DEFINING SCHOOL REFUSAL BEHAVIOUR

School Refusal Behaviour (SRB) is when a child or adolescent shows reluctance or refusal to remain in class all day or attend school on an ongoing basis (Lyon & Coltern, 2007; Heyne et al., 2019; & Sewell, 2008). Caregivers are aware that their child is staying home from school over a prolonged period of time.  SRB is seen in children and adolescents aged between 5 and 17 (Kearney, Cook, & Chapman, 2007).

SCHOOL REFUSAL AS PART OF NORMAL DEVELOPMENT

Most children have occasional days when they do not want to go to school because they’re worried about something, such as a test, participating in a swimming carnival or seeing a peer they had an argument with the previous day. When this happens, families can help their child by talking through the issues, encouraging them or letting them have a rare day off school. Usually, this reluctance or refusal to go to school fades.

SCHOOL REFUSAL BEHAVIOUR OF CONCERN

However, some children show a repetitive and persistent pattern of reluctance or refusal to attend school. When SRB is prolonged and ongoing, it becomes ingrained in the child.  Setzer and Salhauer (2001) use the following descriptors to identify the severity and the chronicity of the various types of SRB:

  • Initial SRB: Lasts for a brief period (less than two weeks) and may resolve without intervention.
  • Substantial SRB: Lasts for a minimum of two weeks and requires some form of intervention.
  • Acute SRB: Lasts for two weeks to one year, being a consistent problem for a majority of the time.
  • Chronic SRB: Interferes or overlaps with two or more academic years.

IMPACT OF SCHOOL REFUSAL BEHAVIOUR

Short-term impacts for the child include poor academic performance, family difficulties, difficulties with maintaining friendships, problems with peers, and increased risk of legal trouble which can lead to longer-term consequences (Kearney, 2001; Wijetunge & Lakmini, 2011). Long-term consequences include social isolation, academic underachievement, employment issues, increased risk of mental health problems and developing a psychiatric illness in adulthood, such as panic disorder and agoraphobia (Fremont, 2003; Flakierska-Praquin et al, 1997 and Sewell, 2008).

For the family, the resulting cumulative stress from supporting a child with SRB can lead to familial conflict, disrupted routines, increased financial expense and increased potential for poor supervision or child maltreatment (Kearney, 2001).

For the school, SRB presents a challenge and causes frustration. Therefore, it is vital that SRB is addressed as early as possible and that home and school work together to support the child.

POSITIVE BEHAVIOUR SUPPORT AND SCHOOL REFUSAL BEHAVIOUR

Positive Behaviour Support (PBS) focuses on evidence-based strategies and person-centred supports that address the needs of the individual and the underlying causes of behaviours of concern, to enhance the quality of life for both the individual and those that support them.

PBS recognises that SRB is a complex problem with multiple factors contributing to its development and persistence. Risk factors are associated with the child, family, peers, school and community (Kearney, 2008).

Child-related factors that increase the risk of the development of SRB include:

  • Children who have internalising problems (g., anxiety, depression, withdrawal and loneliness) and externalising problems (e.g. aggression, oppositional behaviour and defiance)
  • Children in out-of-home care or affected by homelessness
  • Children from an Indigenous background
  • Children who are young parents and/or carers
  • Children who abuse drugs and alcohol
  • Children with developmental disabilities (e.g. Autism Spectrum Disorder, Intellectual Disability and Attention Deficit Hyperactivity Disorder)
  • Children with chronic health issues (e.g. Encopresis (bowel incontinence) and Enuresis (bed-wetting))
  • Children experiencing bullying
  • Children with learning disabilities (e.g. Dyslexia, Dysgraphia and Dyscalculia)
  • Children from families where there is disharmony, dysfunction and poor parental practices
  • Children who have experienced trauma
  • Children from a refugee background

Family-related factors that contribute to SRB include:

  • Caregiver with mental health issues (e.g. Depression, panic disorder and agoraphobia (fear of leaving the home)
  • Caregiver with drug/alcohol problems
  • Caregiver attitudes and responses to a child’s SRB (e.g. child is allowed to engage in preferred activities, such as spending time on technology or games, going shopping or travelling with the caregiver; caregiver encouraging the child to stay at home so they can look after the siblings)
  • Characteristics of the family (e.g. parental separation/divorce; abuse and neglect; financial difficulties affecting purchase of school-related items and/or transportation to school)
  • Unstable living arrangements (e.g. living in more than one home or temporary accommodation)

School-related factors that contribute to SRB include:

  • Moving to a new school
  • Returning to school after a long absence
  • Problems with teachers
  • Difficulties with curriculum
  • Changes to routines and staff

Peer-related factors that contribute to SRB include:

  • Association with antisocial, truant or delinquent peers
  • Social rejection
  • Social isolation
  • Bullying or conflict with peers

(Gubbels et al., 2019; McShane et al., 2001; Heyne et al., 2002; Kearney, 2008).

