School refusal refers to a child's inability to attend or stay in school regularly. School avoidance can be used interchangeably with school refusal because both come as a result of similar reasons. Most teenagers often complain about regular school attendance, and sometimes resist attending school completely. When the tendency to refuse or avoid school becomes common, it wreaks havoc to parents or adults who take care of such children. School refusal comes in various forms of tantrums thrown by adolescents. Such behaviors include overwhelming meltdowns, refusal to leave the house, refusal to board the school bus, avoiding getting in the car, avoidance, defiance, and lashing with physical blows(Schwartz, 2018). Other notable behaviors displayed by teenagers when they want to avoid school include faking sickness like headaches, nausea, and stomachaches, among others. While parents may associate school avoidance or refusal to a normal teenage tendency, they should be worried when the behavior becomes severe or continues for a prolonged period of time. While a myriad of reasons can be attributed to school avoidance, anxiety and depression have caused a considerable amount of this tendency. According to Wimmer (n.d.), between 2 and 5 percent of children avoid school annually as a result of anxiety or depression. In England, nearly 1 in 4 young women between the age of 17 and 19 are depressed (Guibourg & Jeavans, 2018). School refusal or avoidance is a serious emotional problem that can be stressful for the children affected, and their parents or guardians because of various consequences. School refusal can cause significant short and long term effects on the child's emotional, social, and academic development. This paper argues for the reasons why schools are better-placed in coming up with interventions to the problem of school refusal to increase school attendance.
Figure SEQ Figure \* ARABIC 1: Depression Prevalence in Young People (Guibourg & Jeavans, 2018)
Assessment Initiatives in Schools
A normal child spends most of their time in school, meaning that most interventions to the problem of school refusal should be addressed by the educational institutions in which children learn. Before seeking for interventions, parents and schools should first seek to understand the underlying reasons why children tend to avoid or refuse to go to school (Ogilvie., 2018). Children or teenagers may not be the best communicators when it comes to problems affecting them in school. While some children might reveal the reasons, others may not. The first step that schools should take is to collaborate with mental health professionals or institutions and set up assessments to children exhibiting school refusal signs. Occasional assessments should be organized by all learning institutions whereby professional healthcare teams conduct assessments and evaluations using thorough observation, checking student histories of attendance, reviewing school and medical reports, and conducting interviews. Questionnaires can also be used to get information from students regarding their emotional and developmental status(Wimmer, n.d.). The team conducting these assessments should be able to determine if the students refuse to attend school due to academic difficulties (Ogilvie et al., 2018). This evaluation is best done using achievement tests. It is also of great importance to ascertain the antecedents as well as consequences of school avoidance, such as what happens before and after the refusal to come to school. Other reasons that need to be determined by the educators and mental health professionals include parent-related issues like abuse or school withdrawal that can give students reasons to not attend schools. If one or both parents are struggling with mental health issues, then helping the student should begin with the parent. It is likely that the reasons behind school refusal are a combination of factors with depression as a point of convergence. These assessments can inform school educators, counselors, and mental health teams in finding the best intervention.
Figure SEQ Figure \* ARABIC 2: A Depressed student (Schwartz, 2018)
Mental Health Programs in Schools
Schools should come up with all-inclusive mental-health programs that include relevant stakeholders, teachers, social workers, parents, and students. Because school refusal is related to mental illness, strategies like cognitive-behavioral therapy (CBT) can be introduced in all learning institutions. As talk therapy, CBT can help children with mild and severe levels of depression when a skilled therapist administers it (Maag, 2002). With such programs, students can be taught problem-solving strategies, relaxation techniques during anxiety, those that help in reducing negative self-talk, as well as those increasing positive and healthy self-talk.
Mental health education should be part of the school curriculum. The school system should make students to not only experience joy, but also know how to create and maintain it. With such curricular contents, children can be taught about anxiety and depression, the related symptoms, and how to avoid them. Attached to this, should be programs that evaluate school attendances, check unexcused absences, frequent student requests to see the school nurse, absences on significant days, frequent requests to go or call home, sleep difficulties, major family traumatic experience, and instances of possible depressed mood, among others.
