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Aspergers Children and School Refusal

Question

My 14yr old boy dropped out of school 2 years ago. Our present psychologist is very dismissive of his diagnosis although 2 psychiatrists have diagnosed him as having Asperger's complicated by separation anxiety and severe generalised anxiety disorder. I think his refusal to go to school stem from his Asperger's and his disposition to anxiety but our psychologist is saying that it's pure defiance. I am so afraid that he will end up in a wrong residential setting that is not equipped to deal with his autism if we cannot get the HSE to see that it's not just behavioural. He was on Prozac and Seroquil to help with behavioural problems and I wonder should he go back on Prozac while trying to return to school?

He was placed in a residential school last year but unfortunately it was a bad placement and he had to be removed. He is high functioning with above average intelligence and they placed him (against my wishes) in a school for children with severe learning difficulties. I am so afraid that they are not listening to me again and I hope someone might have some suggestions or guidelines for me. I have another meeting this week on Thursday but I am not very hopeful that it will bring about any beneficial change for us.

Answer

Case Example 1: Kayla, an eight-year-old Aspergers girl, has always had difficulty attending school. Since she began third grade two months ago, her problems have significantly worsened. She constantly begs to stay home from school, having tantrums that cause delay in dressing and often result in her missing the bus. After arriving at school, Kayla frequently complains of stomachaches, headaches and a sore throat to her teacher and asks to visit the school nurse with whom she pleads to call her mother. Her mother typically picks her up early twice a week. When Kayla gets home she spends the remainder of the afternoon watching TV and playing with her toys. When her mother is unable to pick her up early, Kayla calls her mother's cell phone periodically throughout the afternoon to "check in" and reassure herself that nothing bad has happened. Kayla's teacher has expressed concern about her missing so much class time which has resulted in incomplete assignments and difficulty learning.

Case Example 2: Jake is a fourteen-year-old Aspergers boy who has missed forty-three days of school since beginning the eighth grade four months ago. When home from school, Jake spends most of the day online or playing video games. On the days he does attend school he is typically late for his first period which enables him to avoid hanging out with other kids before class. He always goes to the library during lunch. When he does go to class, he sits in the back of the classroom, never raises his hand and has difficulty working on group projects. Jake' teachers have noticed that he is always absent on days that tests or book reports are scheduled. His parents have already punished him after his first report card came home since he received D's in Math and Social Studies and failed Gym for cutting. Jake' parents have started to wonder if they should change his school placement and have asked the school to arrange home tutoring while this alternative is explored.

Prevalence and defining characteristics—

As much as 28% of school aged kids in America refuse school at some point during their education.1 School refusal behavior is as common among boys as girls. While any youngster aged 5-17 may refuse to attend school, most youths who refuse are 10-13 years old. Peaks in school refusal behavior are also seen at times of transition such as 5-6 and 14-15 years as kids enter new schools. Although the problem is considerably more prevalent in some urban areas, it is seen equally across socioeconomic levels.

Kayla and Jake are just two examples of how school refusal manifests in Aspergers youth. The hallmark of this behavior is its heterogeneity. Defined as substantial, child-motivated refusal to attend school and/or difficulties remaining in class for an entire day, the term "school refusal behavior" replaces obsolete terms such as "truancy" or "school phobia," because such labels do not adequately or accurately represent all youths who have difficulty attending school. School refusal behavior is seen as a continuum that includes youths who always miss school as well as those who rarely miss school but attend under duress. Hence, school refusal behavior is identified in youths aged 5-17 years who:

1. are entirely absent from school
2. attend school initially but leave during the course of the school day
3. exhibit unusual distress during school days that leads to pleas for future absenteeism.
4. go to school following crying, clinging, tantrums or other intense behavior problems

As evidenced by Kayla and Jake, there are varying degrees of school refusal behavior. Initial school refusal behavior for a brief period may resolve without intervention. Substantial school refusal behavior occurs for a minimum of two weeks. Acute school refusal behavior involves cases lasting two weeks to one year, being a consistent problem for the majority of that time. Chronic school refusal behavior interferes with two or more academic years as this refers to cases lasting more than one calendar year. Youths who are absent from school as a result of chronic physical illness, school withdrawal which is motivated by moms and dads or societal conditions such as homelessness, or running away to avoid abuse should not be included in the above definition of school refusal behavior as these factors are not youngster-initiated.

While some school-refusers exhibit a more heterogeneous presentation, typically these youths can be categorized into two main types of troublesome behavior -- internalizing or externalizing problems. The most prevalent internalizing problems are generalized worrying ("the worry-wart"), social anxiety and isolation, depression, fatigue, and physical complaints (e.g. stomachaches, nausea, tremors and headaches). The most prevalent externalizing problems are tantrums (including crying and screaming), verbal and physical aggression, and oppositional behavior.

