'I don't want to go to school'; Why your child may be anxious and what you can do about it

On the list of top 10 complaints parents have to listen to, "I don't want to go to school today" probably ranks right up there with "He's bugging me" and "I just want to text my friends!"

The difference, it turns out, is that reluctance to go to school is a gripe that should ping your parental radar.

Research and anecdotal accounts from child psychology experts have shown that anxiety among kids is on the rise, and with that rise has come an increased awareness and diagnosis of school anxiety. And, in some cases, that anxiety results in school refusal - a repeated avoidance of or outright refusal to go to school.

School anxiety and refusal have been around for a long time, says Dean McKay, a professor of psychology at Fordham University, "but I think the reasons for kids experiencing school anxiety and exhibiting school refusal have been changing. It used to be and still is the case for many children that they have difficulty separating from their parents, classic separation anxiety was a driving force. But there are other factors today."

Those include increasingly competitive school environments. "There are many reasons that anxiety among children is on the rise," says Christopher Kearney, director of the University of Nevada at Las Vegas Child School Refusal and Anxiety Disorders Clinic, "including that they are responding to the very fast-paced school environment and they're clearly struggling with that." Yet the causes of school refusal and anxiety are complex, Kearney says, and though school refusal is a psychological, not behavioral, problem, kids who refuse to go to school can have some behavioral issues.

"These are messy cases," he says. Which is why it's important for parents to remember that school refusal is an issue that needs to be unraveled with care. Here's how to start that process.

Check for real issues. "First, you want to rule out any real school-based threats," says Kearney. Is there bullying going on? Is there building anxiety for academic reasons?

"You want to ask who your child is sitting with at lunch, how she's socializing with other kids, listen to what she's describing," says McKay. "You said you had a stomachache, but what assignments were due on that day?" Bullying or serious academic issues need to be dealt with immediately.

Impose a two-week rule.Occasional reluctance to go to school is perfectly normal, especially around times of transition at school or home. If your child starts asking to stay home from school, try to be firm and keep them going for a couple of weeks, then reassess.

"In many cases, if they don't want to go to school they'll sort of self-correct in a couple of weeks if parents draw a firm line on it," says Kearney. "But in other kids, the problem persists and grows into something more, and if it's interfering in their daily life functions, that's when you need to seek some sort of psychological help."

Nail the morning routine. Morning is the moment when school refusal is most visceral. "A lot of parents are just confused about what to do," says Kearney. "The child is crying a lot, they want to stay home from school, and it's a natural parental response to just rescue your child. So some parents allow it for a little while, just to see what will happen, but that's also when sometimes it can become more set in stone. For families, it's a really tough call."

Go with your gut, he says, but he recommends trying to keep your child going to school and in the school building, even if they need to sit in the nurse's or counselor's office during part of the day to take a break from the classroom. Let teachers and counselors know what's going on, and keep your morning routine regular and regimented - a steady routine can be reassuring and help get your child out the door.

Keep a log. School refusal is a recurring behavior; if you're concerned about your child's emotional health, be sure to track his school absences. "I've had parents say, 'He seems so anxious,' " says McKay, "and when you ask more specifically about absenteeism, they don't have a clear picture. Maybe a kid is missing school on average once every other week - that's a lot. And that's something that's easy for parents to lose sight of, but it's a warning sign that something is amiss."

Treat the underlying anxiety. Staying away from something that causes anxiety is a natural response, says McKay. "We're programmed to avoid that feeling, because historically, anxiety was an important warning, a signal of danger." Avoidance of school is that same response, attached to an everyday situation. McKay recommends cognitive behavioral therapy as a treatment approach that helps kids retrain their thinking to interrupt anxious thought patterns and behaviors. Cognitive therapy is now widely viewed as more effective for anxiety than traditional talk therapy, and for patients who stay engaged in their treatment and practice the exercises therapists prescribe, "the course of treatment for some cases can be fairly short," McKay says.

cdampier@chicagotribune.com

Credit: By Cindy Dampier - Chicago Tribune - cdampier@chicagotribune.com

Caption: Pamela Moore/Getty