Understanding school refusal

Dr. Mona Nongmeikapam *

School refusal- a relatively simple sounding word and yet, only a parent having faced it can actually decipher the tumult of emotions or magnitude of problems that are encompassed in these two simple terms.

It has been defined by the experts as:
(a) refusal to attend school- leading to long absenteeism,
(b) staying at home during school hours with parents' knowledge
(c) emotional distress at the prospect of attending school (body pains/ complaints, anxiety and unhappiness),
(d) absence of severe antisocial behaviour, and
(e) parental efforts to improve their child's attendance at school.

With a prevalence of 1-2 %, school refusal is a burning psychosocial issue raging in our homes and needs proper identification and understanding so that prompt and essential management can be done. It also needs to be differentiated from bunking that comes with conduct problems.

Why does it happen?

A parent came complaining of severe distress and low mood. The cause: school refusal in their well-behaved obedient diligent 13 year old son. Dig more into the matter and out came the skeletons.

Recently joined a hostel for even better performance......long story of a haunted hostel room.....the boy came across the utensils of the deceased boy in the mess, the subsequent taunts and advice and warnings with the additional conflicts in the boy's family and Lo..... Recipe for disaster!

School refusal is associated with anxiety disorders in more than 50% of the cases. Anxiety can range from separation anxiety, specific phobias, social phobia, generalised anxiety disorder, panic disorder with or without agoraphobia. The figures can be much higher closer home.

Renown schools in the city segregates these youngsters as per their grades in the previous examination. There is competition for schools, better grades, better tuitions, everything. Throw in our bandhs and strikes and there is a pressure even on the schools to complete the curriculum within the decreased time span.

So every happy memory that we associate with school is actually done away with- no more celebrations, no more play, no PT, no sports, just a mad mad rush to "complete the syllabus". Adolescents is a vulnerable age when they are transitioning to grow from children into young adults.

There are so many physical, social, emotional changes going on in the young individual and there is also a heightened awareness of the world around them. An unkind experience, few harsh words and anxiety of recurrence of the episode can reinforce school refusal.

Depression is another finding seen in these children. So the risk factors can be briefly summed as:

1. Individualistic- fear of failure, low self-efficacy, inhibition
2. Family- dysfunctional, overprotective, mental health issues
3. School factors- bullying, classes, pressures, punitive pattern
4. Community- increase scholastic pressure, inadequate support services

What worse could happen?

Besides the inevitable rise of school-dropouts, we also have the burden of creating poorly adjusted adults with little or no socialisation. This again would reflect in rise of various other social issues like increase substance abuse, internet and other addictions, unemployment, rising frustrations and crimes. School refusal indirectly results in 6-7 hours of unsupervised idle time doing nothing.

If not curtailed, this could lead to disastrous outcomes. Family conflict is on the rise, with parents resorting to blame game in the face of the unyielding, unwilling teenager. Name-calling, accusations and bargains with the child to be on the 'good side' leads to differential parenting and worsening of the outcome, in contrary.

What can be done?

o Accept the situation:
School refusal is a universal problem affecting youngsters world-wide. Your child is not being stubborn and is not uniquely abnormal.

o Avoid threats and bribes:
Punitive measures have aggravated rather than relieved the anguished child and has not yielded any good outcome. Bribes show similar effect.

o Leave the "Leikai" and "what will the society think" aside:
Your child is distressed. Your family is stressed. Please don't add to the on-going burden by worrying about what your neighbours are thinking as well.

o Seek help:

School refusal is a psychosocial problem and hence, the treatment has to be a psychosocial approach. Pharmacotherapy, i.e. drugs with right mix of cognitive and behavioural therapy have shown to have great results in these children. Environmental changes both at home and school go a long way in thwarting these undesirable behaviour.

The good news!

Empathetic and firm treatment has shown excellent outcome in children with school refusal. School refusal is more of a symptom than an illness, per se. Behaviour is communication and school refusal is communication of a distress: very real to the child.

It is our duty as parents to educate our children. It is also our duty to understand what is hampering the process. School days are the loveliest treasures we hold in our memory troves; let us work on creating such treasures for the new generation too!