No such thing as "School Refusal"

I have been thinking about the term "School Refusal" a lot this week. Harry Thompson also spoke about this term this in our support group a few weeks back and I’ve been thinking about it a lot since.

Some of the children I work with are labelled as “School refusers” - but the more I think about it the more this just doesn't sit right with me. The irony of this label is that children labelled with it are so often NOT refusing to go to school. They WANT to go to school. They WANT to learn. They WANT to see their friends. They just WANT to be like everyone else. But they CAN’T. Labelling this inability to attend school as “refusal” makes it sound like a choice - and it is not.

For some young people going to school is literally the most terrifying experience they have to endure. It would be similar to me having to go to work every day if I worked as a zoo keeper and had to clean out, handle and touch insects and reptiles all day! The difference is though that I would have a choice about this - I could leave my job if I wanted to. Children are not given a choice about going to school or not. They are told it is compulsory, that their parents will go to prison if they don’t go. The children that do go in are rewarded with attendance prizes which can only compound the feelings of failure and self loathing in some of our children.

My youngest son has had two periods of extreme and debilitating anxiety in his life. The first was when he was in Year 4. Fin had always been happy to go into school, he was a very popular little boy whose teachers always described him as “delightful.” The first inkling something was wrong was when we got to school one morning and Fin complained of tummy ache. It was so out of character for him to complain of illness that I took him home, and the tummy ache immediately disappeared. Things escalated very quickly - and only a couple of weeks later Fin had a full blown panic attack in the car, he was clutching his throat and crying “I can’t breathe!” Every morning Fin said he didn’t feel well enough to go to school, and when we finally got to school he had to be met by a TA in reception where he would sit and cry, having previously run in from the “drop zone” without any difficulty.

Sunday’s nights became a nightmare. Fin became more and more anxious and was unable to sleep, he was angry and defiant and I would often wake up to him standing over my bed in the middle of the night crying. It was heartbreaking.

I was eventually able to identify the main triggers of Fin’s anxiety about school. These were:

• His older brother going to secondary school - Fin missed his big brother enormously and felt exposed by his absence.

• Assembly where he felt trapped and terrified of being told off by the very old fashioned head teacher who believed in public humiliation as a form of discipline.

• Swimming lessons - Fin was scared of drowning and not being seen amongst all the children in the pool.

The other adults in Fin’s life were not always understanding. “Just get him in!” And “he can’t afford to miss so much school - he will get so behind” were some of the less helpful comments I got. My husband just didn’t get it until one day he had to take Fin to school- then rang me quite shaken and upset saying, “Shit - he’s bloody terrified isn’t he!!”

Fin’s Year 4 teacher and TA were brilliant and worked with me to help Fin. We used a 3 point scale where Fin could use a number to say how he was feeling about his triggers. (i.e - 1= this is fine, 2 = it’s tricky but I will give it a go, 3 = I can’t do this.)

Year 4 did get better for Fin and be even managed to go on the residential trip which was a huge achievement for him.

Unfortunately, a long period of illness meant Fin missed a huge amount of school from years 6-9, and the anxiety about being in school started again. This time the thing that made it worse was Fin’s internal anger and conflict about not being able to go to school. One morning I went into his bedroom to find him sitting on his bed crying and bending a metal coat hanger in sheer frustration at himself. I would always say I would go and collect him if he needed me to - but he would explain, “mum it’s not being in school - it’s going to school that is so hard.”

So - it’s not school refusal. It’s an absolute fear of school. It’s being in an environment for 6 hours or more a day where you don’t feel safe. Our school system needs to change so that children are not punished or penalised for being unable to go to school. There need to be more options that are open to them that are seen as just as valuable and effective. Children should be given more choice and autonomy over how they access school and the focus needs to be moved away from them actually being in the building!

Until that happens here are my tips to help support children who are unable to attend school:

1. Never use or allow psychical force to get children into school - this will be highly traumatic and will compound negative feelings around school.

2. Make sure there is at least one safe person and safe place accessible to your child at all times during school.

3. Allow children to leave anxiety provoking situations without drawing attention to themselves.

4. Never use threats or sanctions if a child cannot attend. Be cautious of using rewards or overly praising for attendance.

5. Identify Red, Amber and Green parts of the day - ie Red is highly anxiety provoking, Amber is difficult and Green is ok. Ask if schools can remove Red periods and have options around Amber.

6. If a child cannot attend school try and put some structure around their day still.

7. Ask schools for reduced or flexible timetables.

8. Communicate with school as much as possible to try and work together.

9. Use empathy with your child and acknowledge how hard it is for them. I understand it’s extremely stressful but try not to show your stress or frustration as this will only compound feelings of failure and guilt within your child.

10. Ask school to ease a child into the day - can they go to to the library and read until they feel ready to go into class? Is there a job or responsibility they can have that they may enjoy when they get in?

So let’s move away from the term “School Refusal. Maybe a term like “Educational Placement Anxiety” or "School Based Anxiety" would help schools focus on supporting children with the overwhelming anxiety they experience and consider more reasonable adjustment they can implement instead.

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