'School refusal sounds like a child just being naughty ... when in fact it is an anxiety disorder.' Photo: Rodger Cummins

IT STARTED without warning in just the third week of high school. Marcus, then 12, refused to get out of bed and put on his uniform.

His mother, Phenella Peterson, brushed it off as high school jitters. Most parents, she reasoned, had faced the challenge of persuading a reluctant child to go to school.

Several days later, as the school bus waited outside, Marcus (not his real name) was again anxious and became very distressed, crumpling to the floor in tears.

Psychologist Amanda Dudley says families can struggle for months, even years, to get a child back into the classroom. Photo: Eddie Jim

"I was trying to get him out of the door and he just collapsed in front of me and said 'I can't do it, I can't do it' and I remember looking at him thinking, 'How am I going to pick him up and put him on that bus?'

"I'm really embarrassed by my behaviour then, but I just ranted and raved and said 'What are you doing? There's a bus here, you gotta get up.' This continued for a few days."

She watched with frustration and bewilderment as her once bright and happy son quickly deteriorated and frequently complained of being unwell. Almost every day, he found a reason why he couldn't go to school.

"He'd say, 'I haven't slept all night I don't feel well' and have every sickness under the sun — headaches, stomach aches, you name it. He couldn't sleep because he was worrying . . . it all became a vicious circle."

Although Marcus had made some new friends at school, he constantly worried about what they would think of him and was very self-conscious around them.

By chance, Ms Peterson mentioned her ordeal to a work colleague who had experienced similar problems with her daughter and encouraged her to seek help.

Marcus was diagnosed with social anxiety and school refusal and placed on medication. It was the start of three harrowing years.

He eventually missed 50 per cent of class time in year 7, a pattern that continued through years 8 and 9. Ms Peterson had to miss work to stay home with him.

Now, as another school year unfolds, Marcus has already missed one day and is certain to be dealing with more days when he can't face the prospect of going to school.

Marcus is not alone. School refusal affects about 2 per cent of Victorian students, usually as a result of excessive anxiety.

Psychologists say children who experience school refusal are not simply trying to get out of class; for them the fear is real.

They become severely emotionally distressed when going to school or at the mere thought of doing so. That fear is often accompanied by nausea, headaches, stomach pains, sweating, and rapid breathing.

Like Marcus, they will often complain of feeling unwell, become withdrawn, worry excessively about how things will go and say they don't have friends. Some will cry for hours.

"The thought of going to school can make these children highly anxious and they experience really significant emotional distress and upset," says psychologist Amanda Dudley.

Ms Dudley, program co-ordinator at Monash University's Centre for Developmental Psychiatry and Psychology, says families can struggle for months, even years, to get a child back into the classroom. Some just don't go back.

Ms Dudley says school refusal differs from truancy, as students usually stay home with their parents' consent.

"It can be really sudden or it can build up over weeks or months . . . they might refuse on a day here or there, it might begin with vague statements like 'I don't like school', 'I don't feel like going' or they report feeling unwell," Ms Dudley says.

"They aren't 100 per cent aware of why," she says. "They just know they don't feel good when they go to school."

Reasons vary but psychologists have identified transition times such as the start of prep and the move to secondary school as triggers.

Teenagers are most at risk.

Psychologist Pat Boyhan, who manages CatholicCare's cool2b@school school refusal program, says the centre sees about 50 children each year.

Ms Boyhan says the reasons students refuse to attend school are complex. Often it is general anxiety, but sometimes it can mask something that is deeply troubling the child, such as bullying or problems at home.

"We've had children who are highly anxious and found that there's domestic violence and the child's staying at home to protect mum," she says. "But it can be all sorts of reasons from alcohol and drug abuse to mental health issues or post separation conflict between parents."

Untreated, a child with school refusal will eventually fall back academically, suffer social isolation and be at risk of developing mental health problems, such as obsessive compulsive disorder, social phobia, panic attacks and depression as an adult.

School refusal is also traumatic for parents, who usually have no idea how to deal with a child who suddenly won't get dressed, get in the car or go into school.

"The impact and destruction to family life is really quite significant, troubling and distressing," Ms Dudley says.

"Often there is no clear explanation as to why the problem has surfaced, and parents are left struggling with their child's seemingly unreasonable fear of school."

Well-meaning parents can make things worse by allowing an anxious child to stay at home.

"They may calm down and have a reduction in distress but of course the issue resurfaces the next day when they try to get them to go [to school] and often it becomes more intense over time," Ms Dudley says.

It is a scenario that is all too familiar to Linda Hibbs.

Her son, now 12, first began refusing to go to school in prep. He missed 60 days that year and his erratic pattern continued during primary school. He would become distressed and refuse to leave the house, complaining of headaches, nausea, stomach pain or diarrhoea.

"I would use force to get him in the car," she says. "It was just heart wrenching but psychologists were telling me that's what I had to do.

"He was just getting more and more stressed by me trying to drag him there and he got quite depressed in grade 4 and talked about wanting to kill himself . . . he was depressed for weeks on end." She felt guilty but realised the longer he was away, the more he would miss out on school work and social networks.

"It is very traumatic because you know you have to get your child to school and no matter what you do you can't," she says. "School refusal sounds like a child just being naughty or the parent is being weak when in fact it is an anxiety disorder and it affects more than school."

For her, the problem has been frustrating and deeply affecting.

"It's had a huge impact on me, I haven't been able to work because he spends a lot of time at home and I don't know when it's going to be."

Now that her son has started secondary school and managing his anxiety better, Ms Hibbs is hoping things will improve.

"He is hanging in there and going every day despite feeling like throwing up every morning," she says.

"I have found the support at the secondary school very good as the welfare co-ordinator got the year 7 co-ordinator to ring me to let me know how my son was going during the day."

Experts say close communication with school is important in helping students get back to school, even if only for part of the day.

Ms Dudley says early intervention is crucial. Parents should contact the school's welfare support officer, counsellor or psychologist to develop strategies as soon as they can.

"There is no quick solution to the problem . . . the longer a young person is out of school, the more difficult and challenging it is to assist them with returning to school," she says.

Treatment options vary from helping the child relax and develop their coping and social skills, to counselling involving cognitive behaviour therapy and medication for anxiety and depression.

For Ms Peterson, the guilt, sadness and frustration of that time may have blurred, but the emotional legacy remains. She credits the school's welfare officer for helping Marcus return to school.

"You don't want anyone to go through that. It has taken a huge toll on us, but our marriage is still intact and we're still operating, I count that as a blessing and a big tick, but it has been very hard."

 

LINK

med.monash.edu.au/spppm/research/devpsych/srp-referral.html