Fighting School Refusal: Safety First

A child’s school refusal case has unfortunately progressed to serious levels. He/she is chronically absent despite parents’ best efforts, such as changing schools, elevated mental health care like Intensive Outpatient Programs (IOP’s) or Partial Hospitalization Programs (PHP’s) with specialized therapies, and various psychiatric medications. He/she is at risk for failing courses, being held back a grade, and ultimately not graduating. The child’s underlying conditions may have also caused them to experience various emotionally devastating setbacks, like needing to change schools midyear, or leave a summer camp. The child is also bigger and stronger than he/she was when their school anxiety path began.

By this point, it is likely that the stress of all the child has been through—losing friendships, separation from institutions they trusted, and knowing they are becoming more differentiated from age peers as they fall further behind in social skills and experiences—is taking its toll.

The good news is that the child is still at home, giving parents the chance to continue to do the most they can to help them win the battle to return to school. But they can do this only as long as it’s safe. Effective interventions must be implemented for a child who is liable to harm themselves or other family members if they continue to live at home.

Accordingly, safety needs to be a prime consideration in everything parents addressing school refusal do. The stakes are high. You are struggling to get your child on track knowing time is short before high school grades and attendance records will have real consequences for their future. But the stakes for missteps can be even worse, and you must be prepared to prevent them.

Safety first can take many forms. If a punishment seems proportional and appropriate but will likely cause your child to meltdown, consider finding another penalty to send the message. If your child becomes so dysregulated that they are a threat to themselves or others, and giving them a cell phone to surf the Internet with will calm them down to a safe mood, consider giving it to them. Consider leaving the lesson for what happened and concerns about giving in for another day.

A child battling school refusal can develop thoughts of self-harm,¹ and credible self-harm threats should be taken seriously. These threats can surface at times of apparent progress, like from stress of a period when a child has been returning to school. Moreover, a child experiencing serious school refusal may be spending lots of time at home during the week, including alone when working parents aren’t there. Consult your child’s mental health care team to develop a safety plan. In developing the plan, consider specifics of your locality that your care team should have insight to, like which nearby emergency room to take your child to for a mental health emergency if needed. If multiple facilities may be safely reached, know in advance which may be best for treatment, including if needed to receive prompt transfer to an appropriate inpatient mental health unit. You may also be able get information by visiting hospitals, explaining your situation, and asking to speak with someone on the mental health ER team.

The same applies with medication changes. The throes of battling school refusal may involve various bouts of trying new medication hoped to facilitate return to school. In working with your prescriber, make sure to also stay focused on ensuring your child’s medical regimen continues to support their safety at home.

In short, safety should be top of mind when working to overcome serious school refusal. Progress in overcoming school refusal may not be linear. When and how a transformative solution may appear is hard to predict, and waiting for it while working through challenges of the present can be very stressful for all involved. Safety is your ally in buying time to reach a solution.

1. Epstein, Roberts, Sedgwick, Polling, Finnin, Ford, Dutta & Downs, “School absenteeism as a risk factor for self‑harm and suicidal ideation
   in children and adolescents: a systematic review and meta‑analysis,” European Child & Adolescent Psychiatry (2020) vol. 29, pp. 1175–1194, https://pmc.ncbi.nlm.nih.gov/articles/PMC7116080/pdf/787_2019_Article_1327.pdf.
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