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073: What to do when your child refuses to go to school
16th September 2018 • Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive • Jen Lumanlan
00:00:00 01:01:25

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We’re a couple of weeks into the new school year by now and I hope that for most of you the morning drop-offs have gotten a bit easier than they were in the beginning. But some of you may still be struggling with a child who doesn’t want to go to school, who resists you leaving at drop-0ff time, and who might be suddenly suffering from stomachaches and headaches (particularly on Sunday nights or weekday mornings) that had not previously been a problem. Today’s interview with Dr. Jonathan Dalton, director of the Center for Anxiety and Behavioral Change in Rockville, MD is going to help us understand whether our child is having a ‘normal’ amount of difficulty transitioning to school or if they are struggling enough that they might need extra help – and if so, what to do about it.   References Bergin, C., & Bergin, D. (2009). Attachment in the classroom. Educational Psychology Review 21, 141-170.
Dalton, J., & Beacon, V. (2018). School refusal. In D. Driver & S.S. Thomas (Eds.), Complex disorders in pediatric psychiatry: A clinician’s guide (pp 11-22). St. Louis, MO: Elsevier.
Egger, H.L., Costello, J., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child & Adolescent Psychiatry 42(7), 797-807.
Hallinan, M.T. (2008). Teacher influences on students’ attachment to school. Sociology of Education 81, 271-283.
Hamre, B.K., & Pianta, R.C. (2001). Early teacher-child relationships and the trajectory of children’s school outcomes through eighth grade. Child Development 72(2), 625-638.
Houts, R.M., Caspi, A., Pianta, R.C., Arseneault, L., & Moffitt, T.E. (2010) The challenging pupil in the classroom: The effect of the child on the teacher. Psychological Science 21(12), 1802-1810.
Jerome, E.M., Hamre, B.K., & Pianta, R.C. (2009). Teacher-child relationships from kindergarten to sixth grade: Early childhood predictors of teacher-perceived conflict and closeness. Social Development 18(4), 915-945.
Kearney, C.A. (2016). Managing school-based absenteeism at multiple tiers: An evidence-based and practical guide for professionals. Oxford, U.K.: Oxford University Press.
Kearney, C.A., & Albano, A.M. (2007). When children refuse school: A cognitive-behavioral therapy approach, Therapist guide (2nd Ed.). Oxford, U.K.: Oxford University Press.
Kearney, C.A. (2006). Dealing with school refusal behavior: A primer for family physicians. Family Practice 55(8), 685-692.
Kearney, C.A. (2002). Identifying the function of school refusal behavior: A revision of the school refusal assessment scale. Journal of Psychopathology and Behavioral Assessment 24(4), 235-245.
King, N., Tonge, B.J., Heyne, D., & Ollendick, T.H. (2000). Research on the cognitive-behavioral treatment of school refusal: A review and recommendations. Clinical Psychology Review 20(4), 495-507.
Ladd, G.W., & Dinella, L.M. (2009). Continuity and change in early school engagement: Predictive of children’s achievement trajectories from first to eighth grade? Journal of Educational Psychology 101(1), 190-206.
Ladd, G.W., & Buhs, E.S., & Seid, M. (2000). Children’s initial sentiments about kindergarten: Is school liking an antecedent of early classroom participation and achievement? Merrill-Palmer Quarterly 46(2), 255-279.
Last, C. G., Hansen, C., & Franco, N. (1998). Cognitive-behavioral treatment of school phobia.  Journal of the American Academy of Child and Adolescent Psychiatry 37, 404–411.
Pianta, R. C., Belsky, J., Vandergrift, N., Houts, R. M., & Morrison, F. J. (2008). Classroom effects on children’s achievement trajectories in elementary school. American Educational Research Journal 45 (2), 365–397  
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  Transcript Jen:     [00:00:37] Hello and welcome to the Your Parenting Mojo podcast. Today we are going to help a whole lot of parents who are in the middle of a massive transition, and that is the transition to kindergarten or school. Many people, adults included, don’t love change. It’s certainly much easier to keep doing the same things we’ve been doing with the people we know and love than it is to go to a completely new place with people we mostly don’t know whoever new expectations for us that we don’t know if we can meet and we also have to start getting up really early in the mornings, which can introduce all kinds of new power struggles at bed time so we might not be able to solve all of these problems today, but we’re going to take a specific look at what is known as school refusal, which is pretty much what it sounds like when a child says “I don’t want to go to school.” Jen:    [00:01:24] To help us understand this and figure out what to do about it, we’re here today with Dr Jonathan Dalton, who is a licensed psychologist and the Director of the Center for Anxiety and Behavioral change in Rockville, Maryland. He received his BA in psychology from Villanova University an MA in psychology from the Catholic University of America and this PhD in Clinical Psychology from Fordham University. Dr Dalton specializes in treating anxiety and behavioral disorders with particular expertise in the treatment of anxiety-based school refusal. Welcome Dr. Dalton! Dr. Dalton:  [00:01:53] Thank you so much. Dr. Dalton:   [00:01:54] So I wonder…firstly we should probably get clear on some terms that we’re going to use today because when I started reading your work, there were a whole bunch of terms and I want to be sure that we use them clearly. Dr. Dalton:  [00:02:03] Sure. Jen:  [00:02:04] So you use absenteeism and truancy, school refusal, and so can you define these for us and then perhaps also help us understand how common these issues are. Dr. Dalton:   [00:02:12] Sure. Yeah. So just thank you again for inviting me. This is something that I care a great deal about, and I treat many, many kids with these problems. Absenteeism is a global term. It’s an umbrella term that just defines kids who are not in school for any reason. It could be transportation, it could be illness, it could be anything. Truancy is more in line with delinquency; t’s against the law. These are kids who might leave in the morning and then never show up to school because they’re having too much fun in the parking lot or in the woods behind school. Oftentimes that’s more of a criminal justice issue, where school refusal or school avoidance is a more of a psychological development where kids often because of anxiety do not believe they are able to attend school, and so they literally refused to go. It could be kids won’t get out of bed in the morning. I do a lot of home visits for these kids and I’ve seen kids barricaded in bathrooms with their mastiffs guarding them and sending me off with hairspray when I get there and different things so it can be quite significant for some kids. Jen:   [00:03:13] Okay. So in general we’re talking about slightly older children here, right? Because most of the parents who are listening to this are parents who are just sort of in this kindergarten phase, maybe some of them on the high end are in the transition phase. Some of them were toddlers transitioning into preschool for the first time, and this is probably not such a relevant thing for them. Is that right? Dr. Dalton:    [00:03:33] It really depends, because the research says that there’s kind of a two different ages where we most often see the onset and one of them is five and six years of age, so it’s when kids have to first separate from their family and go into a novel circumstance. It is a time when we really see that now it’s obviously easier to get a five year old in school than it is a 15 year old just physically and logistically it’s a different ballgame, but we do see a lot of that along with a lot of parent tiers on the first day of kindergarten. It’s not just the kids who have separation, anxiety. Jen:   [00:04:03] No, no, it’s definitely not, and when we’re talking about that preschool transition, at least I found it was… It was difficult for sure, but there were three teachers for 18 kids, so if you need someone to hold your child and give your child a hug and hold your child up to the window so that you can be high fived as you’re walking out the door, then that’s something that can be accomplished in that environment, right. Whereas in a kindergarten you’re kind of moving on from that. Dr. Dalton:    [00:04:29] Yeah, I mean we’re looking for kind of the BAND-AID approach. A lot of schools use that so that the parents don’t even walk their kids into the building for kindergarten and then it just eases with the transitions are everyone’s saying goodbye at the door. All the moms are wearing dark sunglasses so no-one can see their tears and then the kids just kind of pivot into what’s happening next. That the separation, physical separation is a hard thing for everybody involved because it’s so novel for the family very often. Jen:   [00:04:56] Yeah. Okay. Alright. So you’ve written that school refusal is a behavior rather than a diagnosis. So I wonder if you can help us understand the difference there from a clinical perspective and also does it make a difference for parents from their perspective