Partnering with Parents to Help School Avoidant Students
by Lucille Carr-Kaffashan, Ph.D. Jordan Katz, LSW, Gerard Barone, LCSW
Much has been written about the youth mental health crisis and how it has been both accelerated and intensified by the COVID-19 pandemic. With the resumption of full-day in-person learning this past fall, everyone had high hopes that the new school year would bring a much-craved return to “normalcy”. But the mutating virus had other plans, creating surging infection rates across the country, and waves of uncertainty for school professionals, parents, and students who knew that hybrid schedules and/or fully remote learning might be re-imposed at any moment.
Under the best of circumstances school avoidance is a thorny and frustrating problem for both parents and school personnel. While all youngsters with mental health vulnerabilities were impacted by the pandemic-imposed social isolation and by the disruption of routines and school connectedness, school avoidant students have been amongst the hardest hit. To make matters worse, some students with no prior history of avoidance began exhibiting these behavior patterns when school resumed in the fall.
Effective School Solutions (ESS) has a long history of treating school avoidance within various Multi-Tiered Levels of Support (MTSS) programs that are offered to districts across the country. This experience has taught us that, above all, successful intervention for school avoidance cannot occur without a strong parent-school partnership.
What is School Avoidance?
School avoidance is a pattern of refusing or avoiding school, not of schoolwork per se, and is a complex syndrome influenced by temperament, genetics, cognitive factors, and family and school environments. It can involve an unwillingness to attend school at all, and/or an inability to remain in school for the entire day. It often occurs after a precipitating event such as a parent’s illness, a bullying incident, a move to a new home or school, or a prolonged absence from school for any reason, including a global pandemic. It is not the same as truancy, which is typically associated with seeking rewards outside of school and is not accompanied by anxiety or emotional distress of any kind.
In many cases, school avoidance is best understood as an anxiety disorder: up to 56% of avoiding youngsters have a primary anxiety disorder diagnosis, including generalized anxiety, separation anxiety, and social anxiety. School avoidance can also be a manifestation of and/or co-occur with other significant mental health disorders including Depression, Bipolar Disorder, or Post Traumatic Stress Disorder (PTSD). If any of these or other mental disorders are present it is imperative that these symptoms be targeted as well with therapy and medication as appropriate.
Boys and girls are equally affected by school avoidance, and it is unrelated to socio-economic status or academic or intellectual functioning. The average age of onset is 10–13 years old, and it often emerges or worsens during times of transition such as the entry into kindergarten, middle school, or high school. It is no wonder, therefore, that the transition back to in-person learning this past fall was a precipitating factor for many school avoidant youngsters.
Problem behaviors associated with school avoidance often begin the night before a school day, with a child expressing anxiety, showing resistance, or complaining of illness. The behavior pattern can include the child being entirely absent from school; attending school but leaving during the day; attending school but skipping classes; attending school but having a lot of difficulty getting there due to crying clinging, and tantrum behaviors; frequently being distressed during the school day and pleading to go home; and frequent trips to the nurse’s office with a range of physical complaints including dizziness, headaches, nausea, or stomach pains that usually improve once the child is allowed to go home.
What Causes School Avoidance?
There are many factors that contribute to the development and maintenance of school avoidance. The School Refusal Assessment Screening (SRAS) tool is especially useful in determining what factors are most relevant for any given student.
Based on their research, Kearny and Albano highlight four primary reasons that students avoid school:
- To avoid school-related stimuli or situations that cause discomfort or anxiety (e.g., noisy cafeterias, bus rides, fire drills, crowded hallways, other children that make them uncomfortable such as bullies, not being able to do schoolwork because of learning differences, etc.)
- To avoid evaluative or social situations related to school performance (e.g., tests, public speaking, athletic performance in the gym or on sports teams, etc.)
- To receive attention from parents or caregivers (e.g., separation anxiety or the feeling that one or both parents need them, etc.)
- To seek tangible rewards that make staying home more comfortable or enjoyable than going to school (e.g., access to video games, ability to sleep in, to work at a job, to socialize with friends outside of school, etc.)
It is likely that more than one of the above factors are involved in any given student’s school avoidant behavior. The most effective intervention plans will target each relevant factor: for example, gradual exposure and desensitization for school-related anxiety, with medication as needed; social skills training and cognitive-behavior therapy to treat social anxiety; trauma-focused interventions for students reacting to a major stressor or change; and coaching to help parents discontinue behaviors that inadvertently reward school avoidance.
The Role of Anxiety and the Focus of Cognitive Behavioral Interventions
Anxiety is characterized by intense feelings of worry, dread, and fear; thoughts that tend to revolve around worst-case-scenario outcomes and a loss of control; and physiological discomfort including heart palpitations, shallow breathing, muscle tension, sweating, an uneasy stomach, and jitteriness. It may or may not have a clear-cut cause in the moment, although unlike depression, anxiety is a normal part of life, an emotion that signals us to sit up and pay attention when in a new or unfamiliar setting that might be dangerous.
Research in Cognitive Behavior Therapy (CBT), a gold standard treatment for anxiety of all kinds, long ago demonstrated that avoidance is one of the factors that maintains and worsens anxiety over time. Hence the phrase “get back on the horse” — failures or negative outcomes of any kind that are followed by avoidance of the feared thing or situation will only increase anxiety over time while undermining an individual’s confidence in his/her ability to tolerate uncomfortable emotions.
CBT targets all three aspects of any given mental health problem: thoughts, behaviors, and emotions and the accompanying physiological symptoms. It targets the cycle of self-defeating thoughts that give rise to anxiety (“I can’t handle it, the kids will be mean to me, school’s too hard, I’m not smart enough, the anxiety will never decrease”), and helps individuals develop more balanced and realistic assessments of the perceived threat. It targets avoidant behavior via a plan for gradual exposure to the feared situation or object (“facing one’s fears”), helping individuals learn that the fear response will habituate with prolonged exposure, and that they can tolerate uncomfortable emotions while moving forward with life’s activities and goals. And finally, it emphasizes the development of a variety of self-management skills (e.g., breathing exercises, physical self-care, planning ahead, etc.) that can help to regulate emotions and mitigate uncomfortable physiological symptoms.
CBT also involves classic behavioral psychology, that is, rewarding desired behaviors while ignoring or punishing undesirable ones. CBT practitioners increasingly include essential concepts from the “third wave” of CBT, known as Acceptance and Commitment Therapy (ACT). This involves learning to expect, accept, and tolerate uncomfortable emotions as a normal part of life, while not allowing these emotions to deter us from the life goals and values to which we have committed.
How Parents and School Personnel Can Inadvertently Maintain Avoidant Behavior
It is natural for a loving parent or a concerned teacher to move in to support and protect a scared child. In doing so, however, they run the risk of inadvertently rewarding or maintaining a problem behavior. This is why a strong parent-school partnership is such a critical aspect of successful interventions with school avoidant youngsters.
Adults can inadvertently support school avoidance by offering excessive reassurance, by allowing or encouraging avoidance behaviors, and by “taking over”, that is, by doing tasks for children that they are developmentally capable of doing. This “taking over” helps reduce a child’s anxiety in the short term but interferes with the child’s ability to develop self-regulation and other necessary coping skills.
Difficult though it might be, parents also need to examine how they might make the home environment more rewarding for the child than being in school. Having full access to video games and other recreational activities, to unlimited snacks, to parental attention, etc. can certainly undermine any desire or motivation to attend school. School nurses, guidance counselors and other school-based adults must also examine how they might make their space and time available in non-productive ways.
The Role of Parents and Teachers in a Child’s Recovery
It goes without saying that a mental health professional should be the driver of any comprehensive intervention plan for a school avoidant student. Beyond that, a collaborative clinician-parent-school problem solving process must start from a position that avoids blame and finger pointing. Frequent communication is necessary to ensure fidelity to the plan that is developed, and to share findings about what the child does and does not respond to.
Parents and educators must reduce “rescue” behaviors and unhelpful accommodations for anxiety. Instead, they must project a stance of expectation and confidence that the child can perform and succeed. In consultation with the child’s clinician, they can provide corrective information about the level of threat in any given situation and help to identify both self-defeating and more balanced thoughts. They can remind the child to label emotions and to use coping skills that have been learned in therapy. Reassurance that there is “nothing to be afraid of” or that “everything will be alright” is not helpful: instead, adults can validate the child’s anxiety and the potentially scary aspects of a situation while also emphasizing that he/she can learn to tolerate the anxiety while engaging in the activity. Anxiety behaviors per se should never be punished, while all desirable behaviors that approximate full school attendance should be recognized and celebrated.
It is also important that both parents and teachers familiarize themselves with a Trauma-Informed Perspective. Within this model, behaviors that adults often find off-putting (e.g., loud tantrums, aggression, disengagement) are viewed as survival mechanisms that students cling to because they have worked in the past to keep them “safe” from unbearable stress. The validation of the student’s experience, along with an expression of understanding that “undesirable” behaviors are the result, not the cause, of a student’s troubles are critical to helping the student begin to improve.
Parents and guardians also need to consider if there are ways that they are inadvertently communicating to their children that they are needed at home for either practical or emotional support. For example, parents who have been ill, who have experienced a significant loss, or who themselves are struggling with mental health symptoms might need to make it clear to their children that they are OK, that they are dealing with their adult concerns, and that the best way that their children can be helpful is to do their job, that is, to be in school.
Finally, parents must make a child’s time at home while school is in session as uncomfortable and non-rewarding as possible. This might involve a variety of things including restriction of internet use, restricted access to the child’s bedroom, limited access to tasty treats, little or no play or affectionate time with the parent, etc.
How District Leadership Can Help
District leaders play an important role in assisting the teams that work with school avoidant students. They can:
- Consider and address possible school-wide triggers for students’ avoidance behavior, e.g., bullying behaviors, COVID-related and other safety concerns, environmental aspects of the classrooms, hallways, cafeteria, etc. that might exacerbate or overwhelm children with anxiety or sensory issues.
- Clearly identify the school team that is involved with each student’s intervention plan: teachers, guidance counselors, administrators, clinical staff, school nurse, parents, etc.
- Ensure that there are ongoing professional development activities about school avoidance for teachers as well as onsite mental health staff.
- Develop ongoing educational activities for parents and guardians and proactively work to discourage blame and shame about their children’s struggles.
- Develop relationships with community mental health providers who can serve as resources for parents and students.
- Collaborate with parent-clinician teams to develop on-site rewards for school attendance, to modify schedules as needed to support gradual exposure plans, and to create a “safe” place in the school where school avoidant students can ground themselves and self-regulate.
- Create, post, and frequently re-state school-wide rules (and encourage teachers to do the same at the classroom level) to foster a sense of safety and structure.
- Greet school avoidant students enthusiastically when they appear in school and recognize even the smallest successes.
School leaders and their teams might also consider forming a support group for parents of school avoidant children. It is extremely difficult and guilt-provoking for parents to step back from rescuing vulnerable children and to adhere to the new routines that will inevitably be required to effect lasting change. School professionals can encourage and support parents who feel as though they’ve failed, and this in turn can make it more likely that the parents will be able to make the difficult adjustments being asked of them.
When Children Refuse School by Kearney & Albano