Imagine for a second that your child suddenly stops going to school. What would you do? How would you try to get them out the house when they adamantly don’t want to? How would you stop them just playing video games or watching TV all day? How would you keep them up to date on schoolwork? Would you have to take time off work? Who would you turn to for help?
It’s a completely helpless-feeling situation, and is one of the most stressful things a family can go through. It takes over home and work life, and even sleep. It’s a family’s worst nightmare. There are things that can help, but today I want to begin by talking about why kids refuse to go to school in the first place.
Why do Kids Refuse School?
Everyone has missed some school, if only for being sick. All of us have probably missed school because we wanted a day off too. Perhaps we faked being sick, or simply played hooky one day….
For some children and youth this is more of a problem because it is a repeatable issue. More serious and chronic refusal behavior is the case for anywhere from 1 to 5% of kids. Those who refuse to go to school for any reason including social anxiety, separation anxiety, perfectionism, oppositional behavior, or avoidance of overwhelming demands, can be said to show school refusal behavior. We know it’s most common around the age of 10 or 11 years and likely to happen during transitions, such as to new schools of following vacation. It’s also associated with long-term consequences such as academic/employment problems and psychological difficulties.
Children and youth refuse school for a variety of reasons and there has been a lot of debate about how to classify this. For example, are there “anxious” sub-types and “mood” sub-types of refusers? What about those who don’t seem to meet any psychological diagnostic criteria? After all these years one thing is apparent: Children who show school refusal behavior are an enormously heterogeneous population. This means they are all very different and so categorizing them into types is difficult. A lot of people commonly assume that anxiety is the main reason for school refusal behavior. However, the research suggests only 50% of children and youth with school refusal behavior meet criteria for an anxiety disorder. In fact, about a third of kids meet no obvious psychological diagnostic criteria whatsoever. Clearly this is not a well-understood area. To date there are fewer than five randomized controlled studies with this population that I can find, which partially reflects our difficulty understanding the issue. If we can’t even explain why children refuse school in a predictable way, then how can we develop effective interventions?
In the late 90’s and early 00’s there was a breakthrough in this field. Instead of trying to classify school refusers into types, a researcher called Kearney asked us to think about the reasons why school refusal behavior continues. He called it the “functional model of school refusal behavior.” Not that catchy, but it’s easy to understand.
Functional Model Of School Refusal Behavior
Kearney proposed that there are 4 reasons why kids refuse school. These are:
- Avoid negative affect
E.g. Timmy feels bad at school. It’s difficult for him to put his finger on it, but he just feels miserable. Staying home provides a massive sense of relief.
- Escape aversive/evaluative situations
E.g. Jane doesn’t like presenting in front of class and gets overwhelmed with homework because she feels such a strong need to get straight As. By not going to school she gets to skip homework.
- Gain attention
E.g. Abdul gets to spend time with his parents when he doesn’t go to school. He goes around with them doing day-to-day tasks like shopping and sitting in their office while they work.
- Gain reinforcement
E.g. Rosalie gets to watch TV at home when she is not in school as no one is home to check up on her.
Two of the functions are for positive reinforcement, or to be given something (gain attention and gain reinforcement). Two of the functions are for negative reinforcement, or to avoid something (avoid negative affect, escape aversive situations). A child can experience any one or all of them together in any combination. Actually, it’s most common that there are multiple functions occurring at the same time.
What’s cool about this model is that it applies to everyone. If you can understand the function of the behavior, you understand why that behavior continues to occur. And then you can effectively develop interventions to help.
Is This Model Legit?
This four-factor model has also been well tested. There are at least three validation articles I can find, which is not bad. They created a school refusal assessment scale for both children and parents, to measure the degree to which these four functions are present. They have found that each of these four factors is significantly related to school absence. In comparison, researchers have found that measures of psychopathology are generally not related to school absences on the population level. This includes the Child Behavior Checklist, general anxiety measures, trait anxiety measures, and social anxiety measures. It’s not to say that these other measures are no good, but they don’t really “tap into” the reasons why a child refuses school or predict this behavior.
As a result of this research, the School Refusal Assessment Scale that has been validated for both children and parents. You can look at them from the source here.