and if it’s not a formal diagnosis, does this school refusal typically coworker with other disorders that are diagnosable? Dr. Dalton:    [00:05:19] Yeah. Great questions in there. So you separation anxiety is one of the more common ones that we see. So in one study, 38 percent of the kids who refused school had that as their primary diagnosis. Our job is to think of kids who refuse school…we liken it to someone who breaks out in hives after eating a casserole and you wouldn’t go to the doctor and say, “oh well my kid is allergic to casseroles.” You have to know which ingredient they’re allergic to. And same thing with school refusal. It can look the same but for very different reasons. So some kids are afraid of getting sick or being near someone who throws up or weather is a big one for the younger kids that we say… Jen:   [00:05:54] Weather? Dr. Dalton:   [00:05:54] Yeah, you know, if there’s a thunderstorm, a lot of kids are afraid of being apart from the caregiver if there’s a thunderstorm. Dr. Dalton:    [00:06:01] So we, we see a lot of that. We see kids who might have panic disorder so they feel like they’ve been struck by lightning from the inside rather than the outside. I don’t know why that happens. And so they try and seek proximity to a caregiver or just to their home environment. It could be social anxiety. We see a lot of younger kids with a phenomenon called selective mutism where they don’t talk in a school environment often for the first time. And so parents don’t know this because at home they’re a chatterbox and they get to their first teacher conference and say, yeah, um, you know, your kid doesn’t ever talk and they say, what are you talking about? They never shut up. And in school environment they literally don’t talk. And so that can morph into social anxiety and some cases school avoidance there as well. Jen:    [00:06:45] So we just wanted to go back to something you said at the beginning of that. You mentioned separation anxiety disorder. My child doesn’t love being separated from me, but I guess what would be helpful to understand would be where do you draw the line between separation anxiety and separation anxiety disorder? Dr. Dalton:   [00:07:02] It’s really coming down to functional impairment. So obviously you know, kids like all mammals, they seek out proximity to protectors, you know, in, in just the way other other species do. And so it’s a very normal response if you are a little one and you are used to being with a parent that’s been your go-to response for a long time. And so trying to seek out proximity. So that makes perfect sense. The difference with anxiety disorders, it’s not the severity of the anxiety, it’s the appropriateness for the situation. So a lot of kids will fear you’re separating and they’ll maybe been clinging behavior when they’re being dropped off. I had a neighbor throw a lunchbox at the kindergarten teacher the first day of school last year because she said, don’t take me from my mom, and that lasts only usually minutes, and then the kids can kind of reorient themselves to a new situation Dr. Dalton:  [00:07:53] Separation anxiety disorder is chronic and impairing. It gets in the way of their ability to fully do the things that otherwise they want to do so they don’t do sleepovers, that cannot babysitter sometimes. Sometimes they don’t go to school, clearly. It can really interfere and even within separation anxiety disorder, it can look very different so some kids have a fear of being alone and so they won’t sleep in their own bed, which drives parents crazy as you can imagine, or they don’t want to be in a different floor than where their parents are and they’ll kind of follow them like shadows throughout the house. Other kids have more of a fear of abandonment where they’re afraid of what if mom gets sick or dad and they can’t come and pick me up and they begin to worry a lot about what may happen down the road. They might fear the horrible things that the grownups fear like, you know, being abducted or school shootings or the horrible things like that. So it really does vary even within that diagnostic category greatly in terms of the way it presents itself. Jen:  [00:08:52] Okay. All right. Thanks for helping us understand that little bit better. So you mentioned a lot of different reasons why a child might refuse school and in the reading that I did to prepare for this episode, I think they fit into four main criteria or sort of categories. Is that right? Dr. Dalton:   [00:09:09] Yeah, that’s what the research shows. Jen:     [00:09:09] Okay. And would you mind just reviewing those so that we can help to understand what those are and decide whether a child might meet one of those? Dr. Dalton:   [00:09:16] Sure. So what you’re referring to aren’t diagnoses, they are functions. So behavior is many things. The one thing it’s never is random. It’s very complicated and confusing, kind of like meteorology with lots of different interacting variables, but it is fundamentally lawful and so when we do our assessment, we don’t just look at what is the diagnosis that someone might have in the DSM V or the ICD 10. We’re looking for what are the dimensions of their suffering, like how is it they experience the world, but also what are the functions of the behavior and there are basically four usual suspects that we can look for and they fall under two broad categories. The first one is positive reinforcement, which most parents have come across during their training somewhere along the way and it just means that if this event were to follow a behavior, that behavior is more likely to occur in the future. Dr. Dalton:   





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