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We run late most days trying to get her out of bed...

Parents Support One Another @ = I need help with the following issue:

My daughter is in her final year in high school (nearly 16), every morning she is complaining about feeling sick (for the last 5 weeks), I don't let her stay off, but it is making mornings very stressful and we run late most days trying to get her out of bed. Her school is 5 miles away so I drive her to school each day then go to work. Most mornings we battle then don't speak all the way to school. It is putting me in such a bad mood even before getting to work!! Any advise?


Comment 1

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

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.

Parents or other caregivers can do several things to control school refusal before it becomes a routine, troublesome behavior.

• Listening to the child's actual concerns and fears of going to school is important. Some of the reasons for refusing to attend school may include another child at school who is a bully, problems on the bus or carpool ride to school, or fears of inability to keep up with the other students in the classroom; these issues can be addressed if they are known. On the other hand, making too big a deal of school refusal may promote the child's behavior to continue.

• Firmly getting the child to school regularly and on time will help. Not prolonging the goodbyes can help as well. Sometimes it works best if someone else can take the child to school after the parent or caregiver says goodbye at home.

• It truly helps to believe that the child will get over this problem; discuss this with the child (the parent or caregiver needs to convince himself or herself of this before trying to convince the child).

• The parent or caregiver should reassure the child that he or she will be there upon the child's return from school; this should be repeated over and over, if necessary. Let the child know that the parent or caregiver will be doing "boring stuff" at home during the school day. Always be on time to pick the child up from school if you provide transportation rather than a school bus.

• Whenever events occur that could tend to cause students to miss school (for example, traumatic events such as terrorism, school shootings, or other traumas) all attempts should be made to help students return promptly to school and to help them to feel safe at school.

• Supportive counseling is often made available at school in these circumstances so as to minimize reinforcement of school avoidant behaviors and to prevent secondary gain from school refusal and should be encouraged for any student who wishes to have it. If the child simply refuses to go to school, some parents have found that decreasing the reward for staying home helps, for example, do not allow video games or television, or find out what work is being done in the school and provide similar education at home, when possible. This is especially if the "illness" seems to disappear once the child is allowed to stay at home.


Comment 2

Teens are notorious for staying up late at night and being hard to awaken in the morning. Your teen is probably no exception, but it's not necessarily because he or she is lazy or contrary. This behavior pattern actually has a physical cause — and there are ways to help mesh your teen's sleep schedule with that of the rest of the world.

Everyone has an internal clock that influences body temperature, sleep cycles, appetite and hormonal changes. The biological and psychological processes that follow the cycle of this 24-hour internal clock are called circadian rhythms. Before adolescence, these circadian rhythms direct most children to naturally fall asleep around 8 or 9 p.m. But puberty changes a teen's internal clock, delaying the time he or she starts feeling sleepy — often until 11 p.m. or later. Staying up late to study or socialize can disrupt a teen's internal clock even more.

Most teens need about nine hours of sleep a night — and sometimes more — to maintain optimal daytime alertness. But few teens actually get that much sleep regularly, thanks to part-time jobs, homework, extracurricular activities, social demands and early-morning classes. More than 90 percent of teens in a recent study reported sleeping less than the recommended nine hours a night. In the same study, 10 percent of teens reported sleeping less than six hours a night.

Big deal? Yes. Irritability aside, sleep deprivation can have serious consequences. Daytime sleepiness makes it difficult to concentrate and learn, or even stay awake in class. Too little sleep may contribute to mood swings and behavioral problems. And sleepy teens who get behind the wheel may cause serious — even deadly — accidents.

Catching up on sleep during the weekends seems like a logical solution to teen sleep problems, but it doesn't help much. In fact, sleeping in can confuse your teen's internal clock even more. A forced early bedtime may backfire, too. If your teen goes to bed too early, he or she may only lie awake for hours.

So what can you do? Don't assume that your teen is at the mercy of his or her internal clock. Take action tonight!

• Adjust the lighting. As bedtime approaches, dim the lights. Turn the lights off during sleep. In the morning, expose your teen to bright light. These simple cues can help signal when it's time to sleep and when it's time to wake up.
• Curb the caffeine. A jolt of caffeine may help your teen stay awake during class, but the effects are fleeting. And too much caffeine can interfere with a good night's sleep.
• Keep it calm. Encourage your teen to wind down at night with a warm shower, a book or other relaxing activities — and avoid vigorous exercise, loud music, video games, text messaging, Web surfing and other stimulating activities shortly before bedtime. Take the TV out of your teen's room, or keep it off at night. The same goes for your teen's cell phone and computer.
• Nix long naps. If your teen is drowsy during the day, a 30-minute nap after school may be refreshing. But too much daytime shut-eye may only make it harder to fall asleep at night.
• Stick to a schedule. Tough as it may be, encourage your teen to go to bed and get up at the same time every day — even on weekends. Prioritize extracurricular activities and curb late-night social time as needed. If your teen has a job, limit working hours to no more than 16 to 20 hours a week.

Sleeping pills and other medications generally aren't recommended for teens.

In some cases, excessive daytime sleepiness can be a sign of something more than a problem with your teen's internal clock. Other problems can include:

• Depression. Sleeping too much or too little is a common sign of depression.
• Insomnia or biological clock disturbance. If your teen has trouble falling asleep or staying asleep, he or she is likely to struggle with daytime sleepiness.
• Medication side effects. Many medications — including over-the-counter cold and allergy medications and prescription medications to treat depression and attention-deficit/hyperactivity disorder — can affect sleep.
• Narcolepsy. Sudden daytime sleep, usually for only short periods of time, can be a sign of narcolepsy. Narcoleptic episodes can occur at any time — even in the middle of a conversation. Sudden attacks of muscle weakness in response to emotions such as laughter, anger or surprise are possible, too.
• Obstructive sleep apnea. When throat muscles fall slack during sleep, they stop air from moving freely through the nose and windpipe. This can interfere with breathing and disrupt sleep.
• Restless legs syndrome. This condition causes a "creepy" sensation in the legs and an irresistible urge to move the legs, usually shortly after going to bed. The discomfort and movement can interrupt sleep.

If you're concerned about your teen's daytime sleepiness or sleep habits, contact your teen's doctor. If your teen is depressed or has a sleep disorder, proper treatment may be the key to a good night's sleep.

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