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Strategies for Addressing School Avoidance Due to Anxiety

Andres woke up to a feeling of dread. He pictured himself walking down the halls of his high school with everyone staring at him and silently judging him, and his stomach turned. He thought about being called on in his English class, and having all eyes on him. His mind then went to the mountains of incomplete assignments piling up and to the questions his classmates would ask about where he had been. The feeling of nausea started to intensify, and he gagged. 

 

“Time to get up! I can’t keep coming in here. I need you to try to get to school today.” Andres heard his mother climbing the stairs and approaching his bedroom. He couldn’t deal with another argument with her about school. So he pulled up the covers and began playing a game on his phone, trying to block everything out.

 

School avoidance is a term used when a child or teen avoids going to school for an extended period of time and/or consistently arrives late or leaves early. It can happen for a variety of reasons, including emotional distress, which is particularly challenging and the focus of this blog. This type of school avoidance often starts in benign ways: students are out of school for a period of time due to medical illness, social, emotional, or learning difficulties, or life events, and then they have difficulty when it’s time to go back. Home serves as a haven from the discomfort, and the fear of going back grows. The challenge here is that the longer they are out of school, the harder it is for them to return.

 

The questions we often hear from parents, school counselors, and pediatricians are: Why won’t this child go to school? And, importantly, what can we do to help them? As outlined by Kearney (2018)*, two key drivers of school avoidance are negative and positive reinforcement. Negative reinforcement in this context refers to the attempt to avoid distress or discomfort by staying out of school. Similar to Andres, a student might stay home to avoid social fears, academic stress, or physical discomfort. They could also be trying to escape a variety of other things, such as being separated from their parents, getting sick, failing, having panic attacks, or feeling sad. Positive reinforcement refers to the student gaining something by staying out of school. Typical examples of positive reinforcement include access to preferred activities, such as screen time or fun activities, and increased attention from family members and pets. In the above example, Andres chose to play a game on his phone instead of getting out of bed.  

 

In order to help a child get back into school, it is important to address both factors by finding ways to help school feel more approachable and by making the home environment less comfortable during the day. Here are some strategies to follow:

 

  1. Assess what is causing the student distress at school. Ask them what feels hardest about being in school and which part of their day is most difficult. Ask them what makes them feel the most anxious about returning to school. Get their parents’ and teacher’s (or counselor’s) perspective as well. 

 

  1. Assess what they are gaining by being home. Talk to them and their parents about what they are doing during the day when they are home. Walk through each hour of the day and how they are spending their time. Pay attention to activities that are particularly reinforcing for them. For example, are they getting access to preferred food or activities or extra attention? 

 

  1. Work with the family to make a plan to remove reinforcers at home. We refer to this as “making home less comfortable” with the idea being that we want home to lack all reinforcers during the school day so that students feel bored being at home (and school, therefore, becomes more interesting). Troubleshoot obstacles such as the removal of screens and internet access when parents are working outside the home and address potential parental concerns about what it would be like to remove attention during the day.

 

  1. Work with the student and family to make a plan for gradual school re-entry. This entails creating a step-by-step plan for getting them back into school and for having them tolerate the associated distress (i.e., phasing out negative reinforcement). Determine whether additional therapeutic support would be helpful in having the student gain skills and strategies for addressing the root cause of their distress. For example, students may benefit from therapy to address the underlying anxiety or depression that is driving their avoidance.

 

  1. Schedule a school re-entry meeting to get the student, family, and key school personnel on the same page. Map out a plan for re-entry that addresses the pace and timeline for re-entry, expectations for work completion, and the roles that various people will play. It’s critical to get everyone aligned on the plan and for the student themself to be part of the process.

 

  1. Identify and implement positive reinforcers for being in school. For younger students, things like star charts with associated rewards can serve as reinforcers for time spent back in school. Younger students can also benefit from having a special role in the classroom, such as teacher helper or line leader. For teens, it can be helpful to shift screen time contingencies such that time on screens is earned in relation to time spent back in the classroom. Attention and praise for the effort a student is putting into attendance can also be reinforcing for students of all ages. 

 

Implementing the above strategies isn’t easy; they require patience, perseverance, and a team-based approach. It’s also normal to feel like students are taking two steps forward and one step back throughout the process. But the good news is that, with the right combination of strategies and support, students like Andres can and do get back into school and into their lives again

 

 

* Kearney, C.A. (2018). Helping School Refusing Children and Their Parents. A Guide for School-Based Professionals. (Second Edition). Oxford University Press.

Watch Sheree Emmons, M.Ed and Director of Coaching at InStride Health, discuss her experiences with exposure coaching for youth who are school avoidant. As a former public school teacher she understands how difficult school avoidance can be for the children, their parents and the school community. She also understands how InStride can help.​

About The Author:

 

Dr. Kathryn Boger 

Co-founder and Chief Clinical Officer of InStride Health

 

Kathryn (“Kat”) Boger, PhD, ABPP is a board certified and Harvard-trained child and adolescent clinical psychologist. Dr. Boger has devoted her career to helping children and teens with anxiety and OCD and their families. She is passionate about improving care for youth and decreasing suffering through the use of innovative, research-based treatment approaches. Dr. Boger co-founded the McLean Anxiety Mastery Program (MAMP), nationally recognized for providing empirically-supported, intensive anxiety and OCD treatment. She has served as an assistant professor of psychology at Harvard Medical School, published a variety of peer-reviewed journal articles, delivered regional and national talks (including a TEDx) and provided training to hospitals, schools, and the community. In 2021, Dr. Boger co-founded InStride Health with the mission of increasing access to insurance-backed, research-based care for children, adolescents, and young adults with anxiety and OCD.

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