Psychological Mind

In today’s fast-paced, ever-changing world, teenagers face a multitude of complex challenges that can have a profound impact on their physical and mental well-being. The COVID-19 pandemic has only served to exacerbate these issues, leading to an increase in mental health problems, specifically among young people. One such problem that has become increasingly common is teen school refusal. As a psychologist I meet more and more families who are facing this issue. Usually, I meet them desperate, after weeks, even months of trying to deal with this crisis. There are many factors and triggers that can cause or contribute to school refusal. I will try to address some of the most prominent in my clinic.

Some data:Recent studies have shown that the number of teenagers experiencing school refusal has increased to between 1-7%. This highlights the urgent need for a better understanding of this phenomenon. School refusal is not simply skipping school; it is a complex issue with multiple factors at play. To gain a deeper understanding of this issue, a comprehensive clinical evaluation should be conducted. This should include a detailed examination of familial and educational factors, as well as the motivations, personality traits, mood, and any psychopathological issues such as anxiety and depression that the teenager may be dealing with.

Parenting: The parenting style and family dynamics have a significant impact on school avoidance. For example, Overprotective or authoritarian parenting styles may result in teenagers feeling anxious and lacking autonomy, leading to school refusal as an act of rebellion. Conversely, permissive parenting can lead to a lack of rules and boundaries, lowering parental self-efficacy and the teenager’s motivation for school. Lack of communication between parents and teenagers is often a common symptom and also a contributing factor to change.

Digital addiction: School refusal is often caused by factors that are not given enough consideration, such as the influence of the digital age. The pervasive use of social media and online gaming among teenagers can lead to addiction and a diminished motivation to engage in other activities, including school. Specifically, teens who are suffering from increased levels of anxiety (social, general, or other types) will commonly hold addictive online gaming and chatting patterns. That is, as a way of “self-medication” that includes high arousal environment, suitable to the high levels of physical arousal they hold. Furthermore, the ability to chat online is reported to diminish the sense of social isolation that usually accompanies school refusal.

Personality: Specific personality traits such as introversion or perfectionism can contribute to school refusal. Introverted teenagers may struggle with social interactions at school, leading to feelings of anxiety and avoidance. Similarly, teenagers who strive for perfection may fear failure and avoid school as a result.

Mood disorders, such as anxiety and depression, are also common factors in school refusal. Teenagers experiencing these disorders may feel overwhelmed by the pressures of school and struggle to cope with their emotions, leading them to avoid school altogether.

The Connection Between ADHD and School Refusal

The search results provide valuable insights into the strong link between ADHD and school refusal, also known as Emotionally Based School Avoidance (EBSA).

Reasons for School Refusal in Children with ADHD

Children and adolescents with ADHD are particularly vulnerable to school refusal for several reasons:

1. Academic Struggles: Many children with ADHD experience undiagnosed learning deficits, such as in written expression or math, which can lead to falling behind academically. This can cause feelings of anxiety, shame, and a desire to avoid the school environment altogether.
2. Executive Function Deficits: The increased demands on executive skills like working independently, getting started on tasks, and staying organized during middle and high school years can be overwhelming for students with ADHD, contributing to school avoidance.
3. Social Challenges: Children with ADHD may struggle with social interactions and be at a higher risk of peer rejection and bullying, further fueling their desire to avoid the school setting.
4. Anxiety and Depression: ADHD is often accompanied by co-occurring mental health issues like anxiety and depression, which can significantly impact a child’s ability and willingness to attend school.
5. Sensory Sensitivity: The noisy, chaotic environment of a typical school can be overstimulating and uncomfortable for some children with ADHD, leading them to prefer the predictability and safety of the home.
6. Preference for Stimulating Activities: Children with ADHD may find the academic demands of school less engaging and appealing than the stimulation of activities like online gaming or social media, further contributing to school avoidance.

Addressing School Refusal in Children with ADHD

ADHD tend to accompany school refusal. Early intervention and a comprehensive approach to addressing school refusal in children with ADHD is a vital step. This may include:

1. Identifying and Addressing Underlying Causes: Conducting a thorough evaluation to understand the specific factors contributing to the child’s school refusal, such as academic struggles, social challenges, or mental health issues.
2. Implementing Cognitive-Behavioral Therapy (CBT): CBT can be an effective treatment for addressing the anxiety, depression, low self esteem and negative thought patterns that often underlie school refusal in children with ADHD.
3. Providing Medication Management: In some cases, medication to address the core symptoms of ADHD and any co-occurring mental health conditions may be necessary to support the child’s ability to attend school.
4. Improving Home-School Communication and Collaboration: Fostering a strong partnership between parents and the school, with clear communication and a shared understanding of the child’s needs, can be crucial in supporting the child’s successful return to school.
5. Implementing Behavioral Interventions: Strategies like positive reinforcement, establishing clear routines and expectations, and gradually exposing the child to the school environment can help build their confidence and motivation to attend.
6. Addressing Digital Addiction: ADHD and addiction have a strong connection. Many of my patients have co existing ADHD and screen addiction.

