School refusal calls for quick action
It’s time to get ready for school, but your child burrows deeper under the covers, claiming illness or crying pitifully.
If the behavior is persistent and your pediatrician has ruled out medical causes, the problem could be school refusal. This behavior is wrenching for parents and children, and should be taken very seriously.
School refusal can be a symptom of anxiety and depression, which often accompany bipolar disorder. It can also be a sign that a child is being bullied or is struggling socially, feels unable to keep up in school, or is having trouble separating from a parent. Staying home can compound the problem, because the child becomes more socially disconnected and falls farther behind academically. Whatever the cause, these kids need help.
My middle child began to find ways to be late or to miss school altogether in 8th grade. This was about the time her older sister went to a residential therapeutic school, so I cut daughter No. 2 some slack—we had all been through a lot. Her transition to high school was very rocky. She sobbed and refused to get out of bed once or twice a week, and withdrew from friends and activities she once enjoyed. She was diagnosed with depression and anxiety, and began treatment with medication and counseling.
Her therapist advised against letting her stay home. On the days when I could not coax or wrangle her out of bed, he recommended letting her know that I expected her to be at school the next day. She missed more than a dozen days of school as a freshman, several days the following year and, by her senior year, just a few.
As a parent, it was hard to know what to do or how to react. I could see that her pain was real, but I worried that allowing her to stay home would only inflate her demons. I also felt angry—her behavior disrupted mornings for the whole family, and kept me from work. The behavior took a long time to overcome, but once treatment began, we saw steady improvement.
School refusal is unlikely to go away without treatment. Medical and psychiatric assessment is very important to identify and treat physical or emotional causes. Cognitive behavioral therapy (CBT) can also help children and teens learn more positive ways of thinking along with healthy coping skills.
Here are tips to help overcome school refusal:
- Don’t get angry or upset—this will escalate your child’s anxiety.
- Be reassuring about school and friends. For younger children, it may help to offer small incentives like a favorite snack after school.
- Enlist your child’s teachers and/or school social worker to identify causes or triggers at school, and to create ways for your child to feel successful and accepted.
- Help your child plan what to do if he or she feels upset or anxious at school. (Some children fear losing control in front of peers, and this heightens their anxiety). Ask the school to identify a safe, supervised place where your child can retreat if necessary.
- Don’t allow your child to skip school if at all possible. Staying home may make the problem worse and, conversely, a good day at school may make it easier for your child to go the next day.
- Have patience—this will take time!
I know parents who have addressed a teenager’s chronic school refusal by reporting their child truant and letting the school and potentially the juvenile court step in. I didn’t go this route, but I understand that some parents have exhausted all other options and see outside authorities as allies or a last resort.
Untreated school refusal can be crippling, and has been linked to increased anxiety and depression later in life. It is critical to act quickly, to help these kids acquire the tools they need to function today, and to meet future challenges.
My daughter sometimes still struggles with anxiety, but she has insights and good coping skills. She is now a college student and, according to reliable sources, gets herself to class.
--
OhMy
I deal with a similar issue on school days. My dh came up with the idea of telling our daughter that she could eat breakfast, get dressed, brush her teeth and hair. Then she wraps herself up in a throw on the couch and reads a book. Yes, I get all the "lip" when it's time to put her shoes and coat on.
I hate to say it and feel it; but I'm glad when the bus comes.
She is 10 and definately changed our lives. Despite medication she's not the child I had hoped she'd be. We adopted her at birth. From the start she had multiple issues caused by her bmothers drug addiction.
I've heard early intervention helps.....I certainly hope so.
OhMy
My son was also adopted at birth and has very difficult mornings before school. I don't know if there was drug addiction but I know the birth mother was on depression meds and the birth father had anger issues. My son seems to find something to be angry about each morning. This morning he wanted me to unfreeze his lunch account so he can get a snack (we took that privilege away from him). I told him if he does good for the next two days I will give him money for snack for Friday. He proceeded to take money from my wallet and he is only 6 years old. I was trying to keep him somewhat calm as I had to get my other son to school as well and could not leave this son at home alone. When I left the room so I could get ready he said he is getting angrier and kicked things around, threatened to throw over the table. He said I had to sit there till he finished his breakfast which ofcourse took forever. I said I wanted to pull out the car so we could get going I was even tempted to just leave so I could get my other son to school. I was so upset I didn't even care if I left him and I would have gotten arrested, luckily I didn't but that is how I felt. I didn't want my other son to have to suffer and be late because of this one. It is really difficult. I need help for him and have not found the right help yet. I would even be willing to medicate him which I am normally not willing to do. It was horrendous.
