QUESTION
My 13-year-old son has always been a little reluctant to go to school, but it has got much worse since he started secondary. He constantly refuses to go. The night before school he begins to get stressed and then the mornings are dominated by his anxiety.

We manage to get him there most days, but it is daily stress for the whole family. He denies that there is a specific reason for him not wanting to go; he says he is not being bullied or anything like that, though he does find it hard to make friends. He is a high achiever in school so it is not academic problems. Can you help us?

ANSWER
In helping your son, the first step is to encourage him to express some of the thoughts and feelings behind his anxiety about going to school. Pick a good time when he is relaxed and calm, and not anxious, to discuss this. Gently ask questions such as “When you feel you don’t want to go to school, what thoughts are in your head?” or “What do you imagine might happen?”

It helps also to review his school day: perhaps go through his timetable and ask him to describe each class, rating how enjoyable each is. While there are lots of different reasons for school refusal, frequently it is a “social anxiety” with worries about friendships or fitting in being at the heart of it: these anxieties are particularly heightened starting secondary school.

Try to agree a goal with your son
A crucial step is to agree a goal about getting to school. At a calm time, help him to consider the importance of getting to school for his own life goals. Help him to describe and acknowledge the presence of the anxiety that is blocking him.

It helps to talk about the anxiety as something external to him – “I appreciate the anxiety is making it hard for you to get to school,” or “Let’s not let the anxiety get in the way of you getting what you want in school.”

Strategies to address causes of anxiety
Explore with your son solutions that might make it easier for him in school. For example, you could support him making friends by helping him to invite classmates over or by joining in extracurricular activities or think of different ways he can speak up more or be assertive in class.

Help your son to understand his anxiety
Help him to understand the cycle of anxiety: he feels worried about school, which causes him to engage in avoidant behaviour, which in turn makes him more anxious the next time.

You want to help him to break this cycle by acknowledging his feelings but not avoiding action: essentially, you want him to learn to “feel the fear and do it anyway”.

There are lots of tactics for this, such as learning to be mindful of his feelings, and to accept them. Relax his body via awareness of his breathing or progressive muscular relaxation, and relax his mind by using positive visualisation or thinking coping thoughts.

All these strategies can be learned using self-help books, in formal classes or individually with a professional. Finally, do check in with the school and his teachers and get further support if needed.

Dr. John Sharry, May 2015. John writes in The Irish Times Health+ every Tuesday.
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