Aspergers Children & School Refusal

Question

What do you do if your 9 year old with Asperger's is refusing to go to school ever again? Do take him kicking and screaming?

Answer

Some Aspergers kids experience fear or panic when they think about going to school in the morning. These kids may tell their moms and dads that they feel nauseous or have a headache, or may exaggerate minor physical complaints as an excuse not to go to school. When the Aspergers youngster or teen exhibits a developmentally inappropriate and excessive anxiety concerning separation from their home or from those to whom they are attached, they may be experiencing a Separation Anxiety Disorder. Separation Anxiety Disorder is characterized by the youngster exhibiting three or more of the following for a period of more than four weeks:

1. persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
2. persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
3. persistent reluctance or refusal to go to school or elsewhere because of fear of separation
4. persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
5. persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
6. recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
7. repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated
8. repeated nightmares involving the theme of separation

In addition to the symptoms described above, Aspergers kids with an unreasonable fear of school may also:

• display clinging behavior
• fear being alone in the dark
• feel unsafe staying in a room by themselves and frequently go check to find their parent or have a need to be able to see their parent (e.g., a teenager in a shopping mall who feels a lot of distress if they can't always see their parent may be exhibiting a symptom of separation anxiety)
• have difficulty going to sleep
• have exaggerated, unrealistic fears of animals, monster, burglars
• have nightmares about being separated from their parent(s)
• have severe tantrums when forced to go to school

School Refusal Warning Signs—

While one student may complain of headaches or stomachaches, another may refuse to get out of bed, while a third repeatedly gets "sick" and calls home during the school day. Symptoms can run the gamut and may even include combinations of behaviors. Here are some typical warning signs that an Aspergers youngster is suffering from school refusal disorder:

• Anxiety or panic attacks
• Depression
• Drug/alcohol use
• Failing grades
• Fatigue
• Frequent physical complaints such as headaches, stomachaches
• Physical aggression or threats
• Risk-taking behavior
• Social problems

Many symptoms, particularly physical complaints, can mimic other disorders. When these occur in combination with a pattern of not attending school, a complete evaluation should be made by qualified professionals to determine whether a student has school refusal disorder or another psychological or possibly even a physical disorder.

Separation Anxiety Disorder can be exhausting and frustrating for the moms and dads to deal with, but it is worse for the Aspergers youngster who feels such intense fear and discomfort about going to school. If moms and dads are unable to get the youngster to school, the youngster may develop serious educational, emotional, and social problems.

Because the anxiety is about separating from the parent (or attachment object), once the youngster or teen gets to school, they usually calm down and are OK. It's getting them there that is the real challenge.

School avoidance or school refusal may serve different functions in different kids or teenagers. For some Aspergers kids or teens, it may be the avoidance of specific fears or phobias triggered in the school setting (e.g., fear of school bathrooms due to contamination fears associated with Obsessive-Compulsive Disorder, fear of test-taking). For other kids or teenagers, it may serve to help them avoid or escape negative social situations (e.g., being bullied by peers, being teased , or having a very critical teacher).

When school refusal is anxiety-related, allowing the Aspergers youngster to stay home only worsens the symptoms over time, and getting the youngster back into school as quickly as possible is one of the factors that is associated with more positive outcomes. To do that, however, requires a multimodal approach that involves the student's physician, a mental health professional, the moms and dads, the student, and the school team. The same therapeutic modalities that are effective with Panic Disorder and Obsessive-Compulsive Disorder are also effective for school refusal, namely, exposure-response prevention (a form of cognitive-behavior therapy that may include relaxation training, cognitive alterations, and a graded hierarchy of steps towards the goal).

There is some research that suggests that education support therapy may be as effective as exposure therapy for treating school refusal. Working with the school psychologist, the student talks about their fears and is educated in the differences between fear, anxiety, and phobias. They learn to recognize the physical symptoms that are associated with each of these states and are given information to help them overcome their fears about attending school. The student is usually asked to keep a daily diary where they record their fears, thoughts (cognitions), strategies, and feelings about going to school. The time of day that they arrived at school is also recorded, and the record is reviewed each morning with the school psychologist. Although it might seem like a good idea to incorporate positive reinforcement for school attendance, that may backfire and merely increase the student's stress levels and anxiety.

Parent training in strategies to work with the Aspergers youngster in the home is also an important piece of any school-based plan to deal with the student with school refusal.

When it comes to school refusal, accommodating the Aspergers youngster by letting them stay home is generally contraindicated, unless there are other issues. So what can moms and dads do? Here are some tips:

• A youngster's reluctance to go to school can be irritating to moms and dads. Expressing resentment and anger is counterproductive. And you won't feel the urge to do so if you adopt specific strategies to assist your Aspergers youngster.

• Be open to hearing about how your youngster feels. However, lengthy discussions about the youngster's problems are not always helpful and can be experienced as a burden by the youngster. The focus must always be that you want to help your youngster be free of worries and fears.

• Do not deny the youngster's anxiety or worries, but acknowledge them and reassure him/her. For example: "I know you're worried I won't be there to pick you up, but there's no reason to worry. I'll be there."

• Do not quiz the Aspergers youngster about why s/he feels scared. The youngster often does not know why. By not being able to provide an explanation, in addition to being anxious, the youngster feels guilty about not making sense of what is happening. Better to acknowledge that the fears make no sense and that the Aspergers youngster has to fight them.

• It is most important to tell the Aspergers youngster exactly what s/he is to expect. There should be no "tricks" or surprises. For example, a youngster may be told that he should try to stay in school for only one hour, but after the hour he is encouraged or asked to stay longer either by the school or parent. This will backfire. The youngster will eventually refuse future arrangements for fear that they will be modified arbitrarily. Part of being anxious is anxiety about the unknown and the “what if?”.

• Punishment does not work, but kind, consistent, rational pressure and encouragement do.

• Try to find ways to enable the Aspergers youngster to go to school. For example, a youngster is likely to feel reassured if times are set for him or her to call the mother from school. In extreme cases, mothers may stay with the youngster in school, but for a specified length of time which is gradually reduced.

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