If you’re a parent, you’ll hopefully never experience it. As a provider, if you work with kids you will inevitably experience school refusal behavior. If you are going through such difficulty, then this article is for you!
We know that the research is quite lacking, but Cognitive Behavior Therapy (CBT) with parent training intervention is the most evidence-based treatment for this issue. However, there are also many other interventions you can use. My goal today is to take you through 20 different things that might help. This is certainly not an exhaustive list, and if you have any other suggestions please let me know.
1. School meetings
They can guide you in all directions. Schools vary wildly in their willingness to help out and provide accommodations. However, the most helpful schools will provide you with concrete advice and a great deal of flexibility. For example, hopefully they can find a teacher close to your child that will reach out to support them. Or they can get all teachers to provide a list of only the most necessary homework assignments. They might be able to even remove homework requirements for a short time period. They can provide additional tutoring, or guide you in applying for an IEP if needed. If there is bullying going on, they can help. The only thing I can say here is to ask for the moon.
2. Target The Behavior Of Just Getting To School
For some children, it’s ok to just target getting to school. I know you’re desperate to get them back into classes, but one way of easing back into this is to simply set the expectation of being in school. They can hang out in a counselor’s office or the nurse’s office. You’ll quickly increase expectations, but know it’s ok to start with just getting to school.
3. Shorter Days
Likewise, shorter days can be very helpful. Often, expecting your child to immediately start attending 100% of classes when they have been out of school from sometime is unrealistic. As such, starting with shorter days, such as the first two periods of school, is a really good way to start.
4. Reduced Academic Workload
While working to help your child get back to school, it can be helpful to work with school and teachers to temporarily reduce the academic workload, so they can pass in classes even with less homework to complete. For example, to implement this may mean coordinating with teachers to only require essential homework. The reduced workload should be similar to following a medical issue, and it should focus on helping kids to pass their classes without overwhelming them.
Note: Often schools will recommend increased time to complete assignments or having delayed deadlines, but I don’t think these are very helpful. Often, these strategies just put them further behind which just makes children feel more overwhelmed.
5. Consider a 504 Plan or IEP
This is part of talking with the school. If your child meets criteria for a 504 or IEP (individualized education plan) they can receive special accommodations that are truly helpful. Both 504 and IEPs are simply systems where children with some prolonged difficulty, such as emotional/behavioral difficulty, can receive help from schools to aid their education. Speak with school staff to find out more information.
6. Changing Schools
Sometimes it can be worth considering changing schools. This is a more extreme measure and needs to be fully considered first. Often it can be a false hope, as school refusal behavior will often not change by switching schools. However, there are cases where this can be considered, such as in extreme bullying situations.
1. Check your contingencies (you may need to speak with a psychologist to help with this)
Getting a good contingency management system is critical. Often, kids who show school refusal behavior will significantly benefit from a system in place to reward attendance behavior and remove privileges on days when basic expectations are not met. This intervention is a key part of evidence-based treatment for school refusal behavior. Examples include giving access to electronics only on days when they meet the expectations of going to school. See my article on contingencies for more.
Reward school attendance!
Contingencies are one of the most important aspects to your treatment. Don’t underestimate the power of contingency management. Contingencies create capabilities.
2. Regular Routines
Make sure morning, evening, and weekend routines are consistent and reward behaviors you want to see with lots of attention, while ignoring any behaviors you don’t want to see.
3. One on One Time
It’s incredibly important that you spend one on one time with your child. This can be watching TV together, but preferably would be something where you interact in some way, such as walking, throwing a ball, or playing a game. When you do this, it can be tempting to ask lots of questions, but avoid this trap. Your child will hate the demands of multiple questions. Instead, it’s ok to be quiet or talk about things you’re interested in.
4. Don’t negotiate!
Although it may be tempting to negotiate and persuade your child to go to school on any given day, remember that the goal with these interventions is to create a system that will sustain school attendance in the long-term. Negotiation only guarantees future negotiation. So don’t bother! If they don’t go to school on any given day don’t despair. You may lose the battle, but you’ll win the war.
5. Don’t Accommodate
Accommodation is parental behavior to make the situation easier for your child. For example, I know that parents sometimes complete homework for their child to keep up, or let them stay up later in evenings because they worry that their child will get mad otherwise, which may make them less likely to go to school. However, while accommodation is well-intentioned, it is quite toxic. In fact, around 90% of children who don’t get better from treatment experience a “severe” level of parent accommodation. I once heard the phrase “enabled to the point of disability” referring to school refusal behavior, and I think that phase aptly sums up the problem with accommodation.
6. Change behavioral targets so they are realistic
It may be that going to school is too daunting. However, you can change the target with your contingency management system. For example, it may be that for a couple of days they just have to attend lunch at school. Alternatively, if things are really extreme, you may only target leaving the house on time and try to work up from there. If you’re in that situation, definitely seek professional help though!
7. Keep Your warmth
You’re likely incredibly frustrated. However, one of the least effective things you can do is yell at your child or express frustration. This is called “expressed emotion,” and higher expressed emotion by parents predicts a range of negative outcomes for kids. Instead, take a breath and figure out ways you can spend quality time with your child. Be warm at dinner and in other interactions you have. Getting mad won’t help either of you.
8. Hire a Morning Helper
I have seen this be extremely helpful. When a child refuses school, staying home is a relieving feeling. Having a morning helper come over, whose only job is to make sure the child is on time to leave the house blocks this comfort. It also takes pressure off of you so that you can leave for work or attend to your other kids. Seriously consider this intervention as it can be miraculous! If you do, don’t get in the way of the helper as this will interfere with their effectiveness!
9. Technological Help
You may need to employ various technological devices to help with contingency management. I recommend the “Circle” device to many parents as it allows you to control Internet use with incredible efficiency. It means you can block wifi access even when you’re not home. Honestly, this thing is a life saver! I’ve included a link below if you want to research it.
I recommend that if you are giving phone access contingent on school attendance behavior then you figure out how to control phone data or block phone access remotely. This may involve calling your phone provider.
1. See a psychologist
Do this if you feel you need expertise or support to help guide you. As you know, CBT with parent intervention techniques is the most evidence-based treatment for this issue.
If your child has a clear mental health difficulty that you believe is related to their school refusal behavior, then consider treating this issue with professional help in order to make progress.
2. Focus on increasing school attendance
In many cases, especially with anxiety, this is good advice in the short term. Kids are usually very motivated to improve attendance. The data shows that we can improve attendance a lot more quickly than we can resolve other mental health issues. We believe that anxiety and other mental health issues often subside at least somewhat once school attendance is consistent. Focus on improving school attendance first.
It can be helpful to provide increased support at this critical time. Tutors are an awesome resource that can help with both structuring homework and completing difficult assignments in a short amount of time. They can also be a positive figure that your child connects with.
4. Academic Testing
Sometimes children have difficulty attending school in part because the subjects are too difficult. It might be worth considering academic testing to figure out learning strengths and weaknesses. A psychologist can do in-depth testing, called neuropsychological assessment.
5. Keep Social Gatherings
If your child doesn’t go to school, it may be tempting to keep them from hanging out with friends after school too. Or going to sports events. Except in extreme cases, it can be more helpful to allow them to attend these events in order to continue receiving in-person social time with their peers. This can help get them back to school and prevent isolation.
There are many interventions you can try, and these aren’t all of them. However, I hope this gives you some ideas that might just make the difference! If in doubt, I’d highly recommend finding a psychologist with expertise in this area to consult with.
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