Effective Strategies for Addressing School Refusal in Children

1. School Refusal Presented by: Valery Bailey, MPA, VP Operations Sonia Cohen, MSc, Marketing Director First Children Services

2. Demographics

3. Risk Factors Transition to new school, a new home, a new sibling, or sick parent Parent with anxiety disorders Family dysfunction Comorbid Conditions7: • Separation Anxiety Disorder • Social phobia • Simple phobia • Panic disorder • PTSD • Major Depressive Disorder • Dysthymia • Adjustment disorder • Autism Spectrum Disorder

4. Common Warning Signs • Frequent unexcused absences or tardiness • Absences on significant days (tests, presentations, physical education class) • Frequent requests to go to the nurse’s office despite no apparent signs of illness • Frequent requests to call home or go home during the day • Difficulty or resistance to getting out of bed in the morning to go to school despite no apparent signs of illness

5. Somatic Symptoms

6. Externalizing Symptoms

7. Symptom Timing

8. Early Response to School Refusal! • When symptoms begin, immediate action should be taken (recommended after three unexcused absences) • Consider allowing attendance to be systematically increased • Use a team approach to assessment and early intervention • Team should be multidisciplinary and include school staff, providers, and the family and student • Goals should be mutually developed and accepted • Participation of all parents/guardians/family members • Lower family stress levels • Remove all competing activities to school

9. Assessment

10. Types of Interventions

11. Reentry Plan Tips for School • Welcome the anxious student when he/she arrives at school • Provide a safe harbor with the counselor, nurse, or school psychologist where the student can go when feeling stressed or overwhelmed • Assign a peer buddy especially at recess or lunch to help a socially anxious student • Address school safety issues through antibullying and anti-violence initiatives • Issue personal invitations to events and activities to help the student feel welcome • Positive Reinforcement -praise and encourage the student and set up rewards for school attendance

12. Reentry Plan Tips for School Academic Interventions • Provide interventions and supports for students who have academic difficulties i.e. extra help, extended test times, etc. • Provide alternate test-taking environments • Address any sensory challenges the student may be experiencing • Show sensitivity to students with performance anxiety (reduce or eliminate the need for the student to give presentations or be called on) • Help the child become involved in getting organized for the school day

13. Reentry Plan Tips for Home • Encourage parents to set up regular evening and morning routines • Establish plan for parents for each step of getting their child from their bed to school • Help parents set up positive reinforcement plan for reentry steps • Work with parents to effectively respond to their child’s complaints about school, while clearly ensuring that the child attends school • Work with parents to monitor attendance, particularly for older students

14. Alternative Instruction

15. In-home support

16. Transitions Program • Full Day Programming • Therapeutic Environment • Counseling • Small Group Intruction • Behavior Analyst Consultation • Social Skills • Career Prep • Executive Functioning Skills • Life Skills

17. Behavior Support aftercare

18. Behavioral Health Consultation

19. Behavioral Health Services

20. Training and Education Services

22. References • Kearney, C.A. (2008). School absenteeism and school refusal behavior in youth: a contemporary review. Clin Psychol Rev. 28(3), 451–471. Published online 2007 Aug 3. doi: 10.1016/j.cpr.2007.07.012 • Fremont, W.P. (2003). School refusal in children and adolescents. Am Fam Physician. 68(8), 1555-60. • Kearney, C.A. (2007). Forms and functions of school refusal behavior in youth: An empirical analysis of absenteeism severity. Journal of Child Psychology and Psychiatry, 48, 53-61. • Ollendick, T.H. & Mayer, J.A. (1984). School phobia. In S.M. Turner (ed.) Behavioral Theories and Treatment of Anxiety. New York: Plenum (pp.36-411). • King, N.J. & Bernstein, G.A. (2001). School refusal in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry,40, 197-205. • Egger, H., Costello, E.J., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 797-807. • Munkhaugen, E.K. et al. (2017). School refusal behaviour: Are children and adolescents with autism spectrum disorder at a higher risk? Research in Autism Spectrum Disorders, 41–42, 31-38.

23. First Children’sPROGRAMS AND SERVICES FOR STUDENTS WITH ANXIETY AND SCHOOL REFUSAL For more information, please contact: (856) 888-1097 referrals@firstchildrenservices.com www.firstchildrenservices.com