The cause and maintenance of school refusal behavior—

Kayla had several physiological symptoms at school and went home to be with her mother and play. Jake on the other hand, avoided potentially distressing social and evaluative situations at school which negatively impacted his academic performance. Although many behaviors characterize youths who refuse school, there are a few variables that serve to cause and maintain this problem. School refusal behavior occurs for one or more of the following reasons:

1. To avoid school-related objects or situations that cause general distress such as anxiety, depression or physiological symptoms
2. To escape uncomfortable peer interactions and/or academic performance situations such as test-taking or oral presentations
3. To pursue tangible reinforcement outside of school
4. To receive attention from significant others outside of school

The above four reasons for school refusal behavior can be explained by principles of reinforcement. Any one youngster can refuse school for one or more of these reasons. The first two reasons characterize youths who refuse school to avoid or escape something unpleasant (negative reinforcement). For example, one of the reasons for Kayla's crying in the morning is her fear of riding the school bus. By tantruming she accomplishes her goal of avoiding the school-related object (the school bus) that causes her distress. Another example of negative reinforcement is when Jake escapes aversive peer interactions and exams by school refusing. The third and fourth reasons characterize youths who refuse school to gain rewards (positive reinforcement). Kayla, as is common with many younger kids, tries to avoid school as a means of having her mother provide her with excessive attention and closeness. Thus, Kayla's behavior in this situation may be associated with separation anxiety.

Another instance of positive reinforcement is exemplified by Jake, who basically has more fun being at home on the computer and listening to music than being in school. It is important to note that alcohol and drug use can occur among adolescents who school refuse for one or more of the reasons listed above. For example, a teenager who is extremely socially anxious may drink alcohol as a way of enduring distressing social or evaluative situations. Another youngster who avoids school may smoke marijuana during school hours as a means of gaining acceptance by peers or simply because it is more enjoyable than attending school. While all forms of school refusal can be equally debilitating, typically, mental health professionals receive fewer referrals for youths who have internalizing as opposed to externalizing behavior problems. In other words, the youth who exhibits anxiety is less likely to receive treatment than the youth who is disruptive.

Home Schooling and Aspergers Children—

A common strategy in dealing with school refusal in Aspergers children is to switch to a home school environment. However, home schooling a child with Aspergers is completely different than educating a non-Aspergers child. Here is a summary plan:

• Child can only grow to be fully functioning if he first experiences a fully functional home life. Fighting, crying and meltdowns do not positively contribute to a functional home. Child functions best when conflict is removed so ALWAYS remove conflict and remain flexible.

• Meltdowns are worse for the child than they are for you. Remain calm and use the child's logic, obsessive compulsiveness and anger as a learning experience. Shutting your ears is tantamount to saying you know everything and are a superior person.

• Nobody can accuse you of being a bad mother. By designing education around the need of your child you are being the best mother you can be. Most people will be grateful that their children do not have Aspergers.

• Nobody can read your mind. Think abusive thoughts but NEVER say them because they will destroy the child's confidence and reinforce further unacceptable behavior and school refusal.

• Short term goals are not time specific. They can be revisited and strengthened at any stage. Know that the goals can be re-met if you do things differently.

• Teachable moments are everywhere. School does not have to represent that which we know as beneficial for us. School is everywhere and Aspergers learning occurs best without stress.

• What I value as important is not important to the child or his development. Allow him to explore that which he is highly interested in, even if it has no recognizable educational value to you.

• When you reign in and block outsiders from coming to your home and adding over stimulus, remember that it will only be for a short time while the child reaches emotional and social equilibrium again. Email and on-line Aspergers support groups produce no over stimulus to the child and are there 24 hours per day. Use them.

• Work through obsessions. On days when the child is focused on issues not included in the home school learning areas, it is acceptable to investigate the child's obsessions. These are teachable moments that will otherwise be lost.

• You are a team, a package, a caring parent. Team work means working together to get the best result. Work with the child, not against him.

• You can only recognize a bad day because you have first had good days to measure against. Things do improve. Hasten improvement by reducing conflict and grabbing whatever teachable moments you can.

My Aspergers Child: Preventing Meltdowns in Aspergers Children

9 comments:

Anonymous said...

As always, your newsletters and advice are timely. School will be over next week and I am thrilled. It has been a nightmarish year and it is almost over. Amina will be going to high school next year. We have included some adjustments to her IEP. I am hoping she can get over her School Phobia/School Refusal issues. Everyday is a struggle to get her to class.

Anonymous said...

Thank you so much for your prompt reply. I have a meeting tomorrow with our disability, child and educational authorities and this information may help me with that. It is a great service that you provide and I will be passing that on to my facebook friends. We have quite a considerable on line support group. Once again thank you.

Anonymous said...

Hi again Mark.

I just read your school refusal letter. Good information! Casey, 14, has been attending the same private Christian school for the past 4 years. It is very small and there is a group of bully's that continue to taunt and tease Casey. Of course, he reacts. He will yell, over-react if physically touched, he will throw up, or have nose bleeds leading to someone having to pick him up from school. I have suggested to his parents, who are now divorced, that perhaps the school could gather these children and sit them down to explain Casey's situation. Perhaps knowledge would help them accept Casey. Of course, we also need to teach Casey how to alter his behavior. The school keeps saying that they really aren't equipped to handle Casey. I don' think that they have been asked to examine the problems by his parents. Frankly, I don't believe that he should be there, but...I'm not the parent. I know that the school administration and faculty are very frustrated with Casey. Is there any type of training the school could be given to help them understand?

Thanks for your help.

Valerie

Anonymous said...

Mr. Mark, my child still has a problem with going to school. There are days that I just give up and let him stay home, than to have to deal with the emotional stress he or it puts on the both of us. He has 4 days left and I'm still going though it with him. Especially if he feels that things aren't right or fair. The refusal starts at home and continues until I just walk away and leave him. I've been dealing with this from daycare, preschool, kindergarten, first grade and now second grade. I'm so afraid for third grade, after the summer or for any holiday breaks during school term. I can't really home school due to the fact of work. He does not do well at my job from 3:00- whatever time. He requires too much of me from working while he's there. But I can't keep going though this ever year, he makes me feel like I'm the problem...he blames me for everything wrong. Than the aggression comes out towards me, only in words not in actions. To re-act on him seems to give him more power. I’m drained in every way. Thanks for the articles and for listening.

Sandra Barwick said...

The main problem in the UK is that mainstream schools are forced to take ASD children with insufficient training and backing for teachers.
An Aspie child who is terrified of the school bus should not be on it. If there are problems in form time skip form time, which is noisy and chaotic and in which he is not learning.
In gym he has to deal with putting clothes on and off, which may be difficult because of motor problems, and he has to cope with noise in changing rooms, the smell of apray antiperspirants, and maybe bullying. Has the school looked at how they mitigate this?
Can he do non team sports? Is there a separate room to change in? Is it so much of a problem that he should skip sports and do something less awful at weekends, like running or swimming?
The answer lies in the understanding of schools.

Anonymous said...

Can anyone give me their advice/opinions on Prozac. Effectiveness, what kind of things it helped, side effects, etc. We have a script for this for anxiety, but as always I am leary about meds. My 9 yo old son has shown lots of signs of anxiety & stress. He has constant canker sores (which I get when I am stressed) and has been making lots of comments about dying, told his class that he once attempted suicide, and is always negative. He is also extremly emotional. We tried Zoloft, but saw no change....

Anonymous said...

My son is 7 and was diagnosed with aspergers and depression in November. He use to get very anxious about the smallest things. He would scream,hit,and behave out of control. He started taking 10mg of Prozac a few weeks ago and seeing a counselor. Since then he's rarely has meltdowns. He seems happier. I am skeptical about giving him meds but I'm glad we gave Prozac a try.

Anonymous said...

We have tried so many things to help her, but when she talks about her negative social experiences (either conflict or bullying) or when something negative happens to her , it is almost as if she has a trauma reaction, as if she has PTSD, and it always either makes the situation worse, or she begins to yell and cry hysterically. We did manage to get her into a more supportive environment for next year (a spec. ed/ class with partial integration), but regardless she will stilll be out on the playground and in some classes with the nt kids. She has done CBT, anger management and 2+ years of psychological counseling ($$$) among other things. By the end of this year she was refusing school and threatening to stab herself if she had to go. Now I'm not sure which direction to go in to help her. Any suggestions?

Mark said...

School avoidance or school refusal may serve different functions in different kids or teenagers. For some Aspergers kids, it may be the avoidance of specific fears or phobias triggered in the school setting. For other kids, 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 (which sounds like the case with your daughter), allowing the child to stay home only worsens the symptoms over time, thus getting her back into school as quickly as possible is fairly critical. To do that, however, requires a multimodal approach that involves a physician, a mental health professional, you, your daughter, 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).

I don’t see any shortcuts here. You will need a team effort to push through her initial school-anxiety issue. But once she tests the waters and sees that the past is not going to repeat itself, she should be good to go.

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the Aspergers child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

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