Refusal: How schools are handling student anxiety

Refusal: How schools are handling student anxiety

(Maine) High schoolers at a Maine charter school were racking up a significant number of absences, so administrators hatched a plan to keep them on track for graduation: send teachers to the students.

School personnel quickly discovered that some of the more common barriers keeping older students form showing up–teen parenthood or even a lack of sleep, for instance–were rarely the problem among their pupils.

Rather, nearly every student they worked with suffered from anxiety so severe that they flatly refused to go to school, believing that it wasn’t a safe place to be.

Such programs, like that adopted late last year at the Academy of Natural Sciences charter school in Fairfield, aim to help students affected by school refusal or other barriers in regular school attendance to graduate.

Maryland-based psychologist Jonathan Dalton, who specializes in treating anxiety and behavioral disorders that lead to school refusal, applauds such an effort to get school personnel out to a child’s home because it shows kids that the adults in their lives aren’t willing to let them fail.

The program at the Academy of Natural Sciences, required teachers to provide personalized instruction for those who regularly miss class in hopes that it would continue their progress toward earning a diploma.

The school's director of instruction and education programming told a local NPR affiliate that the program was originally developed as a way to get disengaged students reengaged, with the assumption that the majority of participants would be teen parents. But, as it turned out, only three of the 21 students enrolled in the program had children to care for.

The rest were found to have an anxiety disorder which led to school refusal.

While Dalton said the intention of the charter school is a good one, there is a risk: If the overall goal is simply to help students graduate instead of helping them reenter school, such programming would only further enable students to continue relying on avoidance behaviors like school refusal.

As described in part one of this two-part series from K-12 Daily, school refusal generally refers to school absenteeism driven by a child’s anxiety. And while it’s difficult to determine how many students are affected, Dalton–also the director of the Center for Anxiety and Behavioral Change–says he’s received an increasing number of calls from school systems reaching out for help.

More than ever, schools and teachers are being expected to work with families and their communities to address the physical and mental health needs of students. Districts have quickly realized, however, that they can’t help students who aren’t present, and many have implemented programs as a result that aim to reduce absenteeism.

Throughout Texas, California and Kentucky, schools are providing health clinics, laundry services, mental health resources and improved transportation options, among numerous other services, in an effort to ensure children can get to school and be ready to learn once they’re there.

While such programs are invaluable to many families, none will address the underlying cause of the absences quickly racked up by students experiencing school refusal. Researchers from the University of Nevada, Las Vegas found in 2004 that among children regularly refusing to attend school, 22 percent met criteria for separation anxiety disorder; almost 11 percent for generalized anxiety disorder; 8 percent for oppositional defiant disorder; and nearly 5 percent met for depression.

For some children, ensuring they have access to clean clothes is enough to get them to class every day–but for students affected by school refusal, addressing the individual fears spurred by their anxiety must be the first step in helping them cope with their anxiety so they can show up and stay focused in school.

Without treatment, research shows that children with anxiety disorders are at higher risk to perform poorly in school. A key factor is because students are so focused on whatever they are anxious about–be it reading aloud in class, or having a panic attack in front of their peers–and how to avoid it, that they can’t process and retain new information, according to Dalton. 

“They’re processing threat cues like we would if we were in a hijacked plane, and so they aren’t going to process information that doesn’t seem so vitally important, like how to conjugate a verb in a foreign language, for example,” Dalton said. “I describe it like you’re trying to learn calculus while you’re next in line to go bungee jumping.”

Even just identifying the root cause of a child’s anxiety is a monstrously large task, and isn’t something school personnel can likely do alone.

As Dalton explains, school refusal is complicated and pinpointing the cause of a child’s anxiety can be incredibly difficult. For instance, he notes, some research suggests 30 percent of students affected by school refusal miss due to separation anxiety disorder, but separation anxiety itself can be broken into four pillars:

  1. A fear of being alone (these kids won’t likely refuse school, but they may not want to sleep in their own bed at night)
  2. A fear of abandonment (children are constantly worried about something happening to their parent or guardian that will prevent them from reuniting)
  3. Worries regarding physical illness (students will persistently have thoughts such as ‘what if I get sick and mom or dad aren’t there?’)
  4. Fear of some impending catastrophic event (a tornado, school shooting, etc.)

“Just knowing what a kid has been diagnosed with doesn’t really tell you enough to help figure out a game plan to help them,” Dalton said. “We think of school refusal as an allergic reaction to a casserole, and we have to know what ingredient they’re allergic to in order to help them.”

Ultimately, districts can’t handle every aspect of school refusal alone, but they play a vital role in helping children reenter school. When Dalton treats kids at the Center for Anxiety and Behavioral Change in Rockville, Maryland, school reentry directly involves school personnel, professionals also work with a student’s teachers, administrators and other necessary faculty who develop a game plan that touches on everything from how and when missed work will be completed to concerns regarding seating arrangements.

Plans may even include developing an appropriate “cover story” for peers that may ask about the child’s absences, as well as ensuring teachers understand the differences between appropriate accommodations for a student and enabling avoidance.

Perhaps more than anything, treatment for school refusal is about teaching both children, their parents and teachers and administrators that avoiding school to deal with anxiety isn’t a viable option. Just like parents who enable avoidance behaviors must be shown how to better address their child’s anxiety, schools also mustn’t show students that avoidance is a proper response by relying on home-based academic instruction alone.

“Where we can get these kids back into school, it’s not really about the curriculum they’re returning to, it’s about the skills they’re learning about how to navigate the world using coping skills other than avoidance,” Dalton said. “Anxiety is temporary but avoidance can ruin lives–this matters too much, and we can’t let these kids just trail off.”

Parents and school officials can find additional resources at the Anxiety and Depression Association of America, as well as School Refusal Hope.

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