By addressing the unique challenges faced by children with ADHD and taking a comprehensive, multifaceted approach, parents and educators can work together to support these students in overcoming school refusal and achieving academic and social success.

key ways parents and teachers can work together to support students with ADHD:

Collaboration and Communication

• Establish open and regular communication between parents and teachers to share information, strategies, and progress.
• Involve the school counselor or psychologist to provide additional support and expertise.
• Work together to develop a comprehensive plan to address the student’s needs, whether through an IEP or 504 plan.

Classroom Accommodations and Strategies

• Implement evidence-based classroom management strategies like behavior reward systems and organizational training.
• Provide accommodations such as:
  • Reduced distractions (seating near the front, limiting visual stimuli)
  • Allowing movement and fidgeting
  • Extended time on tests
  • Shortened assignments
  • Note-taking assistance
• Observe the student and get their input on what helps or distracts them (e.g. use of fidget tools, background music, etc.).

Advocacy and Support

• Ensure the student receives the appropriate special education services or accommodations they are entitled to under IDEA or Section 504.
• Advocate for the use of evidence-based behavioral interventions and treatments.
• Coordinate with the student’s healthcare providers, such as their pediatrician, to align on the treatment plan.
• Provide the student with positive reinforcement and encouragement to build their self-esteem.

The key is for parents and teachers to work collaboratively, communicate regularly, and implement a comprehensive, evidence-based approach to supporting the student’s academic, behavioral, and social-emotional needs. By working together, they can help the student with ADHD overcome challenges and experience success in the classroom.

Treating school refusal

Daily life function : When evaluating an individual’s need for rehabilitation, it is essential to take into account different aspects of their daily functioning. These aspects include, but are not limited to, sleeping patterns, level of independence, involvement in household chores, food intake, and interpersonal skills. For instance, poor sleeping habits can have a detrimental effect on an individual’s overall health, cognitive abilities, and even their mood. A lack of independence in activities like dressing, grooming, and cooking can lead to frustration and feelings of helplessness. Limited involvement in household chores can affect an individual’s sense of self-worth. Poor food consumption can result in malnutrition, fatigue, and other health issues. Lastly, limited interpersonal skills can lead to a sense of loneliness and neglect by other family members.

It is important to note that school refusal is a complex issue that requires a comprehensive approach to address its various contributing factors. This may include cognitive-behavioral therapy(CBT) and or Psychiatric evaluation to address anxiety and depression, family therapy or parental guidance to improve communication and support, lifestyle changes to reduce digital addiction and improve overall well-being, and finally building up an intervention program with the educational system.

As a parent, it can be challenging to understand and help your kids through their struggles.

However, there are several things you can do to make it easier:

First, listen actively and be empathetic when your child talks to you. Try to put yourself in their shoes and understand their needs. Many parents struggling with this phase may label their teen as “lazy”.is “just lazy”

Second, establish open communication with your child and encourage them to express their thoughts and feelings freely. This can help build a strong bond of trust and understanding between you and your child. Communication is crucial – many times teens feel lonely and confused.

Third, be supportive and encouraging when your child faces challenges. Let them know that you are there for them, and help them find solutions to their problems.

Fourth, set appropriate boundaries and rules for your child and enforce them consistently. This can help them develop a sense of responsibility and respect for rules.

 Finally, seek professional help if your child is struggling with serious issues such as mental health problems. A qualified therapist can provide valuable guidance and support to your child, to you, and, if needed, to the educational system.

Things you should know about your child:

1. Sleep habits- when are they going to sleep and why? Do they have trouble falling asleep or waking
2. How do they usually feel?  Sad? Depressed? Angy? Frustrated? Do they know why?
3. Do they exhibit any physical symptoms when feeling worried or anxious, such as an increased heart rate, sweating, or stomach issues etc.
4. Gaming habits – how many hours a day? Which platform (chatting, FPS or other gaming) , do they feel difficulty detaching from it?
5. Were there any other triggers? Did something happen at school or in their social or educational life that could be causing their school refusal?

Finally, I invite you to feel free to write here or to my email any questions or insights you have.