School Refusal – Advice from Female Psychiatrist.

It’s been more than two months since the school year began. Numerous kids as well as their mothers and fathers settled down with school routines, modified to a new environment, to new students as well as teachers. Although a majority of kids easily shif and like the studying, some children continue to experience distress from school attendance be responsible for school rejection. One out of 4 children can occasionally refuse going to school, however it becomes a program issue in about 2 to 5% of children.

Children who are refusing school often existing with anxiousness symptoms, crying spells, outbursts, threats of self-harm and fear. Also it can be observed through somatic signs and symptoms such as dizziness, shakiness, sweating, stomach discomfort and diarrhea, joint or even back pain, head aches, queasiness, palpitations or upper body pains. These signs and symptoms can generally be present in the morning and improve if the child is permitted to stay home.

School refusal can be gradual or abrupt event and it depends on the precipitating factors. Most commonly symptoms of refusal may begin after a holiday, illness, long weekend or vacation. Important to note: the longer the child stays out of school, the more difficult it becomes for a child to return.

A few reasons for refusal to attend school include the following:

1. Unwillingness to face school-related issues that can subsequently lead to anxiety, depression or other psychological problems.

2. Avoidance of uncomfortable peer interactions and/or academic performance situations such as test-taking or oral presentations.

3. It may also be driven by seeking for attention from significant others outside of school.

4. Engagement of the child in more pleasurable activities outside of school such as playing video-games, watch movie, see friends.

School refusal can lead to impairment of child’s daily functioning, and subsequently cause delays in personal and academic achievements.

How can we help such children to reach their potential and improve their daily functioning? It is essential to recognize early signs and assist the child in receiving help when it is necessary. Appropriate assessment needs to be done for children who tend to refuse school on a more regular basis. School staff can facilitate the referrals and also provide additional information to aid in assessment, including review of attendance records, report cards, and psycho-educational evaluations. Child’s evaluation should include interviews with the family and individual interviews with the child and parents.

Complete medical history and physical examination should be part of the assessment to rule out medical conditions. It is important to understand the history of the onset and detect development of school refusal symptoms. All associated stressors must be identified and placed in prospective with peer relationships, family functioning, psychiatric history, substance abuse history, and a mental status examination.

Assessment should be followed by treatment if it is necessary. The main goal of treatment for children with school refusal is providing supportive environment and successful return of the child to school. Treatment should be also focused on addressing primary psychiatric conditions, any family dysfunction, and other contributing problems. The child psychiatrist may need to educate a family and a school that the reasons of physical symptoms that child develops are manifestation of psychological distress rather than a sign of illness. A collaborative team approach should include the psychiatrist, pediatrician, child, parents, school staff, and other mental health professionals.

Treatment options may include education and consultations, behavior strategies, family interventions, and possibly pharmacotherapy. The best treatment outcome is based on multidisciplinary approach and includes professional help, parental involvement and exposure to school.

Marina Doulova, MD is a New York Child and Adult Psychiatrist at ABC Psychiatric Services. [youtube:7OZK4c5fdYw?version=3;[link:ABC Psychiatric Services];https://www.youtube.com/watch?v=7OZK4c5fdYw?version=3&feature=related]

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