School Refusal: A Multi-Dimensional Approach for a Multi-Dimensional Problem

When children repeatedly refuse to go to school there can be a variety of causes and ripple effects for the individual and family. Resolving school refusal is not as simple as “just get them in the building,” and interventions should involve multiple groups of people working together. School refusal can stem from anxiety about separating from parents, academics, or social situations taking place at school. It may be a way to receive attention or some other tangible reinforcer, such as spending time with friends or extra sleep, or to avoid negative evaluative or social situations. When a child or adolescent is refusing to attend school, it is critical to thoroughly assess the source of their distress and behavior in order to treat it appropriately.

No matter the cause of the school refusal, a multi-dimensional approach to treatment is appropriate and necessary. Treatment may include individual therapy, family therapy, parent coaching, executive functioning skill development, academic tutoring, and collaboration with school teachers, counselors, and administrators. Collaboration with the school can include making plans for re-entry in a step-wise approach, setting up classroom supports or accommodations, or discussing the results of evaluations regarding learning disorders, attention deficits, or anxiety. There may also be a need to discuss medication with the child’s pediatrician or a pediatric psychiatrist if there is significant anxiety or physical symptoms present.

Throughout treatment, parents will need to help establish consistent routines, reinforce the use of anxiety coping and emotion regulation skills, and change patterns of accommodation that may reinforce school refusal. Family therapy sessions can help manage the emotional distress occurring within the family due to school refusal, and help create more effective patterns of support, discipline, problem-solving, and communication. It’s important for both parents to be involved in the process, as it is a trying experience to manage the emotional and behavioral difficulties taking place. Weekly therapy sessions may be the typical treatment for anxiety, but when school refusal is involved there is a need for a more intensive and collaborative approach.

To help families navigate the complexities of school refusal, the staff at Meghan Barlow and Associates are teaming together to provide a School Refusal Response Plan that targets elevated anxiety and other issues that disrupt a child’s ability to effectively attend and participate in school. Dr. Rob Adams will coordinate individualized treatment plans to develop a schedule of services across two to three weeks that will address anxiety coping, parent-child conflict and support, executive skills, academic support, and coordination with other professionals and school staff. This intensive, multi-disciplinary, and coordinated approach to treatment is designed to effectively address elevated anxiety, develop coping skills, maintain academic progress, and transition back to school. Home practice and parent participation will be encouraged to help generalize and maintain treatment progress. Dr. Adams will consult with school staff to develop a supportive plan for returning to school.

If your child is struggling to attend school, even if you’re not sure why, our goal is to provide effective interventions to address the individual and family needs that are present. Contact our office to schedule an initial consultation with Dr. Adams or to learn more about the program.

Posted in Articles, Parenting, School-Aged Children.