We published a post related to school refusal and what to do about it

Based on societal expectations, most children will regularly and voluntarily go to school the majority of the time. When your child refuses to go to school, can be representative of a larger issue at play. It’s not always just your child being oppositional and argumentative, but could also be an expression of anxiety or depression. A thorough assessment of your child’s problems can be helpful to better understand why your child is refusing to go to school.

Difficulty with attending school is typically related to some form of emotional distress, often related to anxiety or depression. It is a serious issue, especially because the law mandates school attendance. It can cause severe consequences to not only their grades, but it can also negatively impact on both, peer and family relationships, influencing your child’s social and emotional learning.

Recent research shows that approximately 5% of children refuse to go to school, and typically occur between ages 5-6 and 10-11. One study evaluated 80 school-refusing children and found that 1/3^rd had a disruptive behavioral disorder, and 1/5^th had an anxiety or mood disorder. Within the domain of anxiety, researchers found that the most common anxiety disorders that contributed to school refusal were separation anxiety disorder (38%), social phobia (30%), and specific phobias (22%) (Berg et al, 1993; Last & Strauss, 1990)

Often times, these children may express physiological and somatic complaints, such as autonomic or gastrointestinal concerns. When you hear these complaints as a parent, it’s important to consider that psychological factors may be contributing to your children’s somatic complaints.

Additionally, school refusal may be due to several other reasons such as problematic family functioning, or academic and communicative frustration stemming from a learning disability. Before assuming the cause of school-refusal, it’s important to get a thorough assessment by a professional to identify the underlying cause of the truancy.

Fortunately, there are effective treatments available for school-refusing children. The American Academy of Child and Adolescent Psychiatry (AACAP) in 1997 provided a list of multimodal recommendations for school-refusing children, encouraging education and consultation initially, then behavioral or cognitive-behavioral strategies (such as exposure therapy, coping skills, contingency management, and behavioral plans) with family interventions. If the symptoms are severe enough, medication may be needed, but behavioral interventions should be the first line to address these issues (AACAP, 1997; Eville et al., 2001).

If you’re struggling with a school-refusing child, it’s important to get help from a professional to thoroughly assess and provide the most effective treatment recommendations for your child.

American Academy of Child and Adolescent Psychiatry (1997). Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry 36(suppl):69S–84S

Berg I, Butler A, Franklin J, Hayes H, Lucas C, Sims R, (1993). DSM-III-R disorders, social factors and management of school attendance problems in the normal population. Journal of Child Psychology and Psychiatry 34:1187–1203

Eville J. King, Gail A. Bernstein. (2001) School Refusal in Children and Adolescents: A Review of the Past 10 Years. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 97-205. 10.1097/00004583-200102000-00014.

Last CG, Strauss CC, (1990). School refusal in anxiety-disordered children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 29:31–35

According to the Anxiety Disorders Association of America (ADAA) approximately about 15 millions of adults in the United States have social anxiety, and 36% of them report symptoms for 10 years or longer.

More often than not social anxiety is underdiagnosed and therefore, it continues to be a very debilitating struggle.

If this something you are concerned about, either for yourself or someone you care about, read the next paragraphs, see if some of those descriptions relate to your experience, and learn briefly about effective treatments.

When thinking about your social life:

Do you feel extremely uncomfortable in social situations to the point that you avoid them?
(Avoidant behaviors include for example turning down an invitation, never talking in class, leaving early from social gatherings in order to avoid making small talk, etc.).
Do you only attend social gatherings if you find ways to be safe?
(Safety behaviors include for instance carrying a cell phone to distract yourself from interacting with people, taking your anxiolytic medication just in case, wearing a turtleneck sweater so people don’t see your blushing, etc).
Are you concerned about being negatively criticized, doing something embarrassing, or making a fool of yourself when interacting with others?
Do you closely inspect your behavior when interacting with others to the degree that at times it’s really hard to pay attention to the person in front of you because you’re busy planning what you’re going to say and how you’re going to say it?
Do you experience some physical sensations, including panic attacks, when interacting with others?
(This is different from panic disorder).
Do you think over and over about a social event weeks before it happens?
(This is called anticipatory anxiety).
Have you been experiencing the above characteristics to a degree that they significantly affect your relationships, career, and professional performance?

Your responses to the above questions may or may not suggest you’re struggling with social phobia; just be honest with yourself.

In addition, it’s possible that these ongoing struggles may have led you to developed a “story” about being defective or unworthy.

Is this something you relate to as well? (Click here to read previous post on schemas).

Ultimately, the main consequence of social phobia/anxiety is very clear: loneliness. It’s that “loneliness” that I very often witness in my clinical work when working with clients who struggle with this form of anxiety.

And, that’s the main reason to write this post: I fundamentally believe that you can learn a different behavioral response to your anxiety.

Cognitive Behavioral Therapy (CBT) has proven to be the most effective treatment not only for social phobia but anxiety in general.

Within CBT there are also other therapy modalities such as Acceptance and Commitment Therapy (ACT).

Both therapy modalities share some common ground: exposure work and behavioral change.

Therefore, it’s extremely important for you to be aware that an effective therapy treatment is gently going to prepare and invite you to face those fearful social situations and other situations that are consistent with your interpersonal values.

Finally, keep in mind that a therapy that doesn’t embrace change in your daily life is simply not going to be effective with the ongoing sense of “loneliness” you have been struggling with because of social phobia/anxiety.

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