Hi, Oh my --
Early intervention certainly helps. So does hope! A friend of mine recently told me about a system of tokens and rewards/payments that she and her husband used to improve the behavior and cooperation from their daughter (also adopted, at 5 months) with many MH issues. She picked up this system from the book "The Willful Child". It's in my vast home library, but obviously I did not pay close enough attention. If I had a 10-year-old, I would go back to this book and employ some of these motivating strategies.
Best wishes
Jean
--
Jean Meister
Dear Sad and Stressed --
I am so sorry for all that you are going through. I was there once, and so were so many other parents who are part of CABF. If you have not gotten your 6-year-old assessed by a child psychiatrist, that would be a good place to start. If your son has been evaluated and diagnosed, it is important to seek treatment and behavioral training (for you and for him) to help redirect when he is aggressive or otherwise inappropriate. None of this is easy--it's exhausting. But early intervention has a great impact, and the positive effects can make a lifelong difference. Keep trying to find the right help. I would ask community resources to direct me to an expert clinician. Try asking for recommendations from your local school social workers, psych nurses at a hospital pediatric inpatient psych unit, or other parents with challenging children.
Please also take care of yourself too. Recruit an ally--your spouse, a relative or a close friend. Maybe even a therapist who will help you nurture yourself. You should not go through this alone!
Best,
Jean
--
Jean Meister
I would love some input from anyone about teenage years. I no longer know if my daughter is being a teenager or being bi-polar. She was diagnosed 4 years ago and as she gets older she is terrible at following through with directions and chores. She also battles us every morning to go to school. It has caused terrible stress at home and between me and my husband.
Not sure as far as parenting, when we punish and when we don't because of her being bi-polar.
Are there limitations for children with bi-polar? She is making good grades and a freshman in high school. She does take medication also.
Anyone have any input?
Desparate Mom
It is important to set limitations for kids with bipolar! We fired a therapist who told my daughter that her actions were not her fault because of her illness. Our kids will be held responsible in the real world. When our daughter is medically stable, we expect her to exercise control and to recognize when she is veering off and use calming skills, so that she does not get to the point where she truly cannot control herself. She is usually successful.
In addition to trying the steps suggested in my blog, you could also ask for advice from your daughter's therapist and a social worker at her school. If she is not getting talk therapy, I would find a therapist ASAP--this is very important in addition to medication. It is important to address this problem early, because it can get worse, and can derail school performance.
I am glad that your daughter is earning good grades.
Best,
Jean
--
Jean Meister
My son recently was enrolled in a private school after being the victim of bullying and threats at a public school. He was doing well academically until that happened. Now he is in a spiral and getting mostly -0's and m's, not even completing work in class. He hasn't refused to go to the new school but I know he is not happy. He did refuse to go to the public school and that is how I found out about the bullying and threats to "shank" him. 6th grade, middle schoolers are the cruelist. So I would caution parents to make sure there isn't a good reason behind child's refusal before insisting they go. Our kids are different and unfortunately that does make them targets. Compassion is lacking in our society's young.
--
Patsy W. 59
Chris 12
Trileptal 600 mg @ bedtime, 300 mg in am
ADHD, Depression, Post Traumatic Stress Disorder, poss. BP
School-mainstream classes this year, math LD
You are right--the first thing to do when your child resists going to school is to find out why. In cases of bullying, the victims are often embarrassed or fearful that a parent's involvement will only make the bully mad, so it can take time and compassion to get to the bottom of the problem. That's another reason it is important to cultivate allies at school--teachers, social workers and others who may be able to provide insights about what is going on.
I am so sorry about what your son has gone through!
Jean
--
Jean Meister
I completely relate to this problem. My 16 year-old Junior daughter doesn't have a problem with going to school but staying there is more difficult. Since she shook her addiction to prescription drugs she has turned instead to promiscuity. Her therapist says that it is most likely a replacement behavior for the addiction to drugs. Well needless to say she is called names and teased constantly about it and is called "slut" and much, much worse. She cuts herself and talks about suicide. She severed ties with the "drug" group but now those people are retaliating by threatening verbally and physically. I have talked to the administraton several times but they have not been much help without "real proof." She calls me crying and begging to pick her up if even just for an hour. I usually do because I feel so terrible for her. Is this right? Should I leave her stranded? I dread phone calls in the middle of the day now. help
--
Kathy
Hi, Kathy --
It is important to take your daughter's suicidal expressions very seriously. You have probably read stories about children who took their own lives because they were tormented by bullies. Tragically, this happens.
