face of challenges.
- How to Ask for Mental Health Help
- School Refusal Treatment - Rewriting the Narrative: From "I Can't" to "I Can"
- How Do I Know Which Type of Mental Health Treatment is Right for Me? | A Clinician’s Guide to Understanding Levels of Care
- Which Mental Health Diagnoses are Treated at the PHP/IOP Levels of Care at Compass?
- The Connection Between Mental Health and Substance Use Among Youth
Director of Child Mood and Anxiety Program