Although a child or young person may present with clear anxiety about attending school, in many cases there can be an overlap between worries at school and anxieties about separating from parents or carers (separation anxiety).
It is important to distinguish between school refusal and truancy.
- Truancy is widely used to describe children or young people who avoid attending school without their parents’ knowledge or permission.
- Truancy is usually seen as a deliberate act of defiance where the child or young person finds something they would prefer to do rather than attend school.
- Truancy is often done for social reasons. Several young people will meet up outside of school to be together or socialise. They may form a truanting group.
- Truancy is sometimes connected with anti-social behaviour.
- School refusal is when a child or young person starts to miss school frequently because of vague illnesses or symptoms.
- The symptoms the young person complains about are similar to those associated with worry, for example stomach aches, diarrhoea, nausea, headaches, fatigue, dizziness, vague and general aches and pains, etc.
- The child or young person shows extreme determination not to attend school, for example reluctance to get dressed, to leave the house or enter the school premises.
- The child or young person appears to be anxious or agitated on the mornings of school attendance.
- The child or young person may have difficulties settling to sleep on school nights.
- The symptoms appear to settle fairly quickly after getting into school.
- These symptoms are worse the night before starting a new school week, after school holidays, and are less obvious during weekends and holidays.
- A child or young person who has a genuine fear of attending school often wants to be on their own at home or outside of school.
- School refusal can present for two main reasons:
- Firstly that the child or young person has a phobic reaction either to the general school situation or to a particular situation or thing within the school.
- Secondly, where the child or young person displays a fear of attending school but the main source of the worry is leaving home or separating from family.
Although, on the surface, the two appear distinct, a single cause of the young person’s anxieties can be difficult to establish.
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In trying to understand why a child or young person may be displaying school refusal or truancy, ask yourself the following:
- Could this be a specific fear or anxiety around a particular subject or activity that they feel they are failing in or likely to become embarrassed by, for example reading, maths, physical education? This is probably the easiest cause to tackle, but more often than not there are other anxieties involved.
- If it is an adolescent, are they worried about not keeping up with their peers? Or are they worried about teasing, embarrassment or lack of confidence?
- Do they appear to be scared to leave their home or worried about separating from their family? In this situation, the parents are often very caring and protective of the young person. It is important to consider the attitudes of parents towards their non-attendance, for example are the parents unable to be firm, are they anxious themselves or are they accepting the young person’s excuses too readily?
- Consider whether there have been any significant life changes or stresses affecting the young person, for example:
- Has there been significant loss or bereavement such as parental separation, the death of a close family member or friend, a change of school or move of house?
- Is the young person struggling academically in one or more of their subjects?
- Is the young person confident and socially integrated with strong friendships and alliances?
- Is the young person different from the majority of other young people, for example from a different ethnic or religious group?
- Does the child have an obvious or hidden disability?
- Is the child or young person suffering from a physical illness?
- Could the child be a victim of bullying, teasing or another form of abuse?
It is important to bear in mind that some physical illnesses can present vague and intermittent symptoms; therefore it is important to ensure that the child has a medical examination if there is any doubt about what is causing their symptoms.
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If you have displayed school refusal or separation anxiety yourself, it is important to separate your own feelings and experiences from those of the young person you are trying to help. While it can be useful to empathise with the strength of feelings that the young person may be having, your own experiences can sometimes inhibit you from helping them to the best of your ability. Being aware of the need to be firm and encouraging in spite of your own feelings is important. If you realise that you may be over-identifying with the child’s problem or family‘s dilemma, you may not be the right person to offer the most effective help and encouragement.
For more information, see section on being aware of yourself and your own response.
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- Listen to the child or young person and find out if there is anything specific that is bothering them at school, for example exam stress or bullying. Remember that the young person may not be forthcoming with this information due to fear or embarrassment.
- If there are no genuine problems at school then school refusal/separation anxiety symptoms can be improved with firm and supportive encouragement to attend school every day.
- Keep a diary of the child or young person’s reluctance to attend school or non-attendance at school and the type and frequency of their physical symptoms to determine if there are any patterns, or encourage the parents/carers to keep a diary.
- Talk to parents and find out if the young person has symptoms during holidays or only on school days.
- Sensitively talk to the young person about any worries they have either in school or at home. For more information, see section on counselling techniques.
- Ask the young person or parents if there have been any significant changes or stressors in their life for example, bereavement or parental disharmony.
- Try and resolve or help the young person to resolve any specific reasonable worries they have about home or attending school.
- Explain to them that you understand how upset they feel, but that experience tells us that this upset will settle fairly quickly if they attend school consistently and will get worse if they continue to avoid attending.
- Encourage support from their friends, for example get them to call for the young person on school days.
- Give the parents information about school refusal and separation anxiety and discuss with them how they are dealing with the young person’s reluctance to attend.
- Explain to parents that allowing the child or young person to stay off school is likely to increase the child’s reluctance to attend and make the problem considerably worse.
- Engage parents in an alliance to help the young person return to school.
- Draw up a plan of gradual steps to reintegrate them to full time schooling with support.
- Support and encourage parents to be firm in their expectation that the young person will attend school.
- If appropriate, introduce a reward for attending school. For more information, see section on behavioural techniques.
- Avoid sending the child home when they complain of feeling unwell before first getting a detailed description of their symptoms to check that the symptoms are genuine and not the result of anxiety. However, if they have non-anxiety symptoms, such as raised temperature do send them home or seek medical advice.
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- If the child or young person is not attending school at all or is making no progress towards attending school.
- If the child or young person’s school avoidance and anxiety occurs in combination with other worrying behaviours or psychological problems, for example self-harm, depression, sleep disturbance, etc.
- If the child or young person discloses serious issues that you lack the skills and experience to deal with, for example sexual abuse.
You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.
Remember - you can contact your local mental health specialists for a number of reasons, for example:
- For advice on how to make a referral about a named child.
- For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).
- For advice about what to do (once again there should be no necessity to name the child).
By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.