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“Get up. You’ll be late!” It’s something many parents have probably said at least a few times as they try to get their kids ready to go to school. While some kids may negotiate five more minutes to snooze, some parents in the D.C. area have a more “relentless and exhausting” challenge when their child refuses to go to school.
It’s called school refusal, or school avoidance. More than simply playing hooky, it’s a term for when kids have difficulty attending and remaining in school due to the “emotional distress of being in the building,” said Dr. Jonathan Dalton, a psychologist with the Center for Anxiety and Behavioral Change in Rockville, Maryland, and McLean, Virginia.
Historically, the most common reason for school refusal is anxiety-based avoidance, where people have an anxiety disorder, Dalton said. But it can also be due to an undiagnosed autism spectrum disorder.
“It can look the same, but can happen for very different reasons,” Dalton said.
Data collected by the National Institute of Mental Health found that 2.8% of 8-year-olds were estimated to have autism spectrum disorder in 2020. School refusal is a different experience for children who have autism spectrum disorder.
“They are often very overwhelmed, they don’t have the ability to maintain daily attendance because they’re exhausted from the effort it takes to regulate their sensory and social and emotional systems,” Dalton said.
When the root of school refusal is anxiety, however, Dalton’s work involves educating parents about how powerful and negative the force of avoidance is, and he helps kids become an “informed observer of their own urge to avoid” but not follow it, he said.
Student mental health: ‘The numbers are horrible’
Even before the COVID-19 pandemic, Dalton said anxiety disorders among children in the U.S. have never been higher, with the average teenager five to eight times more likely to show symptoms compared to previous generations.
The National Institute of Mental Health said that the prevalence of any anxiety disorder among adolescents was higher for girls (38%) than for boys (26.1%).
“The numbers are horrible. When it comes to the level of anxiety that the kids are experiencing now, they’re numbers that we’ve never seen before,” Dalton said.
Mara Nicastro, the head of The Nora School in downtown Silver Spring, Maryland, said some students may refuse to go to school when their “sense of self has been interrupted,” such as if they’re in a family crisis that could involve economics in the home, death, illness or divorce. The school teaches students in grades 9 to 12, and it works a lot with teenagers who have been experiencing some school refusal.
“Those crises impact your willingness to get up and go and go to school” and make it hard to do the things that teenagers want to do, Nicastro said, adding that the COVID-19 pandemic has exacerbated these issues.
Schools struggling with attendance
Sally Reed is the coordinator for the Prince George’s County Truancy Reduction Court Program, which works with students throughout the county who have been referred to the program because of absenteeism and truancy.
Nearly every state is still struggling with attendance after the pandemic, and some 12 million children in 42 states and D.C. missed at least 10% of the school year during the 2022-23 school year, The Associated Press reported.
Reed said that since the pandemic and up until about a year ago, the program has seen students who felt “extreme anxiety” about returning to school.
“Those are the most challenging, honestly, those cases — to kind of get them to be comfortable and confident to return to just a typical school environment,” Reed said.
Nicastro said the pandemic exacerbated a sense of isolation, and some students started to feel a “lack of social connection, other than electronic social connection,” which she added is not the same as face-to-face relationships.
For younger students, the pandemic interrupted the social emotional learning that happens in school, causing them to have this “uncertainty over how to reconnect,” Nicastro said. “Once that anxiety starts to heighten, it gets harder to come to school. And that’s when the school refusal really, really sets in.”
A counterintuitive treatment
Psychologist Dalton said the “gold standard” when it comes to anxiety-based avoidance is habituation, which he compared to getting in cool water early in the summer.
“The goose bumps will go away just because you’re used to the temperature of the water,” Dalton said. “We teach everyone that anxiety is two things — it’s temporary and harmless — but avoidance can ruin lives.”
Dalton said that almost every parent gets it wrong by enabling avoidance or offering reassurance to an anxious kid.
“It makes sense like it would make sense to put a grease fire out with water,” Dalton said. “It seems like it would work but it actually makes things a lot worse.”
He added that “counterintuitive strategies” help parents to not accidentally reinforce the anxiety and allow the avoidance to persist.
He likens the anxiety disorder to a dog begging for food. And while it’s tempting to give in and give the animal a treat, it will come back and ask for another one.
“The same is true with anxieties,” Dalton said. “If we give it avoidance and we give it reassurance, it goes away very briefly, and comes back and makes a bigger mess when it comes back the next time.”
What he helps families with is to arm children with effective, non-avoidant coping skills that help them “overrule the urge to avoid,” so they are strong, capable and able to move forward despite having the anxiety, Dalton said.
Nicastro, with The Nora School, agrees that the way to feel better is to go into the “uncomfortable” place and believe that you can handle the discomfort and take the steps that teenagers are expected to: going to school, “Every single day.”
“That’s really what we try and say, like, ‘Your job is getting up and going to school,’” Nicastro added. “When that’s not working, you have to know that’s a really serious symptom because that’s what teenagers are supposed to do.”
Dalton said “anxiety itself is not a harmful experience to go though,” but using avoidance as a means of interacting with the world is detrimental for the future.
“We don’t call it work refusal, we call it unemployment. And it’s a big issue for these individuals unless they’re helped,” Dalton said.
Nicastro said all children will need to learn how to navigate the world.
“There isn’t any teenager that imagines, ‘I’m going to be able to stay in my room or stay in my house for the rest of my life and never have to leave it,’” Nicastro said. “There just isn’t any way to live life that way.”
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