I Dont Want To GoWould You?

Turner 1

I Dont Want To GoWould You?

The Direct Connection Between Separation Anxiety and School Refusal.

Ruby Turner

Howard High School

I Dont Want To GoWould You? Turner 2

I Dont Want To GoWould You?

The Direct Connection Between Separation Anxiety and School Refusal.

Abstract

School refusal has been a direct result of separation anxiety in elementary to middle
school students. The purpose of studying this topic is to raise awareness in the school
community and help educate school personnel, mental health providers and families on various
ways to help students cope and manage this issue. It was also intended to increase parental
involvement in the students day-to-day activities and ultimately aid in the identification and
elimination of behavior that trigger the episodes.
The collection of research data included interviews, internship field experience, online
sources and databases which have been recorded in a synthesis paper that highlights the disorder
of separation anxiety, the purpose of the research and a call to action for the audience. There has
been very little research on this topic and the information collected during my research is meant
to decrease the chances of this disorder and increase the school systems knowledge on this topic.

Sams parents came in his room on Monday morning to wake him up for school. It was

the first day back to school since Sams mother was released from the hospital. Sam missed

school for a week because his parents allowed him to stay with his mom. Sam is very close to

both of his parents and seeing this image of his mom brought him pain. When they wake Sam up,

would not get out of bed, and he complained of stomach pains, so they allowed him to stay home

from school. This pattern continued for two weeks but when they allowed him to stay home, the

pain would remain. This is a sign of what a psychologist calls a mixture of school refusal.

Kids often endoor a phase when they are "clingy" and afraid of unfamiliar people and places.
I Dont Want To GoWould You? Turner 3

When this excessive fear occurs in a child over age six, and lasts longer than four weeks, the

child may have separation anxiety disorder (WebMD, 2017). There is a direct connection

between separation anxiety and school refusal. The connection has been shown through

elementary age when child had a hard transition to a full day of school.

Separation anxiety disorder occurs when a child becomes fearful and nervous whenever

they are away from home or separated from their loved ones.(T. Shank, Ph.D, personal

communication, January 10, 2017). Separation anxiety can be defined as a condition burdened

by an excessive and inappropriate display of fear and distress when the individual is faced with

situations of separation from home or from a specific attachment figure (Pozzi, Bruschi, De

Angelis, Pascucci 2014). When a child is growing up, he or she deals with separation from their

parents where it occurs with a baby sitter or starting school. The childs discomfort to their new

environment tend to arise when their adult figure leaves (Pozzi, Bruschi, De Angelis, Pascucci

2014). Parents also have separation problems occur when a child show significant stressful or

traumatic event in the child's life, such as a stay in the hospital, the death of a loved one or pet, or

a change in environment (such as moving to another house or a change of schools) (WebMD,

2017). Psychologists conclude children who have overprotective parents tend to have

separation anxiety (WebMD, 2017). Overprotective parents can cause their child to have a hard

time adjusting to a different environment without them. Studies show First of all, some anxiety

is well founded. For example, if the school situation is rife with violence and lack of adult

supervision, it would be the unusual child who would not be anxious (Pellman 1998).
I Dont Want To GoWould You? Turner 4

This unusual environment can cause great anxiety to the child and it could lead to stress when

they are forced to change environments.Parents have become so extreme that Presumably,

parents now worry that school bathrooms are not good enough for their children (Estroff

Marano, 2004). Children has started to feel that "Parents and schools are no longer geared toward

child development, they are geared to academic achievement says Elise Kramer, a Cornell

University junior (Estroff Marano, 2004). According to my interviews the overall point of

agreement is that there in needs to be a relationship with home and school in order to better the

child.

