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Most children will, at some point, wish to avoid going to school.  Almost every parent could regale one with stories of phantom stomach aches, faked fevers, or doe-eyed pleas for a “mental health day.”  To a large extent, this kind of occasional and mild school avoidance can be seen as normal and relatively innocuous.  However for as many as 28-35% of youths (Mihalas, 2014), at some point in their lives this kind of behavior may escalate into what psychologists term School Refusal Behavior (SRB).  With SRB, it’s not that a child won’t go to school; it is that for all intents and purposes they can’t.  Symptoms such as panic attacks, vomiting, excessive tantrums, and severe parental separation anxiety surrounding school attendance can signify problematic SRB which should motivate a consultation with a qualified mental health professional.  If SRB seems to be developing and becoming more severe, it is crucial that parents avoid continuing to try forcing the child to go to school, as that can often exacerbate the underlying issues.

A key point to remember is that SRB can almost always be traced to a root cause.  SRB may be due to severe bullying, difficulty adjusting to a new environment, emotional issues related to academic difficulties, problems separating from one or both parents, or any number of other causes.  Regardless of the root issue, the important thing is that it is identified and dealt with.  Parents can encourage their children to open up and talk about their problems by being compassionate, empathetic, non-judgmental, and by asking questions.  Keep in mind however that younger children may have difficulty articulating the causes behind their distress, and older children or adolescents may be reticent to divulge this information.  In these situations a qualified child psychologist can be invaluable.

A psychologist can provide a safe space where children or adolescents can share their thoughts, feelings and fears outside of the normal family environment.  This can be particularly helpful if the relationship between one or both parents and the child is difficult or conflictual, but even in cases of good parent-child relationships some children may be embarrassed or ashamed to speak to parents about such painful issues.  Once the root cause(s) of the SRB have been identified, the psychologist can work with the child and parents to devise an appropriate treatment strategy.  One common approach is cognitive-behavioral therapy (CBT), which helps children identify how their thoughts, feelings, and actions all influence each other, and how to interrupt problematic cycles.  Parent training can also be an important component to treatment, as parents may need coaching on how best to support their child at home by changing behaviors or routines that are maintaining or exacerbating the problem.

In cases where the root cause of SRB appears more mysterious, or the child is too young to assist in this process, a child psychologist may be able to conduct a functional-based assessment (FBA).  In an FBA, the psychologist observes the child and parent(s) during the normal morning school routine multiple times and attempts to assess the underlying purpose of a child’s SRB.  While conducting a FBA in these situations could be considered best practice, the higher cost of such a procedure and the possible lack of appropriately trained local practitioners may render a FBA unrealistic (Mihalas, 2014).  Additionally a proper FBA should ideally include the assistance of school personnel, such as allowing the psychologist access to school grounds for observation.

This raises another crucial issue surrounding SRB, which is the importance of cooperation from school personnel, whenever possible.  SRB can lead to children missing weeks or even months of class.  Therefore, school administrators and teachers who are willing to work with parents to keep kids on track academically from home are imperative.  Likewise, trusted friends from school can be enlisted as informal liaisons, keeping a child up-to-date on classroom activities and acting as a buddy during the re-integration process.  In addition, it can be extremely helpful in some situations if schools are willing to accommodate a child’s different needs in order to combat SRB, such as being dropped off at a different place from other children, attending certain classes but not others temporarily, or allowing a child to have quiet time alone instead of needing to leave school completely.  Unfortunately some schools are unwilling to work with families dealing with SRB and this can present a hindrance to treatment (Mihalas, 2014).

The bottom line is that while an occasional desire to avoid school is normal, any number of issues may drive a child to begin refusing to attend school altogether.  Parents are advised not to ignore this behavior if it becomes severe, nor are continuing to attempt to force school attendance likely to alleviate the underlying problems and, instead, may further inflame them.  A child psychologist can help determine the core issues influencing the SRB and devise a treatment plan.  School assistance can be invaluable in this process.

Feel free to contact me. I am happy to help.

Dr. Stephanie 

References:

Mihalas, S.T. (2014). School refusal behavior. In L. Grossman & S. Walfish (Eds.), Translating Psychological Research Into Practice (pp. 85-88). New York, NY: Springer Publishing Company, LLC.

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