What Does this Mean for Me?
You should be concerned if your child misses school on a regular basis. Although there is no definitive definition for this, the research sometimes uses 90% attendance as a cut-off, and in Washington State 10 days of unexcused non-attendance can result in schools having to take action.
If you have this situation, or you believe you’re on the path to it, the next step is to seek help. Don’t try to solve this alone, it’s incredibly stressful. A common worry is that you must be a terrible parent or are doing something wrong. However, this is so far from the truth. No one is to blame, we don’t have any real understanding about why this starts, it just happens. Blame only gets in the way of taking important action. Just as if your child was diagnosed with asthma you wouldn’t blame anyone, you would only seek ways to help make it better. Do the same in this case.
The first step is to talk with your school and see if they have any resources in the community that may be able to help. They may be able to refer you to someone, or they may be able to alter the school structure to help your child reengage. A psychologist can be well-positioned to help you if they have experience with this population. Whoever you see, ask them about their experience. From there you should hopefully get some guidance to help.
What Assessment Steps Are Needed?
Whoever you meet, I’d recommend that you complete the following 3 things as part of your assessment:
- A diagnostic assessment. This can be very helpful is figuring out why refusal behavior is occurring and provide treatment direction.
- A function of school refusal behavior assessment.
- An assessment of school attendance and current school performance.
This may take more than one session. Whoever you go to see, they should talk with both you and your child. You should feel comfortable that they know what they are talking about and they can speak confidently about a plan based on the results of the assessment. They really need to be able to talk about functions of refusal behavior and help you conceptualize reasons why your child may be refusing school. I’ll cover more about what the research says on intervention in a future article.
Criticisms of the Model
Be forewarned, this section is not for the light-hearted. It gets a little “sciencey”, but if you don’t mind that then read on!
Although this function of school refusal behavior model has really advanced the field, I definitely have some criticisms.
First, although the school refusal assessment scale is great, it doesn’t account for everything. It actually misses a massive amount of information. Unfortunately, the research that exists doesn’t present all the data needed to analyze how much it does account for. There are statistical ways to identify the amount of variance accounted for, which is a fancy way of saying how much of that factor it explains. For example, if something, such as how much ice cream I eat, accounts for 100% of the variance in another thing ,such as my happiness level, then it explains everything. Thus, my happiness is entirely dependent on how much ice cream I eat. It’s unclear to me how much the functions of school refusal behavior account for actual school refusal behavior because the data are limited. Often the papers don’t report it all. Taking crude data from one recent paper for example, the largest amount of variance in school absence that any one of the four functions accounted for was 8%, which is nothing! If all four factors accounted for 8% of school refusal behavior (which they don’t), then it would only account for 32%: Which at best leaves 68% of reasons why kids refuse school unexplained. Although this is a guess, based on the data presented and assuming that the functions overlap, the school refusal assessment scale only accounts for 10-12% of total variance. Therefore, while it does give invaluable information there is a ton that is being missed.
Second, and I think most importantly, is that there are no norms given for the scale. This is a problem because it makes interpreting the data more difficult. If you or a clinician completes the measures I have linked to above, you have no idea what the scores mean unless you refer to the means on the tables in the research articles. These scales need some way of giving a sense about whether a particular score is weak, average, or strong. Currently all you can do is order the scores from highest to lowest, with the highest score being the primary function of school refusal behavior. The scale also needs some way of interpreting whether the differences between the different function scores matter. For example, let’s imagine you complete this for your daughter and find the below:
|School Refusal Function||Score (average of items, max of 4)|
|Avoid Negative Affect||1|
|Avoid Aversive/Evaluative Situations||1|
Clearly, gaining attention and gaining reinforcement are the primary functions of the school refusal behavior. However, does the difference of 3 vs. 2.5 really matter? As of this writing there is no guidance on this. For the scientists among you who are interested, the standard deviations are quite large, so presumably the difference between 3 and 2.5 is not significant and they can be treated equally.
This article has hopefully guided you through how to assess school refusal behavior, and some other important considerations as you think about this process. It’s definitely not a simple issue or you would have already figured it out. Definitely contact people who may be able to help so that you don’t have to do it alone.
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