School Avoidance/School Refusal

Last week my son wanted to play hooky from kindergarten. As I was getting him ready for school, he said, “Mommy, my stomach hurts,” trying to look as pathetic as possible. I had a feeling that the problem wasn’t his stomach, but might have been connected with the fact that my husband was in the hospital recovering from shoulder replacement surgery. Whenever one of us is ill, Lawrence doesn’t like being separated from us. Or perhaps the wish to continue playing “Lego Star Wars” on the Wii.

Unfortunately, the timing was not great. Although I believe in the occasional day of hooky for kids (and for adults), I thought that it was a little too soon in the school year to have one. Also, I couldn’t miss work. When you work in the classroom scheduling department of a large university, the first three weeks are insane. My husband works from home, so normally Lawrence being sick or wanting a day off wouldn’t be an issue, but as he was in the hospital, well, it would be up to my parents. So I had to hurry him along and hope he was just faking (which, fortunately, he was).

But that incident, along with us reading “The Never-Want-to-Go-to-Schooler” in Mrs. Piggle-Wiggle’s Magic (the Mrs. Piggle-Wiggle books by Betty MacDonald are a must-read if your kids are under the age of ten) reminded me of my own childhood and my ongoing battle to avoid going to school. I had frequent, mysterious stomach aches and missed more school than I should have, given that I was a fairly healthy child.

At least, I was healthy physically. From the age of seven or eight, I suffered from untreated depression, anxiety and Attention Deficit Disorder (ADD). The ADD and the depression made schoolwork and learning difficult. I also was the target of almost constant bullying and teasing. These two things combined meant that school was not somewhere I wanted to be.

School avoidance, also referred to as “School Refusal,” is not a disorder in itself, but rather a pattern of behavior that can indicate that a child is suffering from disorders such as Separation Anxiety Disorder, anxiety or depression. Sometimes the reason for the school avoidance is obvious (back to school after a long vacation or a long illness) and sometimes it’s not. In many cases the child will claim illnesses that seem to be groundless, and in other cases the child will simply refuse to go to school.

Now, in addition to return after vacation or illness, there are obviously times when school avoidance symptoms are to be expected, to some extent. When a child starts kindergarten, moves from grammar school into middle school or high school, or changes schools due to a move, there’s going to be a period of adjustment. Some kids will breeze through this period quickly, and others may need some help from the school, the parents and possibly a therapist.

But when none of these predictable issues are present, it’s time to see the pediatrician – for two reasons. One is to eliminate the possibility that there is some underlying illness that is causing the physical symptoms. The other reason is to rule out depression and/or anxiety causing school avoidance. These disorders are, by one study’s estimate, responsible for the school refusal in a quarter of the children they surveyed.

In addition it’s worth considering if the child is suffering from Seasonal Affective Disorder (SAD). This, instead of school itself, could account for a child being upbeat and active in the summer, but not in the fall and winter.

A fact worth noting is that clinical depression and anxiety can cause unexplainable symptoms, including stomach aches and head aches, even in adults. We still don’t know exactly why this happens, but it’s very possible that the child is not faking the vague, unexplainable symptoms.

So for parents in this position, advice from the American Academy of Pediatrics suggests a two pronged approach. Find out what the underlying cause is, but also focus on getting the child back to school.