Refusing to go to school is a legitimate psychological problem, one that leads to serious psychological problems later in life. So, why are we just hearing about it now?
Being a parent can be the most difficult job on the planet. So can being a child. At the end of 2016, Mission Australia and the Black Dog Institute brought out their Youth Mental Health Report. It made for grim reading: almost one in four teenagers are “at risk of serious mental illness”, the researchers found. Depression and anxiety are the top problems, and their prevalence is growing. In 2012, 18.7% met the criteria; four years later that was 22.8%. Particularly vulnerable are girls, and Indigenous kids, for whom it is a startling 31.6%. One of the good things about reports like this is that they get us talking. More to the point, it gets the children talking. And talking helps. At least a little. What we are not yet discussing very much is a phenomenon that is closely related to depression and anxiety, called school refusal. Before you start to scoff: no, I am not talking about truancy, or wagging. School refusal is a serious psychological problem, where the fear of school is so intense that even the thought of going puts people into a tailspin. Sufferers don’t have an issue with learning, but with getting out of the house. Whatever they and their parents try to do, very little works. Often just getting dressed makes people throw up and leaves them so scared that they literally think they are going to die. Researchers around the world don’t necessarily agree on how many children are afflicted by school refusal, but the general consensus seems to be between 1 and 5% of school-aged children. In Australia, that means between 40,000 and 200,000 kids. And if you accept that every child has on average three family-members, the number of people having to deal with this on a daily basis is between 160,000 and 800,000 in this country alone.
They are children like Maria*. She is 13, and has been at home for almost a year now. Her school refusal started when it usually does: at a moment of transition, in Maria’s case from primary to high school. She can’t remember ever being scared at primary school. Yes, maybe a little when there were tests on, but who isn’t? Maria is smart, very smart, and when she was younger she always got the highest marks. That was important to her, because she wanted to show her parents what she could do. Her parents are smart too and they expect a lot of her, although they never say so. But Maria knows. In fact, she often frets about what her parents think, and when they don’t feel well it hurts her. Just after Maria went to high school, her dad got a new job. It is further away from where they live, so he is home later, and frequently tired. That worried Maria. Often, when she went to bed, she dreamt that something would happen to her father. That he would have an accident, or maybe decide that he didn’t want to live with them anymore. Something like that happened to a friend of hers, and her parents are now divorced. Maria couldn’t concentrate on school anymore, and in the beginning she came home early, with a stomach – or headache. Then it felt impossible to get on the bus in the morning. Even the idea of school made her sick. If she was at home, she felt safe, and certain that nothing would happen to her family. At home, she could do something about that, have some control.
Early intervention is the gold standard. Everybody needs to respond as soon as possible. The moment you think your child has a problem, you need to act.
School refusal used to be called school phobia, and as far as academics know, it has been there forever. Although, we really don’t know that. Schools have only been forced to record attendance for a few decades, and even now every school does it differently, and most don’t mention the reasons for absence. But there are a few things we do know. First of all, children at every age can suffer from it, and that it affects as many boys as girls, from families across the socio-economic spectrum. It is unclear why it happens, but we do understand when: at a crossroad in a young person’s life. That can be when children change schools, or when something serious is going on at home. Children that are most susceptible are the worriers, those with a temperament that makes them more vulnerable to anxiety, as psychologist and researcher Amanda Dudley says. She has been investigating school refusal for years, first at Monash and now at Deakin University. She describes it as a symptom of something else, usually anxiety. That can have a lot of reasons: bullying at school, fear of separation, friendship challenges, having to go through tests. Often, those children have parents who are overly protective, overly reassuring. Instead of letting their children manage their own feelings, their instinct is to make the world a safe place by taking them under their wing. This way, what the child picks up is that they can’t solve their own problems, number one, and that staying at home is a real option. So they do. And the longer they are out of the classroom, the more difficult it becomes to go back. Some children miss school for weeks and months, years even. With serious consequences.
