Monday morning and the tension is high. Suddenly, she’s curled up into a ball on the floor. Clinging with every muscle to a stair runner. Sprinting down the hallway to her bedroom and slams the door. Sound familiar? If your morning routine for school dropoff continues to devolve over and over and over because of school refusal anxiety, you’re not alone. Two-hour ordeals to get out the door are more common than you might think, but that refusal oftentimes is more than just “playing hooky”…it can be a physical and emotional reaction to something that feels unsafe.
At Mind-Body Pediatric Psychiatry, we look at school refusal through a dual lens. There’s the clinical symptoms (anxiety) and then the physiological manifestations that are a byproduct of that anxiety. For the classic school refusal anxiety case, these two go hand in hand. Here’s how to understand what is happening and how to help your child find their way back to the classroom.
Is your child’s School Refusal Anxiety a ‘Will not’…or is it a ‘Cannot’?
The first step for parents is distinguishing between behavioral defiance and an anxiety-based “freeze” response. When a child experiences school refusal anxiety, their sympathetic nervous system, the ‘fight or flight’ center located in the amygdala, is in the driver’s seat. We’ve talked about fight or flight symptoms before on the blog, so we know their power is real…and often out of your child’s hands to control.
But how do you determine what is willful, vs. what is a simply uncontrollable reaction due to anxiety? Here are a few ways:
- Physical Complaints
- Frequent morning stomachaches, headaches, or nausea that miraculously disappear by 10:00 AM or on weekends.
- The Sunday Scaries
- Increased irritability, sleep issues, or clinging behaviors starting Sunday evening.
- Meltdowns over Transitions
- Extreme distress during the transition from home to the car, or the car to the school door.
The Mind-Body cycle of School Refusal Anxiety
Anxiety’s ability to deliver a physical reaction is one of the reasons we focus on a holistic approach. In the case of school refusal anxiety, that anxiety can trigger a physical sensation (beating heart, cold sweat, overall tension) that ‘proves’ to the child that they really should stay home where it’s safe.
But every time a child stays home from school, due to their anxiety, their avoidance reinforces the fear. And the next day becomes harder, and harder, and harder, and so on and so on.
Shifting your Prompts from Demands to Support
In the heat of the moment, in the frustration of yet another long morning, it can be tempting and almost second-nature to entrench with curt demands. But the gamesmanship of those demands can backfire, causing both you and your child to dig in, until the only alternative feels like physical help. Here are a few ways to break that cycle:
- Validate the Feeling, Not the Danger:
- Instead of saying ‘There’s nothing to be afraid of,’ try ‘I can see your body feels really tight and worried right now. It’s okay to feel worried, and we are going to work through it together.’
- Look for the ‘Why’:
- Is it social anxiety? Is it a specific sensory issue in the cafeteria? Or is it Pathological Demand Avoidance (PDA)? Identifying the root allows for a targeted plan. (We can help with this)
- Create a ‘Soft Landing’:
- Work with the school to identify a safe person or place. Sometimes knowing they can spend the first 10 minutes in the library or with a favorite counselor can lower the stakes enough to get them through the door. (If you’ve been through it, this person is a life saver! Thank them!)
When to Seek Professional Help for School Refusal Anxiety
If your mornings have become an ongoing source of family trauma, or if your child is missing significant amounts of school, it may be time for a clinical discussion. Visit our scheduling page to sign-up for a :15 minute phone call and see if we’re the right fit for your family.
At Mind-Body, we focus on a comprehensive approach that may include:
- Nutrition and lifestyle habits
- We can assist in ordering lab tests when indicated and/or building individualized treatment plans that fit the needs of your child.
- Medication Management
- In cases where the anxiety is so high that the child cannot even engage in therapy, a low-dose medication can sometimes lower the volume enough for them to start accessing coping skills.
School refusal anxiety is an exhausting hurdle for any family, but with the right blend of physiological understanding and clinical support, it is a hurdle your child can overcome.
This is general education, not to be mistaken for a patient-provider relationship. Please consult with your provider for more information.