It is common for other family members to have mental health disorders when it is present

inside of the child. Treatment for separation anxiety expands on a large scale of options

depending on the level of their anxiety. The main goal of therapy is reducing anxiety in the

child, developing a sense of security in the child and the caregivers, and educating the child and

family/caregivers about the need for natural separations (WebMD, 2017). Psychotherapy

(''talking'' therapy) is the main treatment approach for separation anxiety disorder. The focus is

helping the child tolerate being separated from their loved one. (WebMD, 2017). Cognitive

behavioral therapy and family therapy are alternatives. A psychologist may suggest medication

if the childs anxiety leads to them refusing school or another outing. Another type of medicine

that are used are clonidine or guanfacine -These are alpha-two agonists; they calm, they lower

arousal levels, but they dont really treat anxiety (Walkup, n.d). The second group of medicines

are antipsychotics (Walkup, n.d.). A few year ago there was a suicidal behavior scare that

caused psychologists to move away from antidepressants to treat people with anxiety. Separation

anxiety comes in various levels but some of the more extreme cases can lead to school refusal.
I Dont Want To GoWould You? Turner 5

School refusal is caused by multiple traumas for example frequently experiences severe

distress related to school attendance (Mersch, 2016). According to Mersch, one in four children

may occasionally refuse school. Research shows many children with school refusal have an

earlier history of separation anxiety, social anxiety, or depression (Mersch 2016). There are also

studies showing that students with undiagnosed learning or reading disabilities can be a

significant development of school refusal. Some common causes for school refusal are: An ill

parent (Surprisingly, school refusal can begin after the parent recovers) Parents separating,

having marital problems, or having frequent arguments, a family members death or the childs

friend;Moving from one house to another during the first years of elementary school, jealousy

over a new infant sibling; excessive parental worrying about the child in some way (for example,

poor health), bullying is unwanted aggressive behavior among school-aged children involving a

real or perceived power imbalance that is repeated or has the potential to be repeated over time.

bullying can include threats, intimidation, and/or attacking someone physically or verbally and

can also be a cause of school refusal (Mersch, 2016). Psychologists used comprehensive

treatment of school refusal which includes psychiatric and medical evaluation, when

appropriate, are important for students since studies show that psychiatric disorders are the

cause of a large percentage of students who fail to complete high school in the United States

(Mersch, 2016).

As previously stated the following are non-medicated treatments : Cognitive behavior

therapys goal is to change the mindset the student has and help them work through the problem,

Systematic desensitization technique teaches the child the proper way to react to going into the
I Dont Want To GoWould You? Turner 6

school environment, Exposure therapy goes through a series of exposing the child to the

environment that causes them distress until they can function.

Medication can be used in cases of students with underlying mental health issues such as

depression, anxiety, and school phobia. The goal of treatment for the patients is to help the

student to restructure his or her thoughts and actions into a more assertive and adaptive

framework to allow a rapid return to school (Mersch, 2016). Different forms of therapy

include: Therapeutic techniques include modeling, role-playing, and reward systems for positive

behavior change. Play therapy for younger, less verbally oriented children helps to reenact

anxiety-provoking situations and master them. Interpersonally oriented individual therapy, as

well as group therapy, can be extremely helpful for adolescents to counteract feelings of low

self-esteem, isolation, and inadequacy. This form of therapy centers on the person's

maladaptive responses to interpersonal interaction (usually involves difficulty in interactions

with other people) (Mersch 2016). The goal of these treatments is a faster turnaround for

students returning to campus. Physicians should avoid writing excuses for children to stay out of

school unless a medical condition makes it necessary for them to stay home (Fremont, 2003).

When a child first presents school refusal the also show physical symptoms, the physician may

need to explain that the problem is a manifestation of psychologic distress rather than a sign of

illness (Fremont, 2003).

Principal John stated in her interview that the best way to help a student is connect

home, school and community to ensure that the child is consisting getting the help they need.

With a student in her school she would send letters to the house addressed to the student to let
I Dont Want To GoWould You? Turner 7

them know that someone cared about them and that they were missed. With this one kind act she

was able to help one child feel like they can overcome their feelings of school refusal and now

this child is consistently in school. Mr. Foster, a private practice psychologist, has always

worked with the baltimore county school system with his patients and he said it is different

because the resource are not the same for the students. It had been shown through these two

interview and the other six that there is a connection and that school counselors and private

practice psychologist should work together to find a solution.

