Understanding the Root Causes of School Refusal"

PART 3

DEFINING TRUANCY VS SCHOOL AVERSION – SCOLIONOPHOBIA

SYSTEMIC CHAOS

When Schools Pretend To Be Doctors And Doctors Pretend To Be Special Educators

Navigating the intersection of mental health care and special education advocacy is a complex endeavor that requires coordination and collaboration across multiple systems. Parents and education advocates often find themselves in a challenging position where healthcare providers, particularly primary care physicians, may defer responsibility to schools, citing that educational institutions should handle mental health concerns.

Then we must deal with schools that push back, suggesting that healthcare systems should address special education issues. This disconnect can lead to confusion and frustration for parents seeking comprehensive support for their children.

Moreover, when schools do engage in mental health treatment, there's a risk of overstepping boundaries. For instance, some schools may suggest or pressure parents into asking for medications to manage a student's mental health without the proper medical expertise or licensure. Practicing medicine without a license not only raises ethical concerns but also falls outside the scope of IDEA and is forbidden under IDEA. This practice takes away from the focus on providing appropriate educational services to medical treatment. As a result, parents and advocates must navigate these challenges delicately, ensuring that both educational and healthcare systems work collaboratively to meet the comprehensive needs of students with mental health disabilities. 

Please don’t tell me this doesn’t happen. I've experienced it firsthand in four meetings within the past six weeks! It's almost like people prefer to remain oblivious. These incidents took place in reputable and well-endowed school districts where there's really no excuse for not being familiar with the boundaries outlined in their practice acts and IDEA. (I also have never seen a lawyer address this issue).

ONE CHALLENGE IN ADDRESSING TRUANCY

IS THE LACK OF A

CONSISTENT DEFINITION ACROSS STUDIES.

 Truancy and School Refusal are two distinct concepts in the realm of education and child psychology but no one listens to each other.

DIFFERENTIAL DIAGNOSIS CRITERIA FOR SCHOOL REFUSAL AND TRUANCY:

School Refusal:

• Involves severe emotional distress such as anxiety, fear, tantrums, depression,
• Often involves somatizations - physical symptoms related to attending school.
• Parents are aware of the absence, and the child often tries to persuade them to stay home.
• Not associated with antisocial behaviors like juvenile delinquency are not typically observed.
• Children usually remain at home during school hours.

Truancy:

• Does not involve excessive anxiety or no fear of school
• The student often hides their absence from parents.
• It involves antisocial behaviors such as delinquency, lying, stealing, and disruptive acts,
• Association with antisocial peers.
• The student does not usually stay at home during school hours.
•  

Both Anxious School Refusal & Truancy Are Distinct But Can Co-Occur,

They Are Significantly Linked To

Psychopathology & Adverse Experiences

Both At Home & School.

TRUANCY AND SCHOOL AVERSIONS ARE COMPARED BELOW:

DEFINING TRUANCY

 Truancy is primarily a behavioral issue involving deliberate and intentional absenteeism without valid reasons. A clear definition of truancy is crucial for effective intervention.

It involves:

• absences (excused, unexcused)
• tardiness
• class cuts
• non-enrollment
• deliberately skips school without a legitimate excuse
• factors of disinterest in academics,
• peer influences
• home environment issues.

 Accurate monitoring helps identify potential truants and chronic truants, aiding in needs assessment and program effectiveness evaluation.

TRUANCY RISK FACTORS

1. Disinterest in Education: Students may skip school due to a lack of interest in academics or finding classes unengaging.
2. Peer Influence: Influences from peers who skip school or engage in delinquent behavior can lead to truancy.
3. Avoiding Responsibilities: Some students may skip school to avoid responsibilities like homework, exams, or class assignments.
4. Negative School Experience: Negative experiences such as bullying, conflict with teachers, or feeling misunderstood can contribute to truancy.
5. Home Environment: Issues at home such as lack of parental supervision or encouragement, family conflicts, or neglect can lead to truancy. Low socioeconomic status may contribute
6. Delinquent Behavior: Students involved in delinquent activities outside of school may skip school as part of their delinquent behavior pattern.
7. Substance Abuse: Truancy can be associated with substance abuse issues, where students skip school to engage in drug or alcohol use.

DEFINING SCHOOL AVERSION - SCOLIONOPHOBIA. 

School refusal is primarily a psychological issue that causes students to resist attending school due to emotional distress or anxiety. Refusal to attend school is not a diagnosis but instead, is a manifestation of an underlying affective or behavioral disorder defined in the DSM-5. Apprehensive school refusal and truancy are symptoms are only symptoms, rather than a syndrome or a diagnoses

 A student struggling with school refusal is often due to an undiagnosed condition or underlying and unaddressed stressors.

