School Refusal Should Be Considered A Psychiatric Emergency

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I have been seeing an increasing number of school refusal cases in my clinical practice. I have yet to read any studies which provide empirically based findings as to why this challenging set of behaviors is on the rise but I do have a few (unsubstantiated) theories:

  1. Children and adolescents have access to too many enjoyable activities when they stay home. When I was a child, if I were to stay home from school, I would be bored out of my mind. Unless I could have quickly caught up with the story line of General Hospital, there would be nothing to distract me from the long, drawn out day, where I was lacking in social interactions. Today, the average home has TVs hooked up to cable, computers and ipads, smart phones galore, gaming systems, etc. Who would not want to stay home and “play” with their gadgets, in contrast to engaging in the challenging curriculum and unchartered social relations, of an average day at school? I am always shocked when I hear how the children and adolescents who are too “emotionally ill” to go to school, are allowed to be home, having access to technology. My motto is, if you are too sick to go to school, then you need to be engaging in a behavior that as closely as possible approximates the behaviors one would engage in at school. As long as your kid does not go to a school for programmers and gamers, chances are their school day does not entail being locked into technology. They should therefore not be allowed to do that if they are engaging in school refusal behaviors. 
  2. Parents fail to see the dangerous waters their child is entering, when they engage in school refusal behaviors. When your child is little and screaming about not wanting to go to the doctor, what do you do? Do you negotiate with them? Do you wait until they are ready to obtain their annual checkup? Going to school is as mission critical to survival as obtaining appropriate medical care. Studies have shown that children who engage in school refusal behaviors are more likely to grow up to be unemployed, unmarried, live with parents, and to experience an array of mental health conditions such as depression and drug and alcohol abuse. I always tell parents who meet with me, we need to treat school refusal as a psychiatric emergency. Children not showing up for school is equivalent to adults not showing up for work and not caring for their families’ needs.
  3. It is unclear why the child is refusing to attend school. In treating school refusal, it is critical to first conduct a functional analysis to determine why a child is refusing to go to school. School refusal is not a diagnosis; it is a symptom of a disorder. Is a child refusing to go to school because he is being bullied? Is she refusing to go to school because she is having panic attacks in the cafeteria? Is he refusing to go to school because he fears he will not make straight As and his rigid, perfectionistic thinking is getting in his way. It is critical to figure out why a child is having a difficult time going to school, in order to develop an effective treatment plan, to assist your child in reintegrating back into school. It is also critical to have the support and the assistance of your school. Your child’s school can assist you in creating an appropriate action plan to get your child back to school. That plan may entail a school staff member temporarily coming over and escorting your child to school in the mornings (nothing quite as effective at getting a kid up and out as a school security guard entering the home). The plan may also entail accommodations such as your child being able to take a break from class if he/she feels a panic attack coming on. There are many creative strategies to assist a child in more effectively managing their distress and obtaining the tools and skills necessary to handle life’s challenging moments. What is must important is for children to learn that quitting/avoiding/running away from one’s problems is not a viable long term solution. As we adults have all learned the hard way, it just leads to digging ourselves deeper into the pain and suffering.