Refusal: A large number of kids just say no to school

Refusal: A large number of kids just say no to school

(Md.) Having an anxiety disorder is like being stuck in that moment when you realized you’ve leaned back too far in your chair, but have not yet fallen.

That sentence is in some sense a success story for Jonathan Dalton, a Maryland-based psychologist specialized in treating anxiety and behavioral disorders, with a particular interest school refusal and Social Anxiety Disorder.

The student who coined it had, at one point, not stepped foot in a school building in three years. Now he’s on track to graduate high school and that sentence will be the first thing university officials read on his college applications.

He, along with many students throughout the United States, experience “school refusal”–absenteeism caused by a child’s refusal to attend class due to fears caused by an underlying anxiety disorder. School refusal is not itself a disorder as defined by medical professionals, rather, missing school is a symptom characterized by avoidance behaviors to cope with one’s anxiety.

It’s difficult to pinpoint exactly how many kids experience school refusal. A common statistic cited by organizations that advocate for increased mental health awareness say school refusal affects 2 to 5 percent of school-age children.

According to Dalton, part of the problem with school refusal is that the research is done by so many different disciplines that define it in different ways, so there is no universally agreed upon definition of what school refusal actually is. For example, he says truancy is different from school refusal–which is anxiety or mental health related–but some studies conflate the two and overestimate how many students are affected by school refusal. In fact, the rate at which student are affected ranges from 1 to 28 percent in different studies.

“What I’ve seen is that the three-month prevalence rate is about 2 percent–meaning about one in 50 kids in any three month period refuse to go to school due to anxiety,” Dalton said. “It’s remarkable how common it has become.”

While quantifying how many children demonstrate school refusal is difficult, research is clear that the sort of anxiety disorders that lead to such behavior is on the rise. According to the Anxiety and Depression Association of America, anxiety disorders affect one in four children between 13 and 18 years old.

Children may develop school avoidance to cope with stress or fear for a vast number of reasons, but Dalton says a desire to cut class and hang out with friends is rarely one of them.

Often, through his work as the director of the Center for Anxiety and Behavioral Change, a psychological treatment center in Rockville, Maryland, Dalton treats students who haven’t attended school in two or even three years due to various social phobias. Some kids fear being seen by others as weird, and will avoid school altogether to evade unstructured time in the cafeteria or changing for gym class where they feel most uncomfortable. On the other hand, others may fear appearing “stupid”–they do great in social settings where they aren’t being quizzed or judged intellectually, but they’re terrified of answering a question wrong in class or going to the board and not knowing what to do.

In some cases, specific phobias like a fear of changes in the weather or those tied to other panic disorders can also lead to school refusal.

What’s important to note, Dalton said, is that “students aren’t really avoiding school, they’re avoiding something they feel while at school.”

For students who experience school refusal, developing a pattern of poor attendance is often a gradual process.

Among many of his patients, Dalton says it’s common to see that a student has missed more than a dozen days of school in first grade, followed by maybe 23 days in second grade and 36 days the following year.

School personnel who keep a close eye on attendance records may see that something is wrong and reach out to families to see if available resources at the district can help get kids to class, but absences caused by school refusal are likely to be considered “excused,” Dalton says.

“It’s hard to tell how many students miss school due to anxiety because a lot of parents cover for their kids, and they’ll call into the school building to say their kid is sick” he explained, especially among students whose anxiety will manifest physically in the form of a headache or stomach pain.

It’s important, he said, that as schools track attendance and work to reduce rates of chronic absenteeism, officials make a concerted effort to reach out to families that call in often about their child feeling ill, and work to find and address any underlying cause.