It is also called:

• school refusal,
• school aversion,
• anxious school refusal,
• school phobia, or
• Scolionophobia

It's important to differentiate truancy from school refusal or school phobia, as they have distinct characteristics and implications.

Scolionophobia is an overwhelming fear of school.

• It's often a symptom of other anxiety disorders.
• More likely to affect children during times of transition, such as starting middle school or high school.
• Often become physically ill at the thought of going to school.
• The intensity of avoidance or fear that stays with the child for an extended period.
• Their fear of school, and reluctance to attend, is genuine and extreme.
• It is a long-term condition
• More likely to affect students when they are transitioning from schools, classes or one year to another
• Affect between 2% and 5% of all children

School refusal is a broader term that encompasses a range of psychological issues and anxieties that lead a student to resist going to school.

Unlike truancy, school refusal is often rooted in:

• Emotional distress
• Anxiety disorders
• Adjustment disorders
• Separation anxiety
• Social phobia - scolionophobia
• Other mental health conditions.

Students experiencing school refusal may have genuine fears or concerns about attending school, which can manifest in physical symptoms and somatizations.

A compilation from different hospital programs says that Scolionophobia can look like this:

• Asking to have parents come and take them home
• Crying about going to school
• Difficulties with ADLs like getting ready for school
• Dropping grades
• Emotionally volatile such as having outbursts of anger
• Expressing what appear to be unjustified intense fears of going to school
• Fear of the dark and or nightmares.
• Feeling anxious
• Feelings of worthlessness, shame, or self-loathing at their inability to attend school
• Going to the bathroom often at school (not a result of another diagnosis)
• Going to the nurse often with physical complaints
• Hiding before going to school
• Hopelessness
• Inability or refusal to get out of the car when driven to school.
• Not doing their schoolwork/homework.
• Panic attacks
• Preoccupation with thoughts of safety
• Reaction /symptoms when they start to think about school
• Refusing to do or finish homework
• School refusals
• Somatizations
  • Diarrhea
  • Stomach Aches
  • Insomnia
  • Nausea
  • Vomiting
  • Chest pain
  • Dizziness
  • Palpitations /Weakness
  • Tremors
  • Trouble concentrating
  • Insomnia - Sleeping difficulties -especially on school nights
  • Muscle tension and shakiness.
  • Rapid heart rate, rapid breathing, or sweating at school or the mention of school
• Seeming more withdrawn or shutting down by isolation in their bedrooms.
• Separation anxiety – not wanting to separate from caregivers
• Strong internal emotional response
• Symptoms at the mere mention of the word school
• Symptoms or upset with hearing someone discuss school
• Tantrums or meltdowns.
• Withdrawal from family and friends, phone, physically, social media …
•  

RISK FACTORS ASSOCIATED WITH SCHOOL REFUSAL

Several risk factors contribute to truancy with school refusals, besides just mental illness including child-related factors: 

SCHOOL REFUSAL RISK FACTORS

School refusal affects all students across economic, social, and racial categories.

1. Anxiety Disorders: Students may refuse to go to school due to anxiety disorders such as generalized anxiety disorder, social anxiety disorder, or separation anxiety disorder.
2. Bullying: Being a victim of bullying (student or adult bullying) can lead to school refusal as students fear encountering bullies at school. This can lead to poor self-esteem, insecurities, and giving up.
3. Family Issues: Family or interpersonal difficulties or problems such as conflicts at home, parental mental health issues, divorce, separation, or trauma (significant loss or bereavement) can contribute to school refusal resulting in shutdown behaviors or anxiety. Being youngest or only child.
4. Academic Pressure: Students facing academic challenges, perfectionism, or fear of failure thus developing a negative attitude toward teachers since they are constantly under stress to succeed, develop school refusal behaviors and disinterest in education. This can include interpersonal difficulties at school with teachers or administration.
5. Other Health Issues: OHI - Physical health problems or chronic illnesses can make students reluctant to attend school regularly.

• ADD/ADHD
• Defiant Disorder
• Developmental Trauma
• Sensory Integration /Processing Disorder
• PANS / PANDAS

6. Learning Disabilities: Students with undiagnosed or inappropriately supported learning disabilities may avoid school due to struggles with academic tasks due to lack or specially designed instruction or appropriate related services.

