Every year, thousands of students simply refuse to go to school because of anxiety and depression, a phenomenon that psychologists call school refusal. With the disruption and isolation of the pandemic, schools need to be prepared to deal with what could be rising number of these students. To understand the problem and its solutions, Editorial Director Phyllis W. Jordan talked with Patricia Graczyk, an assistant professor of clinical psychology at the University of Illinois at Chicago. Graczyk has not only conducted research on school refusal but has also worked directly with students as a licensed clinical psychologist and school psychologist.
Can you describe school refusal? It sounds at times like skipping school or truancy.
School refusal refers to students who refuse to go to school or who resist going to school due to emotional issues like anxiety or depression. The behavior could be related to such things as separating from their parents or their caregiver. It could be related to social anxiety. These are students who don't want to go to school because they're afraid that others are going to judge them or that they're going to do something to embarrass or humiliate themselves. Or they’re students who feel depressed—and the depression is just so bad that it's difficult for them to even make the effort to go to school. Or when going to school might make them feel even sadder or experience even lower self-esteem. Some students who have school refusal do go to school, but when they're in school they experience a lot of duress.
Does this affect kids at all ages and stages?
Yes, though some of the reasons could vary by age. For instance, separation issues could be more common with younger students. Social anxiety could occur at all ages, but it’s seen most often in older students.
Are you concerned that the pandemic is going to make this a much bigger problem?
Yes, I am worried that we are going to see an uptick. I found a study that showed that in one part of Australia, they've seen a 300 percent increase in school refusal. And there are a number of studies here in the U.S. that have revealed significant increases in the number of school-aged children and youth who are experiencing anxiety or depression during the pandemic.
That seems especially troubling because school refusal gets worse the longer students are out of school, and now you've had kids out of school for a year.
Yes, that's the insidious nature of anxiety. The longer a child with school refusal is anxious and is able to avoid going to school, the more entrenched the anxiety can become unless the student is helped by learning coping strategies and ways to manage their anxiety.
So what do you recommend that schools do when students return? Are there some simple, affordable steps they can take?
Actually, I tell schools not to wait until students return to school. They need to start planning now. There are simple strategies, low-cost strategies that schools can use. The first is to ensure they have an idea of which students might be at risk for school refusal. Some of these students would be students who were showing school refusal signs before the pandemic. For those students, school staff should check-in with parents and teachers to see how the students have been doing during remote or hybrid learning. Then, other students who could be at greater risk are those who faced issues during the pandemic, perhaps a loved one had gotten sick or even passed away as a result of COVID. Or their family had experienced a number of stressors, like the parents losing their job.
What should they do once students come back to school?
I'm a preventionist at heart, and so I always look at what we can do to catch students with school refusal early, because the earlier that we can identify and help them, the greater the likelihood that we can get them back on track and attending school on a regular basis.
I was talking to an assistant principal at a middle school, and she told me how they're already planning for their students to be able to meet their next year's teachers and also to make friends with future classmates. There's a very powerful connection in “one plus one”—making sure that every student has at least one caring adult and one good friend. For those students who might be at greater risk of school refusal, I've encouraged schools to think about making sure that at least one of their friends is going to be in their classes with them when they return to school.
That's a smart idea. It seems like a lot of what you're talking about is school climate, making sure students are engaged with teachers, engaged with friends. And are there other interventions?
There are a number of strategies that schools can use. First, adults need to be ok for the students to be ok. It’s important that staff and parents are doing self-care activities because we've all experienced this pandemic and we've all experienced stress related to it. So the adults need to be ok for the students to be ok. If we're feeling anxious or worried, our students are going to pick up on that and they will react, too.
The issue of safety is a huge one, both during the pandemic and for students with anxiety in general. I encourage school staff to educate and inform parents and students about the steps they've taken to make their school safe.
And as you mentioned, different aspects of a school climate can help, simple things like greeting students at the door. I've even encouraged teachers when they're doing Zoom classrooms to greet the students as they come in from the waiting room. Simple interventions like that can improve school climate. It’s also an evidence-based strategy that has been shown to improve student engagement.
I always encourage schools to use a multi-tiered framework in dealing with a variety of things, including school refusal. But with the pandemic and as students return to school, they should also consider using a trauma framework. There's a wonderful program called Psychological First Aid for Schools. It's free and available through the National Child Traumatic Stress Network. It’s a program intended to be used during the early stages of the trauma recovery process. Hopefully, the return to in-person learning is a sign that we are in fact beginning the recovery process.
I feel like everybody has had some low-level trauma, just being isolated, being out of school. Do you think this will translate into behavioral issues?
I think schools are anticipating that, at least the educators with whom I’ve spoken. If a student misbehaves, teachers shouldn’t automatically move to punitive ways of addressing the behavior. For students with anxiety, fight or flight is a normal response. It’s what we all do in response to anxiety. I have worked with students who were acting out, showing aggressive behavior. When we dug deeper to find out what was really going on, we discovered that it was actually a fight response in reaction to a situation causing anxiety. The student couldn't figure out a way to avoid the situation so instead they misbehaved and got themselves removed from the situation that way. For example, I had a student who was removed from his music class multiple times due to his behavior. What had happened is that he was scheduled to perform a solo in front of his teacher and classmates, a very anxiety-provoking situation for him. When he couldn’t figure out any other way to avoid his turn to perform a solo, he would misbehave and be sent to the office.
This year, schools have an opportunity to invest in interventions given the influx of federal COVID relief dollars. What could they do to address school refusal?
This is a wonderful opportunity to increase school-based mental-health staff—school psychologists, school social workers. When you look at what the recommended ratios are for these positions and then you look at the ratio of school psychologists and social workers per number of students, the numbers are way out of balance. There are too few of these school-based mental health professionals to adequately serve the mental health needs of all their students, so increasing their numbers could be very helpful to students struggling with school refusal and other behavioral health issues. In addition, schools with partnerships with community mental health organizations could augment their internal mental-health resources by utilizing community-based professionals. Still another resource in which schools could invest is a high-quality social and emotional learning program. CASEL’s website provides a lot of information on wonderful resources.
The pandemic has introduced remote instruction to millions of students, some of whom have thrived learning at home. Is this a possible solution for school refusers, at least until they can be eased back into school?
Those types of decisions need to be made really carefully on a case-by-case basis to avoid reinforcing the anxiety that could be leading to the school refusal behaviors. That said, I do see remote instruction as an option that wasn't as readily available before the pandemic. It has always been the case that for some students with very severe school-refusal issues, the idea of having them immediately return to school on a full-time basis just wasn't realistic. So for those students, a combination of having them in school part-time, as much as they're able, and part-time in remote learning, could be an option while they receive treatment for their school refusal issues. But, as I said earlier, that decision needs to be made really, really carefully.