After Maria had been home for the first few days, her parents put their foot down. They walked her to the bus and saw to it that she got on. They hadn’t done that for years and it was embarrassing. Also: it didn’t work. As soon as Maria and the other children had been dropped off at the school door, she turned around and left. Sometimes she would stay a little longer, but the sound of the bell made her vomit. Most of the time, she would go home, get back to bed. The relief she felt then was lovely, really lovely. Of course, after a few days the school contacted her parents, and she promised she would try to stay. But she didn’t. And then she stopped pretending and just stayed in bed. There were meetings. Between her mum and dad and the school. Sometimes she had to go as well. But that was useless, she felt. How did she know what was going on? She just couldn’t go to school, and that was it. She told the psychologist they called in for her, and then the psychiatrist. He gave her medication that made her fat. For the rest it was just talk. Talk, talk, talk, talk. It made her very, very tired, until all she wanted to do was sleep. Then it seemed the adults came to their senses. They gave her schoolwork to do at home and stopped talking about getting her out the door. So Maria did the work, slept a lot, and stayed inside. Now her mother has taken two days a week off work to be with her. The rest of the time there is a baby-sitter. Ridiculous, by the way! How old do they think she is? Once a week they go to family therapy. Or actually, the therapist comes to them, because Maria isn’t leaving the house anymore. They talk, and these days her parents fight a lot as well. That worries her. Then she’ll have those dreams again.
There needs to be a plan, it read, and as much communication between everybody involved as possible. Everybody needs to do anything that is necessary.
Left untreated, school refusal can, and often does, turn into panic disorders, psychiatric illnesses and social phobias that can last a lifetime. First, the sleep/wake cycle gets disturbed, then children lose their connections to their friends and peers. They fall behind academically, find it difficult to get into a routine or engage in anything but what is in their own head, Amanda Dudley says. The longer they are at home, the worse it gets, and if it takes years it obviously also interferes with finding work, a partner, independence. For their parents it can be very distressing too. Not only do they often not know how to deal with their child, the situation also undermines their own work, relationship, social circles. This is why, Dudley stresses, early intervention is the gold standard. School, parents, child, outside health professionals: everybody needs to respond as soon as possible. The moment you think your child has a problem, you need to act. Get everybody together, come up with a communal plan. And whatever happens: they have to go to school. Even if they are anxious, even if they are overwhelmed. Avoidance simply doesn’t work. You have to face up to the situation and get through it.
Of course, just saying that is not a solution. So what is? According to worldwide research, there are a few options. The first one is CBT, cognitive behavioural therapy. Despite Maria’s description, it is not really talk, talk, talk, but a very practical way of training yourself to look at your problems and trying to solve them by learning a different way of dealing with them. During CBT you retrain your brain into being less anxious and finding ways of coping when you are. In the case of school refusal, it is a good idea for everybody to participate. Children, parents, siblings, sometimes even teachers. Last year the NSW Government published a booklet on school refusal, to assist not only parents, but schools as well. It too focused on early identification and action. There needs to be a plan, it read, and as much communication between everybody involved as possible. The school counsellor, learning support team, parents, the child itself, everybody needs to do anything that is necessary to prevent it from becoming entrenched. Dudley’s team at Monash also looked at whether medication would help. But although it is often used, according to their results it didn’t seem to make much difference. Other experts suggest mindfulness training, hypnotherapy, relaxation therapy, and a few years ago an experiment with web-based consultations seemed promising. Something that the Black Dog Institute also provides, although not geared towards school refusal in particular.
Dudley describes it as a symptom of something else, usually anxiety… And the longer they are out of the classroom, the more difficult it becomes to go back. Some children miss school for weeks and months, years even.
Sometimes, if it is very persistent and clearly related to severe anxiety and depression, a group home or mental health facility can become the only option. And there are some (not many) special schools, like the Travancore School in Victoria, which dedicates itself to children with mental health issues. A 2015 article in The Age spoke to one of its teachers, who had noticed that referrals for school refusal had jumped from 10% in 2009 to 30% in 2013. Obviously, it is much, much better to try and prevent such extraordinary measures. Although it is a bit late for Maria, everybody now finally seems to be on the same page. “Graded exposure” is the term of the moment, and things have stepped up. There are more CBT sessions, some with the family and some without. There is special social skills training and yoga to help her manage her anxiety. And scarily enough, there is a return to school plan on the table. It will start on Monday, with a few hours, and will build up from there. Hopefully, her parents say. Maria isn’t so certain. But she will try. She says.
*Maria’s name has been changed for privacy.
For this story I have used the following sources:
University of Wollongong Australia
Australian Medical Student Journal
University of Wollongong Australia
I have also spoken to Amanda Dudley, Deakin University.
If you need help, you can contact:
KidsMatter: www.kidsmatter.edu.au 1800543767 (for primary school children)
MindMatters: www.mindmatters.edu.au (for children in high school)
Parent Line: www.parentline.org.au 1300130052