Anxiety and School Refusal
Everyone experiences
anxiety at some point in life. It is a normal, adaptive human emotion that
helps us prepare for important events and optimizes performance – think
upcoming tests, ballet recitals, sports playoff games – and alerts us to danger
in situations that threaten our safety. However, some individuals experience
anxiety so intensely and so frequently that it becomes impairing, hindering
their daily functioning. In fact, according to the National Institute of Mental
Health (NIMH), it is the most common mental health disorder in the United
States among adults and children. In my work with children and teens, I have
seen anxiety become such a powerful force that it gets in the way of having
sleepovers at friend’s houses, limits social engagement, results in marked
physical discomfort, impairs concentration in class, and even contributes to
flat out refusal of school.
Anxiety is an inward
focused feeling, meaning that we experience it internally. As a result, it is
often unrecognizable to parents and teachers and can go easily undetected for a
long time until it becomes a problem. Children might be ashamed to talk about
it, try to push it away to avoid distress or be limited in their ability to
fully articulate what is happening. Behaviorally, anxiety causes a
fight-flight-freeze reaction. It leads to acting out and aggressive behaviors
(i.e., “fight”) as well as running away and escaping (i.e., “flight”). Anxiety
can also be an underlying source of noncompliance, disguised as unwillingness
to engage and shutting down in overwhelming situations (i.e., “freeze”).
In a recent New York
Times Magazine article (see link below), writer Benoit Denizet-Lewis takes a
closer look at the increasing prevalence of adolescent anxiety as well as a
residential program, Mountain Valley Treatment Center, that provides services
for more severe cases. In an information age, many teens, parents, educators
and mental health professionals are citing social media as partly to blame for
the uptick in anxiety. The constant comparing to peers through social media is
problematic in that it makes teens feel like they aren’t good enough, which can
greatly impact their self-esteem. In my clinical work I see an overreliance on
smartphones due to the reinforcing function they serve – whether it be a text
back to hang out or a “like” on an Instagram post – and I will often work with
youth on self-reinforcement and finding alternatives that are intrinsically
rewarding to them.
Many of the students
interviewed for the New York Times Magazine article who attended Mountain
Valley had histories of significant difficulty attending their regular school
due severe anxiety and/or depression, a presentation known as school refusal.
School refusing behaviors exist on a spectrum, from the mild (e.g., missing gym
class every now and then due to fears of changing in front of classmates) to
the more severe (e.g., missing entire weeks of school due to persistent worries
about having panic attacks). Early intervention is key. The longer the child or
adolescent is out of school, the more pressure they feel about “catching up”
academically. The more they feel like they are falling behind, the more
depressed and anxious they become. The more upset and stressed they are, the
more difficult it is to get back to school. And the cycle continues.
Understanding this
cycle, NESCA offers a special program for youth who refuse school because of
emotional distress, called Back to School (BTS). In this program, clinicians
use a comprehensive evidence-based treatment approach and work closely with parents
and school faculty to figure out the most effective plan that will help the
student reenter school.
- Given the importance of
catching school refusal early, here are some warning signs to look out
for:
- Test-taking anxiety
- Peer bullying
- Ongoing visits to the nurse
despite no apparent signs of illness
- Frequent requests to phone or
go home during the school day
- Somatic complaints without a
medical explanation (e.g., stomachaches, headaches, etc.)
- Absences on significant days
(e.g., tests, speeches)
- Sleep problems or resistance to
leave bed in the morning
- Changes in mood – anxiety, irritability, sadness
If you have any
questions about the BTS Program or NESCA’s therapy program in general, please
contact Dr. Ryan Ruth Conway at rconway@nesca-newton.com or
617-658-9831. Dr. Conway will additionally be speaking at several workshops
this fall on the subject of School Anxiety, School Phobia, and School Refusal.
Information regarding upcoming NESCA events can be found on our web site
at http://www.nesca-newton.com/events.html.
Article:
Denizet-Lewis, B.
(2017). Why Are More American Teenagers Than Ever Suffering From Severe
Anxiety? The New York Times Magazine. Retrieved from https://www.nytimes.com/2017/10/11/magazine/why-are-more-american-teenagers-than-ever-suffering-from-severe-anxiety.html.
About the Author:
Dr. Ryan Ruth Conway is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.