Your daughter needs help fast--from the school administration (they have a legal obligation to act when there is bullying!), from her doctor and therapist, and from you as a parent. Run, don't walk, to demand action from the school principal, to explore other school options, to consult with a lawyer and police, and maybe to find new clinicians. It's not enough to call promiscuity a replacement behavior--how are your daughter's therapist and psychiatrist addressing her suicidal ideation? Is your daughter bullied by internet or text messaging? Some states have laws addressing cyber-bullying, and maybe your police department can act against the kids who are targeting your child.
We faced a similar crisis. My daughter was bullied and socially isolated at school, and she also called home in tears, begging me to pick her up. When she expressed thoughts about jumping from the window of her 3rd floor math classroom, her psychiatrist advised us to pull her out of that school immediately. It was a private school, and we moved our daughter to our public high school the next day. That provided a new peer environment and some immediate relief.
You can be your daughter's best ally and advocate in this awful situation. Unfortunately, the behaviors you describe--drug abuse, cutting and hypersexuality--can be caused by bipolar. Your daughter should not be blamed. She needs treatment and protection from bullying right away.
This is truly heartbreaking. Please let me know how these next steps go --
Jean
--
Jean Meister
Hi
Thank you so much for your great response. As far as the suicidal threats we have been trying to regulate her meds, specifically Wellbutrin and Abilify. It seems to be the general consensus that she is using the threats as a manipulative tool to sway me to conform to her wants. We see the therapist once a week and although both Maggie and I like her I wonder if she is aggressive enough. Maggie doesn't want to even consider switching.
I can't help but think if I could get the teasing under control her stress level would go down and self esteem would go up. I am going to call the school today to see if there is a safe place for her to go when it gets tough. It is usually during lunch when her best friend is gone.
I would love to switch school but the only options I have is private. No way can we afford that. So our hands are pretty tied as far as that goes. I will start with contacting the school administration TODAY about helping her to have a safe place to go.
Thank you so much,
Me- 42 Bipolar - 200mg Lamictal, 150mg Seroquel, 450mg Lithium twice a day, 1mg Lorizapam as needed
DH - 52
Maggie - 16 Bipolar - 200 mg Lamictal and 200 mg Wellbutrin in the AM and 200 mg Wellbutrin and 20 mg Abilify in the PM
Samuel - 14
Jennifer - 10
Kathy
Hi Kathy --
Just checking in to see how things are going. I hope your daughter's school aggressively addressed the bullying, and that your daughter has gotten some relief. Please let me know how everyone is doing.
Jean
--
Jean Meister
My daughter was 7 when diagnosed and had this issue until we switched schools. She had been going to a private school that was small and refused to assist us in getting her what she needed... HOWEVER we don't have that issue this year. We've tweaked her meds, she is in counseling and they have done everything at the new school to give her safe spots.
Early intervention has also given her the tools to say: I'm struggling today mom. Instead of screaming and fighting. Cling to that hope and be willing to sit with her for a few moments and just give her an extra shot of TLC. I know it's taxing on the emotions and fragile nerves as parents we have, but remember they are trying. Most times... they just don't know. They still need limits and consequenses. They still need expectations. BUT we have to take a deep breath too.
Big hugs from a mom who has been there.
-- Reply to OhMy
Jennifer Dirks
What was your response to him when he told you he was getting angrier and started kicking things?
What was your response when he told you, "you had to sit there till he finished his breakfast"?
You can leave him to take your other child to school. You could have even called the police yourself and tell them you were doing so!
It sounds like your 6 year old is holding all the power and he knows it. Just because a child has a mental illness
it is not an excuse for behavior and you cannot allow them to blame the illness for their behavior or let them get
away with it because of the guilt you feel. They must take responsibility for their actions and as a parent it is your job to discipline them.
--
Steph
My son was diagnosised at the age of 8 years with Bi-Polar disorder. He spent a full year away from home between mental hospitals to an rtf program. When he came home at 9 years old. he went to a special school for special needs students. He was well above these children academically because the "special needs students" were actually mentally retarded. I fought with the school district to get him out of the program. Finally after 5 years he went back to public school. he was in 8th grade. I set up a fail-proof academic IEP with his school. it consisted of the following. 1st period was Emotional Support, there they would help him get organized for the first half of the day. Second, academic class, third academic and fourth was emotional support, where they went over 2nd and 3rd period classes. then lunch. then emotional support to get ready for the second half, followed by two academics and finishing the day off in emotional support to go over the second half of the day, any questions on the first half and go over and due any homework.
He FAILED! He refused to leave the emotional support class from the first period. We switched the programs around because he told us he "didn't" need the emotional support.... we tried everything, IEPs were almost every 30 days! He would go to first period put his head down and refused to move until the last bell rang.
