QUESTION
My daughter, who is 13, is having terrible trouble getting to school. She is in first year of secondary school and wakes up each morning full of anxiety, and making as many excuses as she can about going. I can’t pinpoint anything in particular that is causing her to be worried, other than that she never really settled after the move from primary school. There are tears every day about going, and some days she point-blank refuses to go. The other day, she got hysterical in the car and refused to go in, and I had to take her home for the day. She is a bright girl who seems to do well at her work when she gets there. What can I do?

ANSWER
School refusal is a common problem that is very worrying for well-intentioned parents who don’t want their children to miss out on their education. School refusal can be a mild problem with a child resisting getting up and being upset every morning, to being a more severe problem with a child refusing to go most days and missing large portions of the school year.

The causes of school refusal can vary greatly. Sometimes it is due to a child struggling with or being demotivated about school work; sometimes it can be in the context of behaviour problems with a child acting out or rebelling against rules; sometimes the problem can be emotionally based, with a child feeling depressed and finding it hard to generate the energy to go to school. Frequently, the issue is within the context of worry and anxiety, which I suspect is the case for your daughter.

Usually the anxiety is triggered by specific worries or problems such as finding it hard to make friends, or anxiety about performance in tests and so on, and it can escalate into a panic, as seems to be the case with your daughter in the car. To deal with the anxiety, the child avoids going to school, which reduces the anxiety in the short term, though the underlying problems are not addressed and so the anxiety will return the next day.

The key to overcoming anxiety is to help your daughter understand her feelings, to stop using avoidance, and to address the problems that are causing the anxiety.

Understanding what is at the heart of your daughter’s anxiety
The first step is to get your daughter to verbalise what she is worried about in relation to going to school. Pick a good time when she is relaxed to have a chat – not during a bout of worry in the morning – and ask her what specifically worries her about going to school. What is going through her mind when she is worried?

If she finds it hard to talk, you can help by acknowledging how hard it can be to settle in secondary school and by giving her plenty of time. Sometimes suggesting she write down her worries in a diary can help her to get started.

When she does talk about specific issues, it is important to listen and avoid rushing to reassure her or to dismiss her worries. Instead, ask specific questions: “Tell me more . . . What do you worry might happen then?” Make sure to pick up on and normalise her feelings: “Lots of people feel that way.”

Encourage her to problem-solve
The second step is to encourage her to problem-solve about her worries. For example, if she doesn’t feel included in school, brainstorm with her strategies for making friends, and how she can join in. You can help by facilitating social outings with potential friends, or inviting them over, and so on.

You also want to problem-solve with your daughter as to how she can manage her feelings of anxiety and worry. What can you do when she feels anxious, or in a panic? How can she relax in the moment or learn to think in a more balanced way? Learning skills such as mindfulness, relaxation or even yoga can all help in this regard.

Have a clear plan of action for dealing with bouts of anxiety
Think through a step-by-step plan of action for dealing with a bout of anxiety in the mornings. For example, if she starts to panic in the car, you might pause and take a break from driving to school. Instead, you might go somewhere quiet and take some time to coach her in relaxation or mindfulness techniques – or simply take a break – before returning to school a little later.

The key is to remain positive and encouraging and to help her get to school even if she misses the first or second class. The goal is to break the cycle of avoiding. As a result, you or another family member might need to set aside some time over the next few weeks, so you don’t have to rush to work in the mornings and can be available to support your daughter.

Work with school staff
Working well with teachers and school staff can be crucial in helping your daughter to manage. For example, the school counsellor might be able to provide counselling for your daughter to help her cope and get to school, or they could assign a special teacher as a mentor for your daughter (who she can seek out if she is anxious).

Or they might be flexible about how your daughter arrives at school (for example, going to a mentor’s office first, or allowing you as a parent to accompany her or to be nearby if that helps her to get there).

Alternatively, they might address some of the issues that make it hard for your daughter to attend (for example, friendship problems) or might involve your daughter in special school projects or activities that make her feel more involved and enjoy school. Arrange a meeting with the school to plan how they can help you and your daughter.

Dr. John Sharry, Irish Times Newspaper, June 2015. John writes in The Irish Times Health+ every Tuesday.
www.solutiontalk.ie