When That Stomachache Is Something Else: The Growing Trend of School Refusal

boy with backpackIf you’re like most pediatricians, you’ve seen your share of kids presenting with non-specific symptoms such as headaches, stomachaches, dizziness, or aches and pains that are bad enough to keep them home from school. Yet upon examining them, you can’t seem to find any medical explanation for their ailments.

If this sounds familiar, you could be dealing with a case of school refusal, which affects as many as five percent of kids today. And the problem has been growing in recent years.

What is school refusal?

The Anxiety and Depression Association of America (ADAA) defines school refusal as “the disorder of a child who refuses to go to school on a regular basis or has problems staying in school.”
It’s important to understand that school refusal is not a diagnosis itself; it’s typically a symptom of a behavioral health problem, such as anxiety or depression, according to Laurie Winkler, LMHC, who provides counseling services at Boston Children’s Health Physicians practices in Scarsdale and Bedford Hills, N.Y.

“I’ve been noticing more depression and anxiety in kids and it’s been starting younger and younger,” Winkler says.

Who experiences school refusal?

According to ADAA, school refusal affects kids of all ages but can be particularly common in younger children ages 5 or 6 who may be struggling with separation anxiety as they take their first steps toward independence, as well as in children ages 10 or 11, when social pressures can increase. Kids can also be more prone to exhibiting school refusal during times of transition, such as when moving to a new school, or when experiencing periods of increased stress at home.

Sometimes the school itself is the main source of the stress. Winkler points out children may feel pressure to perform well on tests, have an issue with a teacher or classmate, or be facing unkindness in school or from peers on social media.

For some kids, seeing news coverage of acts of school violence or shootings, or practicing safety drills themselves, can also trigger fear or emotional distress, causing a physical manifestation of symptoms that may make them want to hibernate at home.

An underlying psychological cause

Winkler points out that while school refusal can present like the deliberate act of truancy, school refusal isn’t a defiant act, but rather stems from a psychological cause.

The differences can be subtle, though, so it may be difficult for parents to know whether their child is acting out, is really ill, or is dealing with something else.

Questions to ask

That’s where a pediatrician can be an important part of the equation, performing a thorough examination to look for any medical cause for a child’s symptoms. Pediatricians can also raise some targeted questions.

For instance, consider asking:

  • Do you feel anxious?
  • Are you depressed?
  • Is there any bullying going on?
  • When do the symptoms occur?

 

Winkler says it’s important to tailor your language to the child’s age and aptitude. Also be sure to involve the parents, since they can play a crucial role in helping to solve the mystery.

Ask them to keep track of their child’s symptoms and when they occur. Are there patterns? Is it always Monday or the day after a holiday? Do symptoms resolve over the weekend only to reoccur when it’s time to go back to school? Their answers can provide very valuable clues.

Seeking professional help

Once medical causes for a child’s refusal to attend school have been ruled out, it’s important to support the child and family and refer them to a mental health counselor or therapist for help in working through the issue, often in conjunction with the school.

The need for an individualized plan

Keep in mind that in most cases of school refusal, letting the child stay home can actually make things worse. The longer children miss school, the more they fall behind in their work and the more extreme their anxiety may become. This makes it important that kids work with a mental health expert who can come up with a plan to get back to the classroom that will work best for their specific situation.

Adopting healthful lifestyle choice

In addition, Winkler suggests that children try relaxation exercises and mindful exercises, They can also adopt a healthy morning routine, be sure to get enough sleep, and also eat a healthy diet.

“All of these steps can help reduce depression and anxiety in kids,” she says, which can ultimately help them go to school.

 

Resources for Pediatricians:

  • When you suspect your patient could be experiencing school refusal, there’s a school refusal self-assessment tool that can be helpful in identifying the problem.
  • Children who experience bullying may be reluctant to go to school. Learn more out the problem—and what you can do about it—at gov.