School refusal & absenteeism behaviour in high school-aged youth

Youth in high school sometimes will not go to school or are absent from too many classes. If you are a parent (i.e. parent, parental figure, caregiver, guardian, etc…) of a youth who refuses school, you are probably quite frustrated and concerned. The main reasons why youth do not go to school include:

• Not able to cope with the stress of school
• Not motivated or interested in school
• A mental health issue or unhealthy substance use

The reasons why a youth is refusing school may be different from family to family. The purpose of this information package is to help educate parents about the facts, signs, and support options for a youth who is refusing school. This package will give you information about what you can do to help and where you can get support. There are many ways to encourage school attendance. Supporting a child who is struggling to go to school can be stressful for parents, for youth, and even the school staff. Taking time to learn about the support options for your family is a first step in the right direction.

Many parents first find out that their child is not going to classes through a phone call from the school. Sometimes parents may notice that the youth is skipping class, not going to school, not talking about school, or not doing homework. Here are some additional signs to look out for:

• Changes in sleep patterns (e.g. going to bed much later, sleeping in longer than usual)
• Being more defiant, stubborn, argumentative, tantrums, or angry outbursts
• More/longer periods of sadness, or feeling down or blue
• Increased worry, even over small things or for no reason
• Loss of interest in activities
• Lower self-esteem
• Withdrawal from family, or being secretive or suspicious
• Changes in choice of friends and activities

Substance use, mental health issues (for example, anxiety, depression, and Attention Deficit Hyperactivity Disorder), or other concerns (i.e. learning disabilities) can be related to youth missing school. Knowing the signs of these issues may help you understand why the youth refuses school.

Signs of an anxiety disorder include:

• Frequent and persistent worries (out of proportion to situation)
• Problems sleeping
• Feelings of panic or fear
• Difficulty concentrating
• Physical Symptoms (i.e. muscle tension, headaches, stomachaches, irritable bowel, sweating, heart palpitations, changes in eating habits)
• Recurrent fearful thoughts or preoccupations
• Procrastination

Signs of a depressive disorder include:

• Persistent feelings of sadness or hopelessness
• Loss of interest in activities
• Irritability and hostility
• Frequent tearfulness or crying
• Withdrawal from friends and family
• Changes in sleeping and eating habits
• Lack of energy
• Thoughts of death or suicide

Signs of Attention Deficit Hyperactivity Disorder include:

• Inattention (not paying attention to details, easily distracted, trouble focusing or following instructions)
• Impulsiveness (acting without thinking, interrupting others, intruding on others' activities)
• Hyperactivity (constant fidgeting, quick tempered, trouble playing quietly, frequently leaving their seat when they are not supposed to)

Signs of a learning disability include:

• Avoidance of reading and writing tasks
• Trouble summarizing information
• Difficulty with open-ended questions on tests
• Difficulty with memory skills
• Difficulty adjusting to new settings
• Having a poor grasp of abstract concepts
• Difficulty organizing and concentrating on homework

It is important that you take time to find support for yourself as well as your youth. Different professionals can help your family work through a difficult time and can help youth get back on track.

Youth Supports

• Psychiatric assessment and treatment. Family Physicians, Pediatricians, and Psychiatrists can provide an assessment for youth with school refusal. A specialist can evaluate, diagnose, and medically treat youth who are struggling with mental health disorders. Speak to your Family Doctor to request a referral for a Psychiatrist.

• Psycho-educational assessment. These assessments look at a child's information processing, school performance, and social and emotional skills to identify areas of strength and weakness that can be supported. These assessments can also point to mental health concerns that might be present. Setting up assessments through your child's school board is usually free of charge, but the wait list to get an assessment may be long. Private assessments tend to have a much shorter wait-list, but usually have a fee (approximately $2000-$3000). These assessments are provided by professionals and the cost is not covered by OHIP.

• Individual Education Plan (IEP). An IEP is a written plan developed the student's school. It identifies the student's learning needs and outlines how the school will address these through accommodations. IEPs are created based on a Psycho-Educational Assessment.

• School guidance counsellor. Guidance counsellors work with students and parents to help guide the youth's academic, behavioural, and social growth.

• School social worker. School social workers can offer consultation on a youth's social and/or emotional issues. They can refer to outside agencies, family counselling, individual counselling, and classroom support.

• Alternative school. Alternative schools allow students to learn in traditional environments. Students can participate in self-directed projects, out-of-class learning experiences, smaller class sizes, and credit recovery options.

• Section 23 Program. Section 23 Programs are specialized classrooms in various school boards in partnership with a community mental health service. These classrooms support students who require their educational needs to be met in a specialized treatment setting outside the regular school setting. Students work to develop life skills, work towards high school credits, and receive therapy or psychiatric treatment.

Speak to your family doctor or a teacher or administrator at your youth's school about how to access any of the above resources.

• Parent coach. Working with a professional to lead parents through challenges can be beneficial to the whole family. A parent coach can work with parents to learn different problem-solving skills, conflict resolution, and to speak openly with youth, to achieve the family's goals.

• Family therapist. Family therapists explore the whole family's interactions and emotional state, and work to achieve overall, long-term well-being for families. Family therapists can help to create a strong communication between parents and youth.

Speak to the school social worker or an administrator at your youth's school about how to access any of the above resources.