Case Study

The following case study emphasises this complexity:

When John was six years old, his parents separated. His dad moved interstate, leaving his mum to look after and provide for John and his older brother, who has learning difficulties.

John’s mum reported changes she saw in John after the divorce. John went from an outgoing, fun, talkative boy to a quiet, shy and withdrawn child. He developed separation anxiety and would follow her everywhere in the house. He could only have her out of sight for a few minutes before he had to find her. On the way to school, she would have to reassure him repeatedly that she would be picking him up at 3pm. If she was late by a couple of minutes, John would have a meltdown. She could not convince him to go to school camps or sleepovers because he would never sleep away from home. He would always talk about his fears about what would happen to his mum if he wasn’t next to her.

She also reflected on how John always had trouble making friends. His peers knew his name and would occasionally greet him but there wasn’t anyone he could hang out with at recess or lunch.

In Year 5, his mum noticed John starting to say things like ‘I hate school’ or ‘I don’t want to go to school’, but with her encouragement, he was able to. She didn’t think much of this behaviour as it would happen occasionally and she was able to manage it.

However, the SRB escalated when John started high school. John’s reluctance to go to school started to consistently appear once or twice a week, but John’s mum was able to convince John to go to school by offering him money to buy a treat from the canteen or after school.

At the beginning of Year 8, within a few weeks of school resuming, John started to outright refuse to go to school. He told his mother that he felt ‘lost’, he ‘didn’t belong at school’ and he was ‘dumb’. During this period, he also started to ask questions about why his dad left and why his dad had not been in touch for the last seven years. 

John’s mum could see her son needed help, so she increased the amount of support she was giving him to get to school. She would wake him up in the morning, but that could take up to 30 minutes of going in and out of his bedroom.  She would then help him prepare his breakfast, keep prompting him to eat and to get dressed for school. She would then drive him to school even though it was a 10-minute walk from their house. During school, John started to increasingly complain of stomach aches and chest pains by lunchtime and would then stay in the sick bay for the rest of the day where he would play games on his laptop. Despite John’s mum’s complaints to the school, their limited resources prevented staff from providing consistent additional support to John.

In the meantime, John’s mum was offered a permanent job. As the single income earner, John’s mum had no choice but to accept the job, which meant she would leave home by 6am and get home at 6pm. She would no longer be able to get John ready for school and drop him off. She helped him set an alarm, but John would still not wake up on time. He started to skip school entirely and stayed at home all day playing video games. This quickly devolved into a habit of playing video games until 3am and sleeping until midday. A whole term of school passed by and John had not been to school.

Knowing she needed to do something, John’s mum took him to see a range of professionals. He was diagnosed with Depression, Anxiety (Social anxiety disorder and Separation anxiety disorder) and Autism Spectrum Disorder.

John’s case study shows the complex nature of the development and maintenance of SRB. There is no quick fix or magic wand that can address all these issues overnight. John’s issues, as with any other child, are so multifaceted that a team approach is necessary to assess the underlying factors contributing to his SRB and develop a plan to manage them.

The above example highlights that there is no single cause for SRB. In a context such as primary and secondary school it is not possible to control all the factors that contribute to the SRB outside of the school context. However, factors specific to the school context such as the environment, activity and interactions can be addressed to help the child achieve better communication, social, emotional, behavioural and learning outcomes.

PBS provides a road map to address SRB by using a holistic approach to develop a comprehensive and individualised PBS plan in three stages: Assess-Manage-Prevent.

  • ASSESS: How to identify the triggers (events) related to school that contribute to challenging behaviours related to school refusal,
  • MANAGE: How to respond and support the child when they are triggered at school, and
  • PREVENT: How to minimise or avoid the triggers at school that contribute to challenging behaviours related to school refusal.

ASSESS STAGE

Assess Stage Aims

The Assess Stage aims to identity:

  • School activity related factors which contribute to the challenging behaviours,
  • School environment related factors which contribute to the challenging behaviours, and
  • School staff and peer related factors which contribute to the challenging behaviours.

Assess Stage Checklist:

  • Child’s profile – Gather information about the child to create a comprehensive picture of the child, their abilities and needs.
  • Behaviour data collection forms – Record measurable details (e.g. frequency, intensity, duration) about the SRB.
  • Functional Behaviour Analysis (FBA)- Systematically reflect on an incident by analysing the antecedents (what preceded the challenging behaviour), describing the challenging behaviour, consequences (what happened after the challenging behaviour).
  • Hypothesis – Determine the purpose (function) that the challenging behaviour served.

MANAGE STAGE

Manage Stage Aims

The manage stage of PBS involves recognising the behaviours related to the stages of escalation, identifying effective responses and strategies to safely defuse, redirect and de-escalate the situation in the least disruptive manner.

Manage Stage Checklist:

  • Escalation stages – Help those supporting the child to recognise the number of stages the child exhibits as their emotion rises (i.e. mild escalation, moderate escalation, extreme escalation, and recovery stage).
  • Escalation profile – Help those supporting the child to recognise what the non-verbal and/or verbal behaviours exhibit in the different escalation stages and how long it can last.
  • De-escalation plan – Help those supporting the child with guidelines on how to immediately respond when the behaviour occurs, safely defuse, and de-escalate the situation in the least disruptive manner.

PREVENT STAGE

Prevent Stage Aims

This stage aims to the aim is to firstly, outline the steps that could be taken to gradually progress the child’s school attendance from one lesson a week….. few lessons a week …part-time …..full-time on an ongoing basis.  Secondly, to detail the strategies that should be utilised in each step to minimise or avoid the triggers to maximise the child’s success when they are at school.

Prevent Stage plan

The plan details strategies to minimise or avoid the triggers that contribute to the SRB behaviours by providing the child with:

  • Supportive environments – Tailoring environment related aspects to minimise or avoid triggers that contribute to the SRB.
  • Supportive activities – Tailoring activity related aspects to minimise or avoid triggers that that contribute to the SRB,
  • Supportive interactions – Tailoring interaction aspects to minimise or avoid triggers that that contribute to the SRB, and
  • Teaching the child – Teaching the student positive ways of communicating their messages and managing their emotions and behaviours.

S FOR SCHOOL REFUSAL BEHAVIOUR: POSITIVE BEHAVIOUR SUPPORT

Use the practical tools (checklists, forms, and strategies) in S for School Refusal Behaviour: Positive Behaviour Support to develop comprehensive PBS plans that can be used to support children of all ages consistently in all settings.

This invaluable guide is useful for parents, caregivers, educators in childcare, early childhood, primary and secondary schools, disability, mental health, allied health, and supervisory professionals.

REFERENCES

  • Flakierska-Praquin N., Lindstrom M., Gillberg C. (1997). School phobia with separation anxiety disorder: a comparative 20- to 29-year follow-up study of 35 school refusers. Comprehensive Psychiatry, 38, 17-22.
  • Fremont, W. (2003). School refusal in children and adolescents. American Family Physician, 68,1555–64.
  • Gubbels, J., van der Put, C.E., & Assink, M. (2019) Risk Factors for School Absenteeism and Dropout: A Meta-Analytic Review. Journal of Youth and Adolescence, 48, 1637–1667.
  • Heyne, D., King, N.J., Tonge, B. & Cooper, H. (2001). School refusal: epidemiology and management. Paediatric Drugs, 3, 719-32.
  • Kearney, C. A. (2001). School refusal behavior in youth: A functional approach to assessment and treatment. American Psychological Association.
  • Kearney, C. A. (2008). An interdisciplinary model of school absenteeism in youth to inform professional practice and public policy. Educational Psychology Review, 20, 257– 82.
  • Lyon, A.R. & Colter, S. (2007). Toward Reduced Bias and Increased Utility in the Assessment of School Refusal Behaviour: The Case for Diverse Samples and Evaluations of Context. Psychology in the Schools, 44, 551-565.
  • McShane G., Walter G., & Rey, J.M. (2001). Characteristics of adolescents with school refusal. Australian and New Zealand Journal of Psychiatry, 35, 822–826.
  • Setzer, N. & Salzhauer, A. (2001). Understanding School Refusal. NYU Child Study Center.
  • Sewell J. (2008). School refusal. Australian Family Physician, 37, 406-8.