Every parent has heard their kid say, in response to being told it’s time to get up and go to school, “my stomach hurts.” “I don’t feel good.” “I don’t want to go to school today.” “Can I just stay home today?”

I’ve had a recent surge in kids who refuse to go to school in my practice. Naturally, it causes a lot of stress for parents. Does my child really have “a stomachache or headache?” Or are they just feigning illness to avoid going to school? What is a parent to do about the child who simply won’t get out of the bed? Unfortunately, it is not generally one of those problems that get better with time. The more a parent allows a child to “not go to school,” the worse the problem tends to get. So the question remains: What does one do about a kid who refuses to go to school?

Step 1: Determine the Reason

The key to getting a kid to go to school is figuring out why the kid doesn’t want to go in the first place. There are a hundred different reasons kids don’t want to go to school, but they all essentially fall into 3 categories.

Psychiatric causes: When a kid has an underlying psychiatric illness, doing seemingly simple things like attending school can be an insurmountable task.
1. Examples include: anxiety and depression.
Behavioral component: This area has a much broader scope. Examples include:
1. Trying to escape an uncomfortable situation, like bullying by another student, a “mean teacher,” a stressful math test, etc.
2. Seeking more attention or time with an important person, like a parent or peer.
3. Desire for more entertaining activities, like playing video games at home or going to a local hangout.
Special circumstances: These are much less common, but happen nevertheless
1. Helping at home. If the parent is incapacitated or unable to do things necessary at home, the kid may stay home to care for the parent or younger siblings.
2. Abuse. Kids may fear having bruises or injuries witnessed/reported by others.
3. Truly sick kids. I categorize this as a special circumstance because parents usually know when their kids are sick and don’t make them go to school. I wouldn’t say a vomiting kid is a “refusal to go to school.” I’d just call that a sick kid. Occasionally, a child will really be sick and the parent won’t recognize it as such. This is rare (usually, the kid is trying to pull a fast one on the parents and feigning illness.)

Step 2: Make a plan

Once you’ve determined the reason for the school refusal, create a plan of attack.

Psychiatric causes need medical help.
1. Consider a therapist (psychologist)
2. Determine if medication is warranted (with the guidance of your child’s doctor).
Create a Behavior Plan
1. Address any issues that can be feasibly dealt with (e.g., the bully, get a tutor for difficult subjects, etc.)
2. Motivate successfully going to school. Create rewards or incentives for going to school (e.g., keeping a cell phone, earning media minutes, time with friends, etc.). School accommodations may need to be made for students in some circumstances (e.g., when a child is overwhelmed at school, the child may be allowed to go to the counselor’s office, etc.).
3. Make the alternative (staying home) a horrible choice. Make staying home absolutely miserable for the child (e.g., no media, no cell phones, a Cinderella style list of chores, etc.).

Step 3: Follow through

Once the plan has been established, get everyone on board. Discuss the plan with the school and the kid. Make sure everyone knows the plan and the consequences.
If the kid refuses, hold him/her accountable.

Examples:

I acknowledge how difficult this scenario is for parents, it’s much easier said than done. And every situation is so unique, what works for one kid, doesn’t necessarily work for another. In the last few months, I’ve helped many families come up with “a plan.” Here are examples of actual plans I’ve created with patients and parents that may help you to model your own plan.

I always start the conversation with the simple statement, “School is not optional.”

Example A: Child has underlying depression, lacks motivation, and can’t seem to get up and to school. Consequently, child is failing and getting further and further behind.
1. Plan: Parents and child to meet with the school counselor and teacher. The child agrees to: 1) Attend 100% (only excusing doctor approved medical illnesses), 2) Make an effort while in class, 3) Turn in at the end of class any work done in class (whether complete or not). The child does not then have to do any make up work or homework, simply show up and make an effort from here on out. The teacher agrees to: 1) Give the child a passing grade. I’ve yet to meet a teacher who isn’t willing to give a kid at least a “D” for simply showing up and making an effort while there. The life lesson is that you have to at least show up.
2. It’s worth noting in this example that the kid also had to agree to take prescribed medication (and school was aware of underlying medical condition).
Example B: Child refuses to go to school (stays at home playing video games while mom is at work).
1. Plan: Neighbor takes child to school (since mom is at work). Video games removed and only given as a reward for going to school and getting homework done.
Example C: Child complaining of daily stomachaches, “can’t go to school.” History revealed child was being bullied at school.
1. Plan: Mom to meet with school counselor and parents of the other involved child and create strategy for helping bullying to stop. My patient was empowered with knowledge of “safe grown-ups” to talk to if it happens any more.

Caution: A word of caution about using “a home or an online” school program as a solution. I have had many parents, in desperation, resort to “home school” or “online” school when a child refuses to go to school. Every single case I can think of ended up going poorly when school refusal was the reason for initiating “home school” or “online” school. Ultimately, every parent says they wished they hadn’t, because it ends up compounding the problem. The child doesn’t magically start wanting to engage in academics at home as the underlying problem is not usually solved by home schooling. Usually, it just gives the child a stronger foothold for resisting school (because they no longer have to go to school and the struggle/conflict intensifies between the parent and the child). So be cautious if deciding to go down that road.

