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My daughter won't go to school...

My daughter won't go to school because she claims she is sick. In the evenings however, she seems fine. She only seems to be sick on Mon, Tues. or Wed. gets better on Thur. And is well on Friday.

When I tell her that since she was sick most of the week she needs to stay home on the weekend. Meaning she is not allowed to spend the night with a friend. When this happens she then wants to go to her mom's. However, she doesn't go see her mom on weekends unless she is in trouble at home. She seems to want to run away from her problems instead of facing the consequences of what she has done to get herself in trouble.



Anonymous said...

School refusal occurs when a student will not go to school or frequently experiences severe distress related to school attendance. Comprehensive treatment of school refusal, including psychiatric and medical evaluation when appropriate, is important because studies show that psychiatric disorders are the cause for up to 46% of students who fail to complete high school in the United States. Parents can do several things to help their child who refuses to attend school and treatment may be necessary. With treatment, the rate of remission is excellent; approximately 83% of children with school refusal who were treated with cognitive therapy were attending school at 1-year follow-up. School refusal is considered more of a symptom than a disorder and can have various causes.

Although young children usually find going to school fun and exciting, 1 in 4 children may occasionally refuse to attend school. Such behavior becomes a routine problem in about 2% of children. Many children with school refusal have an earlier history of separation anxiety, social anxiety, or depression. Undiagnosed learning disabilities or reading disorders may also play a significant role in the development of school refusal.

Signs of a psychiatric disorder called separation anxiety disorder can include the following:
· School refusal
· Excessive worry about losing a parent; excessive worry that a parent might be harmed
· Excessive reluctance to be alone at any time
· Persistent refusal to go to sleep without a parent or other caretaker present
· Repeated complaints of physical symptoms whenever the child is about to leave a significant parental figure

These behaviors must begin before the child is aged 18 years, must last for 4 weeks or longer, and must cause serious problems with academic, social, or other functioning in order to be called a disorder.

Some commonly cited reasons for refusal to attend school include the following:
· A parent being ill (Surprisingly, school refusal can begin after the parent recovers.)
· Parents separating, having marital problems, or having frequent arguments
· A death in the family of a friend of the child
· Moving from one house to another during the first years of elementary school
· Jealousy over a new brother or sister at home
· Parents worrying about the child in some way (for example, poor health)

Other problems at school that can cause school refusal include feeling lost (especially in a new school), not having friends, being bullied by another child, or not getting along with a teacher or classmates.

Refusal to go to school may happen at any age but most typically occurs in children aged 5-7 years and in those aged 11-14 years. During these years, children are dealing with the changes of starting school or making the transition from elementary or middle school to high school. Preschoolers may also develop school refusal without any experience of school attendance.

Generally, the child or adolescent refuses to attend school and experiences significant distress about the idea of attending school. Truancy (absent from school without permission) may be due to delinquency or conduct disorder and can be differentiated from school refusal. The truant student generally brags to others (peers) about not attending school, whereas the student with school refusal, because of anxiety or fear, tends to be embarrassed or ashamed at his or her inability to attend school.

Signs of school refusal can include significant school absence (generally 1 week or more) and/or significant distress even with school attendance. Distress with school attendance may include the following:
· A child who cries or protests every morning before school
· An adolescent who misses the bus every day
· A child who regularly develops some type of physical symptom when it is time to go to school

Treatment of school refusal includes cognitive behavior therapy along with systematic desensitization, exposure therapy, and operant behavioral techniques.
· Cognitive behavior therapy: Derived from behavior therapy, the goals include the correction of maladaptive and inappropriate behaviors.
· Systematic desensitization: A technique by which the child is gradually helped to modify his or her emotionally distressing reaction to school so that eventually the child can return to school without experiencing distress.
· Exposure therapy: A technique by which the child is exposed in a stepwise fashion to increasing intensity and duration of the emotionally distressing event coupled with encouragement to modify maladaptive and inappropriate cognitions gradually enough that the child becomes able to tolerate the previously distressing experience (that is, school attendance) without distress.
· Operant behavioral techniques: These involve reward for desired behaviors in order to increase their frequency.

Principles of treatment

The goal of therapy is to help the student to restructure his or her thoughts and actions into a more assertive and adaptive framework to allow a rapid return to school. Therapeutic techniques include modeling, role playing, and reward systems for positive behavior change. Play therapy for younger, less verbally oriented children helps to reenact anxiety-provoking situations and master them. Interpersonally oriented individual therapy as well as group therapy can be extremely helpful for adolescents to counteract feelings of low self-esteem, isolation, and inadequacy. Interpersonally oriented individual therapy centers on the person's maladaptive responses to interpersonal interaction (usually involves difficulty in interactions with other people).

What can teachers and school staff do?

Teachers and school staff should help the student identify and recognize the triggers for school refusal. Opportunities to practice relaxation techniques can significantly reduce anxiety.

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