The School not knowing what to do sent him on to 9th grade with the hopes that getting him into a votech school with a hands on approach to learning would change his world. We start 9th grade off with a Bang! He is excited! Goes to every class every day. For almost two marking periods this kid brings home grades between C's and B's. Then right after the new year he flipped a switch and turned himself off. NO EXPLANATION!
He refused to go to school! He would tell us he was going to go the next day. Would promise the night before that he was going to get up in the morning. Over 30 days not once did he follow through. We took all of his electronic toys away. He was grounded to his room! He didn't care! It didn't matter because in the end he got what he wanted, he didn't want to go to school!
Finally the last straw, he ran away. His excuse, he was tired of us being mad at him so he thought he would go live with his Uncle. He was hospitalized and then sent to an RTF.
He just came home 3 weeks ago. Everything was great. Today he didn't go to School!
--
Steph
I AM A SINGLE MOTHER OF A 16YR GIRL SHE A NORMAL TEENAGER DOES NOT WANT TO HELP OUT AT ALL AROUND THE HOUSE. THEN I HAVE MY 10YR OLD JR.MANIC BIPOLAR CHILD. WE STARTED TO SEE A NEW DR. AND SENCE THEN LIFE HAS BEEN WORSE THEN WHAT WE STARTED OUT WITH. HIS TEACHER HAS EVEN NOTED THAT HE IS NOT WANTING TO BE APART OF DAILY THINGS IN SCHOOL, I DO HAVE A IEP THAT WAS SET UP FOR HIS ANXIETY,ADD/ADHD,SHORT TERM MEMORIE ISSUE. BUT HAVE TOLD THEM THAT THEY ARE CHANGING IT TO JR.MANIC BIPOLAR. I FEEL LIKE I AM BABY SITTING THE SCHOOL 24/7 JUST TO STAY ON TOP OF THEM THEY SAY THERE GOING TO DO THIS BUT THERE IS NO FOLLOW THROUGH AND THEN WE RUN INTO ISSUE LIKE TO DAY PIZZA DAY THAT ALL THE OTHER NORMAL KIDS HAVE EARNED 30 STICKER AND HE HAS ONLY EARNED 1 STICKER FOR READING AND TAKING A TEST. SO MY SON DID NOT WANT TO GET OUT OF BED TODAY, I TRIED TO TALK TO THE IEP TEACHER ABOUT THIS YESTERDAY, ALL SHE HAD TO SAY IS WELL HE JUST HASNT APPLIED HIMSELF HE GET DISSTRACTED AND IS TO BUSSY COUNTING TO SEE HOW MANY PAGES HE HAS HE JUST WAST TIME. THERE SEEMS TO BE A LAC OF GUIDANCE ON THERE END. SO NOW THIS MORNING HE REFUSSED TO GET OUT OF BED, THREATING ME CALLING ME EVERY NAME IN THE BOOK, I HAD TO THREATEN BACK TELLING HIM I WAS GOING TO GRAB HIM BY THE HAIR AND DRAG HIM OUT OF BED AND PUT HIM INTO THE TRUCK. KEEP IN MIND HE IS ALMOST AS TALL AS ME AND I AM 5' 4 HE IS 130 POUNDS. HE IS A VERY BIG KID FOR A 5TH GRADER. WITH ALL HIS KICKING MY WALLS AND NOCKING VERYTHING DOWN TO THE FLOOR AND THROWING THINGS KICKING THE CAT THAT JUST HAPPEN TO BE IN HIS PATH AND CRYING AND SCREAMING HE DID GET IN TO THE TRUCK AND I DROPPED HIM OFF AT SCHOOL. I DID NOT HAVE TO TOUCH HIM AT ALL BUT THE HEART RENCHING THINGS THAT CAME OUT OF HIS MOUTH RIPS MY HEART OUT. I WORK FULLI GET UP AT 4:30 AM JUST TO HAVE A 1/2HR TO MYSELF AND WE HEAD OUT THE DOOR AT 7 AM TIME I GET OFF OF WORK AT 5 PM AND MAKE IT HOME AROUND 6:20/6:30 NOW I HAVE A HUGE MESS TO LOOK FORWARD TO AND WITH HIM ,HE GET WORSE IF I DONT FEED HIM RIGHT AWAY. WOW VERY OVER WHELMING FEELING JUST KNOWING THIS IS HOW MY DAY STARTED AND KNOWING WHAT I AM GOING HOME TO. HE IS VERY SENSATIVE TO MEDICATION (HIVES) AND HE IS NOT ON ANY MEDICATION AT THIS TIME AND WE ARE TRYING OMEGA 3 AND HE DOES TAKE A ANXIETY MEDICATION BUT IF HE TAKES THOSE TWO OR THREE DAYS IN A ROW HE GET VERY TEARY EYED. I CAN NOT HANDLE WORKING FULL TIME ANY MORE AND CHANGING TO PART TIME IS WAYING VERY HEAVELY ON MY MIND. BUT THERE IS ALL THE BILLS. HOW DOES ONE DO IT. THIS IS BECOMING ALMOST A DAILY THING IN OUR LIFES. I CAN TAKE EVERY THING AWAY AND NOTHING MATTERS TO HIM. CYCLING IS VERY RAPID. HELP I JUST DONT KNOW WHAT DIRECTION TO TURN IN ANY MORE
--
some days a life jacket is requierd
You are right about the life jacket! Parenting our children can be overwhelming.