Learning Disorders

• Disorder Of Written Expression Dysgraphia
• Dyscalculia-/Math Dyslexia
• Dyslexia / Reading
• Executive Functioning Deficits
• Working Memory Deficits
• Processing Speed Disorders 

7. Mental Health Conditions: Conditions like depression, PTSD, or OCD can significantly impact a student's ability to attend school regularly. The school refusal is primarily driven by mental health concerns. Higher incidence with the following:

• Autism Spectrum Disorder (ASD)
• Depression
• Emetophobia-Fear Of Vomiting,
• Generalized Anxiety Disorder (GAD)
• Adjustment Disorder
  • Adjustment Disorder Unspecified. 

• Adjustment Disorder With Anxiety
• Adjustment Disorder With Anxiety And Depressed Mood. 
• Adjustment Disorder With Depressed Mood
• Adjustment Disorder With Disturbance Of Conduct
• Adjustment Disorder With Mixed Disturbance Of Emotions And Conduct

• Obsessive-Compulsive Disorder (OCD)
• Oppositional Defiant Disorder (ODD)
• Panic Disorder
• Pathological Demand Avoidance (PDA)
• Post-Traumatic Stress Disorder (PTSD)
• Separation Anxiety Disorder (SAD)
• Selective Mutism
• Separation Anxiety
• Social Anxiety Disorder
• Specific Phobia 

8. Social Issues: Difficulties in socializing, making friends, or feeling excluded at school can lead to school refusal behaviors.

 9.  School Environment: Issues with teachers, classmates, or school policies may contribute to a student's reluctance to attend school.

• Being embarrassed by a teacher, counselor, school nurse, principal
• Bullying by adults or peers
• Changes in class or school
• Feeling unsafe at school
• New teacher
• Reprimanded by a teacher, counselor, school nurse, principal
• Toxic teacher

10.  School Trauma:

• Bullying incidents by students and adults
• Experiencing a school emergency
• Losing a friend
• Feeling humiliated by a test result
• Inability to do homework without extreme stress

We need you to be part of the conversation that shapes a brighter future for all students. The following lays out the 3 remaining blogs in  "REDEFINING TRUANCY PREVENTION AND FAILURE" by DR. MARIE LEWIS, PHD, BCEA 

Coming Up IN the Next Blog!!

4.  TRUANCY INTERVENTIONS

A COMPREHENSIVE MODEL OF INEFFECTIVENESS

RESEARCH BASED INTERVENTIONS

INAPPROPRIATE USE OF TOOLS

ASSESSMENT TOOLS

SECONDARY INTERVENTIONS

TERTIARY PREVENTION INTERVENTIONS

MULTILEVEL INTERVENTION

5.  PREVENTION of SCHOOL REFUSAL AND TRUANCY

IMPLEMENTATION ISUES AND ORGANIZATIONAL CHANGE NEEDED

PREVENTION IMPLEMENTATION PREPARATION

NAVIGATING SPECIAL EDUCATION ADVOCACY AND TRUANCY ADVOCACY

FACING THE UNCOMFORTABLE TRUTH

BUILDING A FUTURE OF EQUITY MEANS DISMANTLING BARRIERS

6.  WHAT SHOULD A PARENT DO WHEN SCHOOL REFUSAL OR TRUANCY RAISES ITS UGLY HEAD?

 "REDEFINING TRUANCY PREVENTION AND FAILURE" by DR. MARIE LEWIS, PHD, BCEA 

  1.  BREAKING THE CYCLE OF TRUANCY

A HIDDEN EPIDEMIC

ARE TRUANCY INTERVENTIONS NEGLECT?

PREVALENCE AND IMPACT

HEADS IN THE SAND

2.  THOSE NOT DOING THEIR JOBS

HISTORY OF TRUANCY LAWS

SCHOOL PSYCHOLOGISTS

SCHOOL SOCIAL WORKERS

EMPOWERING PARENTS

CROSS-TRAINING SPECIAL EDUCATION ADVOCATES

3.  DEFINING TRUANCY VS SCHOOL AVERSION / SCOLIONOPHOBIA

SYSTEMIC CHAOS

DIFFERENTIAL DIAGNOSIS CRITERIA FOR SCHOOL REFUSAL AND TRUANCY

DEFINING TRUANCY

TRUANCY RISK FACTORS

DEFINING SCHOOL AVERSION

SCHOOL REFUSAL RISK FACTORS

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AUTHOR

Marie Lewis is an author, consultant, and national speaker on best practices in education advocacy. She is a parent of 3 children and a Disability Case Manager, Board Certified Education Advocate, and Behavior Specialist Consultant. She has assisted in the development of thousands of IEPs nationally and consults on developing appropriately individualized IEPs that are outcome-based vs legally sufficient. She brings a great depth of expertise, practical experience, and compassion to her work as well as expert insight, vision, and systemic thinking. She is passionate and funny and she always inspires and informs.