We asked mental health workers who work with youth who are refusing school and their families for their tips on how to help. Here are some of their suggestions:

> Encourage good behaviour at home:

• Support your youth's emotions and feelings.
• Create a clear and consistent routine in the morning and evening.
• Promote healthy sleep patterns and nutrition.
• Listen to your youth and talk with him/her.
• Help your youth get involved in hobbies that they enjoy.
• Limit caffeine, nicotine, and internet use.
• Talk about mental health, drug use, and alcohol use with your child, without 'judging' them.

> Every child learns differently
As parents, it is natural to set expectations for a certain academic path that you would like your child to follow. It is important to keep in mind that every child is different. Some children fit best in the traditional education system, while other youths' needs fit best within non-traditional education systems.

> Do not focus on the 'timeline'
If you try to get your youth back into school too quickly without tools for success this may not help. Take time to find the root of your youth's issues and work together to make sure he/she is set to succeed in school. High school is usually done in four years, but summer courses, a fifth year, and alternative schools are also options.

> Remember that there is more than just one option
Treatment for school refusal and absenteeism behaviour can be treated or managed with many programs. Youth may need interaction with multiple programs and different support systems to succeed in school.

> Change the habit, while healing the reason
School refusal can develop into a habit that is hard to break. It is important to change this behaviour quickly, and find out how you can help with the root cause. Healing the reason behind the behaviour can be a long process and may mean you need professional help, but talking openly with and listening to your child is a step in the right direction.

Anxiety-based school refusal – Holly

Holly is a 14-year-old student who recently started her first semester at high school. Holly's parents noticed that she stopped talking about her classes and rarely brought homework home. Holly became very irritable in the morning and often refused to leave her bed to get on the bus. As the semester progressed, Holly stopped going to school, leaving her parents concerned and upset. Holly's mother started staying home from work to try and get her to school, but this only strained their relationship more. By the end of semester, Holly had missed almost half of her classes, and was told that she would have to re-do the first semester of grade 9. Holly's parents always knew that she was a worrier, but never realized her anxiety could progress to a state of such dysfunction. On the road to recovery… Holly's parents got in contact with a parent coach, because they knew they needed support before they could effectively help their daughter. Together, the parents learned how to communicate and support Holly's feelings of anxiety, while creating a structured lifestyle within the home. Holly's parents also reached out to her high school, where they spoke to the vice principal and guidance counsellor, and brainstormed academic accommodations. The parent coach connected Holly with a therapist who specialized in anxiety, who met with Holly to explore the roots of her feelings and coping strategies. Surrounded by an atmosphere of support, Holly was able to start her recovery process.

Substance use & depression – Sam
Sam is a 16-year-old student who had disliked school for as long as he could remember. Throughout his grade 11 year, Sam increasingly skipped school with his friends to play videogames and smoke marijuana. Although Sam's friends only skipped once or twice a week, Sam got into the habit of leaving school every day, with or without friends. By the end of grade 11, Sam had lost all remaining motivation towards school and was addicted to getting high. Sam's parents became worried about his academics, his drug habits, and his chronic low mood. Sam's mother thought that Sam needed psychiatric help immediately, while his father believed that it was necessary to take more disciplinary actions. Getting support… At the suggestion of the school guidance counsellor, Sam's parents first contacted a parent coach who also specialized in marriage and family counselling. Sam's parents both knew that they needed be working as a team and supporting each other before they could support their son. Through his family doctor, Sam met with a psychiatrist who did a psychiatric assessment and prescribed medication for Sam's depression, and suggested a substance abuse counsellor to meet with Sam. Sam's mother involved him with a sports-based community program for male youth struggling with a drug addiction, which allowed Sam to make new friends and get exercise. By working with the school and a few supportive teachers, Sam was able to return to school for grade 12, with the intention of completing high school in 5 years total.

Undiagnosed learning disability – John
John is a 14-year-old student who went to a small elementary school, with supportive teachers and small classes. John was excited to go to a new high school for grade 9, but was also very intimidated. As the first few weeks passed, John enjoyed school less and less, and ignored his parent's constant inquiries about his classes. John started coming home early from school to watch TV, and soon stopped going completely. John's parents were confused and worried when they received a call from his school regarding his frequent absences. When they approached him to talk about it, John got extremely angry and told them they didn't understand how difficult school was. Over the next week, John's parents could not get him to leave his house. Finding the right accommodations… John met with an educational psychologist to pin-point the academic difficulties he was having. After a few appointments, John was diagnosed with a learning disability, and was given academic strategies and tools. John's parents then reached out to a family therapist in order to help their communication at home. John was hesitant, but the therapist understood the frustration and isolation John felt, and advocated for him during the sessions. With the help of the guidance department at his high school, John and his parents decided that he would finish his year at an alternative school and return back to high school for grade 10 after he finished his counselling program with a therapy group for teenage boys struggling with academics. John felt much more comfortable knowing that the people around him supported him and he had the ability to get the help he needed.

• Alternative schools within the Toronto District School Board

• Information about Toronto District School Board guidance departments

• Information about Toronto District School Board special education

• Toronto District School Board mental health strategy

• Hincks-Dellcrest ABC's of Mental Health

• Parents for Children's Mental Health

• Teen Mental Health

• Canadian Mental Health Association Mental Health Meter