I am so sorry for all that you are going through. I hope that you have a partner or other family members or friends who can care for your son occasionally to give you a break.
It sounds like your son (and you) need much more support from your son's school. I hope you have met with the special ed director or your son's case manager and his classroom teacher. Needed accommodations should be part of his IEP, and once listed they are required, are not optional for the teacher. The teacher should not penalize your son or embarrass him because of a disability.
Is there a social worker at your child's school who could advise you on his school refusal issues and his teacher and classroom problems? You need support, and quickly.
Best wishes,
Jean
--
Jean Meister
Thanks Jean I am going through the same ordeal as the other mom and I am losing my mind, It does help to hear some encouraging words of hope
My grandson in 2nd grade has 30% attendance at assigned school. The other 70% would be either school refusals and residential observation.
My daughter, the mom, was adopted at age 5. Looking back, with some insight into birth family history, there is a long lineage of affective disorders, learning disorders and substance abuse, first and second degree relatives. Psychs will focus, did focus, still focus, on attachment and trauma as the source of any behavioral problems. In retrospect, these factors are relatively minor compared to the heritable condition(s) in the genetic family.
Getting back to my grandson with his on-again, off-again school refusal: He matches up quite well with FOH phenotype except that he lacks overt suicidal threats, lacks overt threats against others and lacks general aggressiveness. His territoriality is mainly demonstrated through hoarding. His only aggressive episodes are with his mom. He is giggling or laughing while hitting her. In fact, all of his "defiance" comes against a background of giggling and/or compulsiveness.
Of course, he is only 8. Suicidal thoughts. overt misogyny and/or substance abuse though minimal now might come later (especially given birth family history). He is certainly not hypersexual at this point. He is excessively modest, however. Pathologically modest, I would say.
In his school refusal episodes he shows various moods: either depressive "nope"-ness (but not sad), or grandiose (with elation) or obsessive and compulsive. If forced into school his mood morphs into irritable. On days when he happily goes to school, he has good social skills and academic functioning but does demand special attention from the classroom teacher, wants to control of the agenda, hoard materials, etc. When in the residential school with its very structured setting he does well except for some "listening" problems. These may be due entirely to his auditory processing deficits.
If he is bipolar, mania/depression seem relatively mild (at this stage). If it weren't for the school refusals (big IF), it could all be put down to "adjustment problems." However, severe episodic school refusal has been going on many months, with police and social services involvement and learning delays placing this kid high up on the school system's radar. The school means well, but they are clearly clueless (about bipolar at least).
So he is stuck with DIAGNOSTIC INERTIA, and intentional avoidance of family history of affect disorders.
This stands between current situation and having a close look at biological affect disorder? Current dx is from a 1-hour interview 13 months ago (before school refusals). Kid was diagnosed as ODD and PTSD. Now this diagnosis has stuck to him and seems cast in granite (as far as the school is concerned). This dx does not fit current behaviors. Social workers want him in trauma counselling. He does NOT have PTSD symptoms that I can see. His ODD is more phobic and compulsive than angry. His mom acknowledges as much, and doesn't want him in the counselling being suggested.
School refusals are continuing. Funding for his temporary residential placement is running out. No agreement on what to do.
For 2 months his mom and I have been advocating for a psychiatric evaluation to include screens for social phobia and bipolar disorder. Nothing. Kid is in limbo with an unhelpful psycho-educational eval. Mom has requested an alternative eval. No word on this request yet. They don't know what to do with him, but they continue to pour limited resources into (presumed) effects of recent history (minimal to non-existent, in my book) and ignore 3 generations of family history of evident affective disorders. We don't know how to force "the system" to examine alternatives to current diagnosis.
School refusals do seem common from reports here for JBD kids. You would think there would a standard protocol that school admins could follow to screen for bipolar evidence in family history.