Mrs. Miller, school social worker, stated during her interview that during her time in her

elementry school she has seen cases where the child was not clinicly dignosed with seperation

anxeity but the child has shown the symptoms and sometime the parents will have to stay at

school with them. This proves that in the mental health field separation anxiety and school

refusal are directly connected. Studies of children who, in first grade, present with significant

symptoms of anxiety (enough to cause clinically significant impairment in social and academic

functioning) reflect a correlation with significant impairment in reading and math achievement

5-6 years later. (Bernstein, 2016 ). Studies indicate that students who have been treated for

school refusal because of separation anxiety reveals some children have continued to show signs

of social struggles in different environments. School can help deal with this problem by creating

a welcoming environment for students. In addition, teachers and school staff should help the

student identify and recognize the triggers for school refusal (Mersch, 2016). If the school

successful with helping children to identify their triggers, ultimately the child could manage the

anxiety by better controlling the impact of the triggers. Zero tolerance for bullying, available
I Dont Want To GoWould You? Turner 8

guidance staff, and opportunities to practice relaxation techniques can significantly reduce

anxiety (Mersch, 2016).

There is a direct connection between separation anxiety and school refusal. The research

proves that although the disorders are different. Research has also shown ways that schools can

be an effective tool in the management of the disorders by making the environment better for

students. After researching, schools can learn more about the challenges that students go through.

Start to learn, educate and live what has been taught. Mrs. Kasuda stated in her interview a few

ways school can help decrease school refusal is by increase support personnel, provide

parent/teacher with signs and symptoms of anxiety, provide morc engagement activities

inside/outside the school setting (additional groups, sports activities, classes, clubs, etc),

encourage staff to build relationships with all students. This is a charge to all professional to

learn more about this subject because their is a direct connection and it could be the reason some

of your students are not present in school right now.

References

Bernstein, B. E. (2016, October 6). Separation anxiety and school refusal (M. L.

Windle & C. Pataki, Ed.). Retrieved February 27, 2017, from Medscape

website: http://emedicine.medscape.com/article/916737-overview

Estroff Marano, H. (2004, June 9). Psychology today. Retrieved March 16, 2017,

from Psychology Today website: https://www.psychologytoday.com/articles/

200411/nation-wimps
 I Dont Want To GoWould You? Turner 9

Fremont, W. P. (2003, October 15). School refusal in adolescents and children.

Retrieved December 12, 2016, from American academy of family physicians

website: http://www.aafp.org/home.html

GALE science in context database. (Accession No. GALE|A78917402) Pellman, H. (1998, May).

School daze. Pediatrics for Parents. Retrieved from

GALE science in context database. (Accession No. GALE|A78917402)

Mersch, J. (2016, January 1). School refusal (J. R. Balentine, Ed.). Retrieved

November 29, 2016, from emedical health website:

http://www.emedicinehealth.com/school_refusal/

page3_em.htm#how_is_school_refusal_treated

Pellman, H. (1998, May). School daze. Pediatrics for Parents. Retrieved from

Pozzi, G., Bruschi, A., De Angelis, A., Pascucci, M., Hatzi Giakoumis, D. S., Grandinetti, P.,

...Janiri, L. (2014). Adult separation anxiety and TCI-R personality dimensions in patients with

anxiety, alcohol use, and gambling: a preliminary report. BioMed Research International.

Retrieved from

http://ic.galegroup.com/ic/scic/AcademicJournalsDetailsPage/AcademicJournalsDetailsWindow?
 I Dont Want To GoWould You? Turner 10

Shank, T., Ph.D. (2017, January 10). [Personal interview by the author].

Walkup, J. T. (n.d.). Best medications for kids with anxiety. Retrieved March

16, 2017, from Child Mind Institute website: https://childmind.org/article/

best-medications-for-kids-anxiety/

WebMD (Ed.). (n.d.). Separation anxiety in children. Retrieved February 25,

2017, from WebMD website: http://www.webmd.com/children/guide/

separation-anxiety#1