There should be re-entry plans in place to address the necessary steps to take when students refuse to attend school(Wimmer, n.d.). These plans should be developed in collaboration with the student's parent(s). For younger children, forced attendance can be initiated if the refusal is mild. Preadolescent depression in children is rare with a prevalence rate of 1.5 percent. For older students, a gradual re-entry plan can be used, especially is the students show extreme levels of anxiety or depression. The first step to initiate the gradual re-entry is to have the student come to school but not head straight to class normally. It is recommended that once the student has arrived, they should visit any class in which they feel comfortable. This process should be done with the help of all relevant people within the school set up with authorization from the parent(s) or guardian(s) (Evans, 2000). The student should be assisted in identifying the members of staff with whom they feel safest around or those who can give them a safe space or harbor within the school. This can be done for a couple of days as directed by the therapists.
A progressive re-entry of one to two weeks can be effective for older students with significant depression or anxiety levels. The relevant team formed for this purpose should consider or suggest part-time schooling for the affected children or allow them to attend school on certain days or for particular hours, especially those with extended absences(Wimmer, n.d.). This technique is suggested for those with extended absences for over two years, and should only be used when other interventions have failed. With this plan, students do not feel forced and find no need to defy going to school.
The providers of these interventions in the school setting should understand that depressed children do not choose to underperform, withdraw, or refuse to attend school. When other interventions are unsuccessful, the school can resort to other supportive strategies that can be helpful to the affected children and their families. While coercion is appropriate for certain cases, it might worsen the situation because it does not cater for the underlying reasons that cause depression or anxiety to the student in the school set up. After the assessment is done, and the possibly effective measures taken to remedy the satiation but in vain, schools can consider using psychopharmacologic interventions. Medications such as serotonin reuptake inhibitors and propranolol can treat underlying depression and anxiety, respectively. Students' medical history and records should determine or justify the use of these medications. The school nurse should work with the counselor and therapists to determine how such medication interventions can be effectively used.
Teachers should be able to listen keenly to their students and be compassionate to their affairs with the aim of helping them overcome depression and anxiety while in school. Supportive counseling should be available for learners at all times when they need it. This kind of support is aimed at school-avoidant behaviors (Evans, 2000). The child should feel the support and get assurances that they will get help, and that someone will be there for them during the tough periods, and that they will finally get better. The school should motivate regular attendance through gifts and incentives to encourage children to come to school. Teachers, counselors, and therapists should encourage parents to talk more to their children and listen to their problems and show concern related to solving such problems. Schools should establish antiviolence and antibullying initiatives, while also being sensitive to children with performance anxieties (Wimmer, n.d.). Internet-based CBT has also been tested for anxiety, and its positive results cannot be overlooked; schools can go in this direction too.
In conclusion, school refusal or avoidance due to depression and anxiety has wreaked havoc in families with affected children. Because a normal child spends most of their times in school, the school setting is better suited for establishing interventions that can help children who refuse or avoid school. These methods should come from a collaboration of parents, mental health professionals, and the relevant individuals within the school setting.
Guibourg, C., & Jeavans, C. (2018). Youth mental health report in charts. Retrieved 26 November 2019, from https://www.bbc.co.uk/news/health-46306241
Maag, J. (2002). A Contextually Based Approach for Treating Depression In School-Age Children. Intervention In School And Clinic, 37(3), 149-155. doi: 10.1177/105345120203700303
Ogilvie, S., Head, S., Parekh, S., Heintzman, J., & Preyde, M. (2018). Association of School Engagement, Academic Difficulties, and School Avoidance with Psychological Difficulties Among Adolescents Admitted to a Psychiatric Inpatient Unit. Child And Adolescent Social Work Journal, 36(4), 419-427. doi: 10.1007/s10560-018-0570-4
Schwartz, Z. (2018). Taking Charge of School Refusal: 10 Warning Signs and 8 Interventions - Sage Thrive Today. Retrieved 26 November 2019, from https://www.sagethrivetoday.com/taking-charge-of-school-refusal-10-warning-signs-and-8-interventions/
Wimmer, M. School Refusal: Information for Educators [Ebook] (pp. 1-3). National Association of Psychologists. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwiN46CKjYnmAhXfTxUIHQFJAbAQFjAAegQIARAC&url=https%3A%2F%2Fwww.nasponline.org%2FDocuments%2FResources%2520and%2520Publications%2FHandouts%2FFamilies%2520and%2520Educators%2FSchool_Refusal_Information_for_Educators.pdf&usg=AOvVaw2vklftWPNamIcpg2VYxdhJ
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