It’s not a secret that I’ve been slow to the social media party, but some disturbing trends I’m seeing in my office are motivating me to quickly become better informed. Recently, I’ve had a number of patients who are engaging in risky behaviors and/or self-harm introduced to them by others on social media. Teens are connecting with other teens on social media and “teaching” each other about trying things like cutting, smoking (vape, ecigs., etc.), methods of suicide, etc. I’ll ask a teen who is cutting (the self-harm act), where did you hear about cutting, and often the answer is “social media.” While there is a lot of good that can and does happen on social media, it’s important to be informed about what your teen is engaging in. When you are informed, you can help your teen navigate social media and make safe, smart choices.

Social Media Basics

If you are new to social media, here are the quick basics:

Social media: Is an online technology that allows people to connect to each other and share information in a virtual community or network.

A hashtag (#, the number sign) is a label or tag used on social networking sites to allow users to find messages with a specific theme or content. It’s worth understanding how this works as teens often use hashtags to seek out other users who may be engaging in similar behaviors/interests (both good and bad).

Popular sites

This list isn’t, and can’t be completely comprehensive, but gives you a general knowledge. I included how the site/app generally works. At the end of the list, I added a few that you as a parent may want to steer your teen clear of (due to potential for danger).

Facebook (social network), also Facebook messenger (for messaging)

Twitter (real-time public microblogging)

LinkedIn (Professional/career social networking)

Google+ (social network with communities and collections focus)

YouTube (video content sharing)

Instagram (photosharing)

Pinterest (visual collections on “boards”)

Tumblr (sharing visual content—used mostly by teens, essentially a streaming scrapbook)

Flickr (Yahoo’s photo sharing network)

Swarm (social location tool)

Potentially risky sites

FYI, these are just a few I know of, there are likely dozens more out there that pose significant risk to vulnerable teens. In reality, any social media site can be risky.

Snapchat (instant messaging photos that automatically disappear)

Kik (chatting platform-sharing texts, photos, GIFs, videos, can be anonymous as you don’t have to have real names)

Yik Yak (geographically anonymous social sharing)

Ask.fm (social site where kids ask questions and post answers, can be anonymous)

Omegle (anonymous client chat, often filled with chats containing profanity, sex, drugs, and alcohol)

Whisper (a social confessional app, intended for those >17 yrs). Posted info can be heavy, inappropriate, sexual, and profane.

Burn Note (a text only app that erases after a set amount of time, the trick is that it shows only a word at a time, so it feels secretive).

Line (an all-inclusive social app with text, video, voice messaging, games, and group chats). Has a “hidden chat” feature with temporary messages.

YouNow and Live.ly (live video streaming apps)

Anonymous Apps

Sounds appealing at first to be able to express yourself or ask a question without fear of people know you or making fun, right? The problem is it is a recipe for inappropriate posts. People, especially teens, say much more than they should when they don’t think anyone knows who it comes from. There is lot of cyber bullying, mean comments, and inappropriate sexual posts that happen with anonymous social media.

Temporary Apps

These apps are designed to have the posted info disappear after a set amount of time. The risk is inappropriate posting (similar to anonymous apps). People are more inclined to post or send something that they think won’t last or be traceable. The problem is that everything is traceable (who’s to say the receiver didn’t take a screen shot?). I’ve had a handful of patients get in trouble with the law from sexting while using temporary apps. These apps are harder for parents to track what teens are sending and receiving.

Live video streaming apps

These apps allow teens to stream and watch live broadcasts. The risks are plentiful. Teens overshare (often without realizing the risk in revealing identifying/personal info). Also, because it is live, teens can respond in the moment to viewers in order to gain popularity which as you might imagine can lead to poor judgment.

Tips to teach the teen who already “knows it all”

Internal apps (apps within apps) are often selling something. Help them understand how they are being marketed to. They may not know that “promoted chats” are actually advertising. Teens are usually offended by this once they realize it (because no one wants to feel like they are being profiled or duped).
Understand how different apps settings work. They may inadvertently share content with more people than they intended (things get sent to entire groups instead of just a few select friends).
Anonymous and temporary sites are not quite what they seem. There is always a way to track who sent something and what they sent. Advise a teen not to post something that they wouldn’t have a problem with you, a future boss, or an officer seeing.
Everyone has heard of “online predators,” but teens may not know that it more frequently happens in chat rooms where teens are engaging in sexual conversations. Teens are also naturally naïve and have a sense of being invincible. This is a set up for being careless about sharing identifying information.

Parent Tips

What works for one family, doesn’t necessarily work for everyone. Some teens are more naturally drawn to engage in risky behaviors, while others steer clear. Some basic tips apply to everyone.

Know the sites/apps your teens are engaged in. Anticipate the risks involved in the site.
Be in your teen’s group of “friends” or “followers” when applicable to the social network. This way you can see what is being posted (and help guide your teen through what’s appropriate and not appropriate).
Set limits. This may include allowed apps, how much total media time, media curfews, media free zones, etc. Kids respond best when expectations are clearly outlined.
Establish consequences (ahead of time) for not staying within outlined limits.
Don’t be afraid to say no, turn it off, and cut off access. If the situation is out of control, reign it in. And say what all parents say at some point, “You’ll thank me later.”

Being a teen in this day and age can’t be easy. I had a great teenage experience, but it may have been entirely different in light of social media (where anyone can instantly share every embarrassing or stupid thing you may do). Helping teens navigate waters that we’re just learning to swim in can be tough, but we’ll figure it out together. Good luck.

Tag: cyber bullying

Kids Who Refuse To Go To School

Step 1: Determine the Reason

Step 2: Make a plan

Step 3: Follow through

Examples: