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Ask a Professional: School refusal - to push or not to push?

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Ask a Professional: School refusal - to push or not to push?

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Ask a Professional: School refusal - to push or not to push?

Hi there,

I have read every article I can find about school refusal. Most of them have some lovely advice, but it really doesn't make a difference whether you have a consistent morning routine in the face of panic attacks at the thought of putting the uniform on. We are so compassionate and listen to her distress, but when it comes down to it, she only has the rational thinking ability of a 13 year old on her best days, and less when she is constantly in fight or flight.

As her parents, we can see the damage that is being caused by her school refusal. When she had an eating disorder, we took control and made all her food choices because she wasn't capable of making them herself. So now with school, should we be doing the same thing? If we ask her to identify worries, she comes up blank. If we ask her what she wants her life to be like, she comes up blank. We can see the things she can't.

My question is - will it make her social anxiety worse if we force her to attend? I know she will fight it, and she will have a panic attack getting out of the car. But last term, she started slow and built up to a full day, made friends and was much happier. Now she's back to square one.

PS She also says she doesn't do psychology. She is not interested in (or capable of?) introspection.

Thanks for your advice!


Dear @heythere 

You are obviously very caring and involved parents, and it is really fantastic that you have been proactive in reading articles and trying different approaches. It must be frustrating that these have not proved effective for your daughter.

Things like having a consistent routine can be helpful and part of the picture for many teens, but as you have identified, these steps aren’t always enough. Addressing school refusal often involves working to address the underlying concern, because otherwise it tends to keep the school refusal behaviour going.

You’ve obviously tried to explore your daughter’s worries with her, but it sounds like she hasn’t been able to identify what is happening for her. This is not uncommon. Individuals vary in how well they can reflect on their thoughts, and for some people who are feeling very anxious, the anxiety itself gets in the way of identifying specific thoughts. There is also a developmental aspect to this - children and younger teens tend to find introspection more difficult.

I want to acknowledge that it sounds like you have done an amazing job supporting your daughter through something very challenging. In addition to the difficulties with attending school, you mention that she has also experienced an eating disorder. Eating disorders can be really tricky to address, and it sounds like it is not a current concern for her at the moment, suggesting you were able to work through this with her.

There are some similarities between dealing with school refusal and eating disorders (as well as differences). In particular, in both cases a team approach can be helpful, and in both cases it is important to get professional support. While sometimes school refusal can be mild, if she is having regular panic attacks, then it is at a level where it is important to get input from a professional.

Avoiding a situation which causes symptoms of anxiety is really common. Often, this avoidance can contribute to anxiety worsening over time. Professional approaches to anxiety do include encouraging the person to face the feared situation (like school). However, it is a balancing act to not encourage avoidance, while not overwhelming the person by placing them in a situation where their anxiety is so intense they are unable to function. Too much exposure to the feared situation too quickly can cause increased distress and worsening symptoms.

Identifying where this balance sits and how much is too much is something that requires a professional working specifically with your daughter’s situation. This is particularly important given that your daughter has a history of disordered eating, as stress about school could increase the risk of eating symptoms coming up for her again.

I understand she is not keen to see a psychologist, and this is really understandable when we consider that she finds introspection difficult and uncomfortable. There can be more to seeing a professional than introspection. For instance, it may be more helpful to focus on behavioural strategies, or on exploring your daughter’s strengths.

If seeing a professional is something that really isn’t an option for your daughter right now, you could also consider seeing someone yourself, who can provide support to you in your interactions with her. Providing support to someone who is going through a tough time can be incredibly draining, and parents often find that they are second-guessing all their interactions. Having a third party who can talk through how things are going and help you problem-solve can help you feel supported, as well as helping you decide on the best course of action.

Best wishes,

Linda is a psychologist experienced in working with people across the lifespan, including teenagers and their families, in a variety of settings, and is ReachOut's Clinical Lead.