073: What to do when your child refuses to go to school

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.   Jump to highlights 01:24 Introduction to Dr. Jonathan Dalton, psychologist specializing in anxiety-based school refusal 03:13 Why ages 5-6 are a common onset point for separation-related school refusal 07:02 Where normal separation anxiety ends and separation anxiety disorder begins 09:09 The four functions behind school-refusal behavior: positive reinforcement, tangible rewards, and negative reinforcement through escape or avoidance 18:10 Risk factors for school refusal, including behavioral inhibition in infancy 22:34 The role of the teacher-student attachment relationship, and a 40,000-student Chicago study on liking school 26:17 A vicious cycle: how negative attention and disruptive behavior can compound for some students 29:31 Long-term consequences of school refusal, including lower high school graduation rates 32:36 How to tell ordinary adjustment from a problem serious enough to need professional help 38:08 The four-part treatment model: psychoeducation, exposure therapy, parent training, and school consultation 44:13 Clarifying exposure therapy versus the broader, often misused term "CBT" 50:07 Everyday strategies for parents: routines, "watering the seeds, not the weeds," and a scene from the movie Ray   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