common problems

Difficulties Attending School

"Truancy" refers to young people who avoid attending school without their carer’s knowledge, whereas "school refusal" is when a child or young person starts to miss school frequently because of vague illnesses or symptoms. 

Many children will experience transitory difficulties attending school. Difficulties with peer relationships and issues with learning are often triggers for young people not wanting to attend school or finding ways to avoid it. Good communication between home and school is extremely important. This will enable information to be shared regarding issues that may be impacting on the young person both in and out of school. Schools and families can use resources open to them such as school counsellors, pastoral support, behavioural services, education psychologists and multi-agency teams to support young people to access school and reduce distress .

If this does not effect change or the young person is showing increased distress, either your GP, school or the MAT can refer to CAMHS.

School refusal can present for two main reasons: 

• Firstly, that the child or young person has a phobic reaction either to the general school situation or to a particular situation or thing within the school. 

• Secondly, where the child or young person displays a fear of attending school but the main source of the worry is leaving home or separating from family. 

Although, on the surface, the two appear distinct, a single cause of the young person’s anxieties can be difficult to establish.

SCHOOL REFUSAL SYMPTOMS

• The symptoms the young person complains about are similar to those associated with worry (e.g. stomach aches, diarrhoea, nausea, headaches, fatigue, dizziness, vague and general aches and pains, etc). 

• The child/young person shows extreme determination not to attend school, for example reluctance to get dressed, to leave the house or enter the school premises. 

• The child/young person appears to be anxious or agitated on the mornings of school attendance. 

• The child/young person may have difficulties settling to sleep on school nights. 

• The symptoms appear to settle fairly quickly after getting into school. 

• These symptoms are worse the night before starting a new school week, after school holidays, and are less obvious during weekends and holidays. 

• A child/young person who has a genuine fear of attending school often wants to be on their own at home or outside of school.

THINK ABOUT YOURSELF

If you have displayed school refusal or separation anxiety yourself, it is important to separate your own feelings and experiences from those of the young person you are trying to help. While it can be useful to empathise with the strength of feelings that the young person may be having, your own experiences can sometimes inhibit you from helping them to the best of your ability.

Being aware of the need to be firm and encouraging in spite of your own feelings is important. If you realise that you may be over-identifying with the child’s problem or family’s dilemma, you may not be the right person to offer the most effective help and encouragement.

THINGS TO THINK ABOUT

In trying to understand why a child or young person may be displaying school refusal or truancy, ask yourself the following: 

Could this be a specific fear or anxiety around a particular subject or activity that they feel they are failing in or likely to become embarrassed by, for example reading, maths, physical education? This is probably the easiest cause to tackle, but more often than not there are other anxieties involved.

If it is an adolescent, are they worried about not keeping up with their peers? Or are they worried about teasing, embarrassment or lack of confidence?

Do they appear to be scared to leave their home or worried about separating from their family? In this situation, the parents are often very caring and protective of the young person. It is important to consider the attitudes of parents towards their non-attendance, for example; are the parents unable to be firm, are they anxious themselves, or are they accepting the young person's excuses too readily?

SIGNIFICANT LIFE CHANGES/STRESSORS

Consider whether there have been any significant life changes/stresses affecting the child/young person: 

• Has there been significant loss or bereavement such as parental separation, the death of a close family member or friend, a change of school or move of  house? 

• Are they struggling academically in one or more of their subjects? 

• Are they confident and socially integrated with strong friendships and alliances? 

• Are they different from the majority of other young people (for example; from a different ethnic or religious group)? 

• Do they have an obvious or hidden disability? 

• Are they suffering from a physical illness? 

• Could they be a victim of bullying, teasing or another form of abuse? 

It is important to bear in mind that some physical illnesses can present vague and intermittent symptoms; therefore it is important to ensure that the child has a medical examination if there is any doubt about what is causing their symptoms. 

What can you do as a parent/carer?

• Listen to the child or young person and find out if there is anything specific that is bothering them at school (e.g. exam stress or bullying). Remember that the young person may not be forthcoming with this information due to fear or embarrassment. 

• If there are no genuine problems at school then school refusal/separation anxiety symptoms can be improved with firm and supportive encouragement to attend school every day.

• Keep a diary of the child or young person’s reluctance to attend school or non-attendance at school and the type and frequency of their physical symptoms to determine if there are any patterns, or encourage the parents/carers to keep a diary. 

• Sensitively talk to the young person about any worries they have either in school or at home. 

• Have there been any significant changes or stressors in their life (e.g. bereavement or parental disharmony)?

• Try and resolve or help the young person to resolve any specific reasonable worries they have about home or attending school.

• Explain to them that you understand how upset they feel, but that experience tells us that this upset will settle fairly quickly if they attend school consistently and will get worse if they continue to avoid attending. 

• Encourage support from their friends, for example get them to call for the young person on school days. 

• Draw up a plan of gradual steps to reintegrate them to full time schooling with support. 

• Support and encourage carers to be firm in their expectation that the young person will attend school. 

• If appropriate, introduce a reward for attending school. 

• Avoid sending the child home when they complain of feeling unwell before first getting a detailed description of their symptoms to check that the symptoms are genuine and not the result of anxiety. However, if they have non-anxiety symptoms, such as raised temperature, do send them home or seek medical advice.

Further support, advice and self-help

HandsOn Scotland/Things to Try is a collection of resources to help support children and young people’s mental health and wellbeing, put together by Fife CAMHS. Some are aimed at children and young people, some are more for parents and carers, and some are designed for professionals who work with children and young people.
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Young Minds gives free, relevant, practical information about a range of mental health issues in children and young people. It has information about feelings and symptoms, conditions and looking after yourself. It also has some specific information about self-harm and what to do about self-harm.
Website

Minded is a free educational resource on children and young people’s mental health for adults, but can also be really useful for teenagers. It covers lot of topics.
Website

Relate gives specific advice for different types of worries and problems aimed at young people.
Website