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Dealing with Children on the Autism Spectrum Who Refuse to Go to School

Has your ASD (high functioning autistic) child given you some indication that he is nervous about starting back to school?  He may have even said, “I’m not going!!!”

What youngster hasn't dreaded September, the end of summer and the return to school – but for many ASD students, the prospect of school produces a level of fear so intense that it is immobilizing, resulting in what's known as school-refusal behavior. Some children with autism spectrum disorder have been known to be absent for weeks or months. 

Some may cry or scream for hours every morning in an effort to resist leaving home. Others may hide out in the nurse's office. Some children who miss school are simply truant (i.e., they'd just rather be doing something else), but sometimes there are genuine reasons to fear school (e.g., bullying, teasing).

Anywhere from 5% to 28% of kids will exhibit some degree of school-refusal behavior at some point, including truancy. For children with anxiety-fueled school refusal, the fear is real and can take time to overcome. Families may struggle for months to help an autistic youngster get back into the classroom. Ignoring the problem or failing to deal with it completely can lead to more-serious problems later on. Individuals who experience school-refusal behavior and anxiety disorders in childhood may face serious ramifications in adulthood.

Psychologists say and studies show the following:
  • Alcohol, drug use: A study of kids ages 9 to 13 with an anxiety disorder showed that those who still had the disorder seven years after treatment drank alcohol more often and were more likely to use marijuana than those whose disorders had resolved.
  • Depression: Teens and young adults ages 14 to 24 that had social anxiety were almost three times as likely to develop depression later on than those without the anxiety disorder.
  • Different life choices: Psychologists say they've seen young people with persistent anxiety make fear-fueled choices that can have long term effects, such as selecting a less-rigorous college or a less challenging career.
  • Psychiatric treatment: A study of school-refusing kids showed that about 20 to 29 years later they received more psychiatric treatment than the general population.

School refusal affects the entire family. If a child doesn't go to school, it may be hard for a parent to keep her job. Children are at heightened risk when starting a new school, and especially when entering middle school. It is the perfect storm with the onset of puberty, a huge transition and a chaotic academic environment.

Well-meaning moms and dads can make things worse by allowing an anxious youngster to miss school. Such an accommodation sends the message that school is too scary for the youngster to handle and the fear is justified. Overprotective moms and dads rush in way too quickly to shield their Aspie from any experience that creates distress.

Untreated, a youngster on the spectrum with school-refusal behavior is likely to fall behind academically, which can then lead to more anxiety. And there may be longer-term consequences. A 1997 study followed 35 students (ages 7-12) treated for school refusal. Twenty years later they were found to have had more psychiatric treatment and to have lived with their parents more often than a comparison group.

Some ASD teens with unresolved anxiety may go on to self-medicate with alcohol and drugs. A 2004 study followed 9- to 13-year-olds who were treated for an anxiety disorder. Seven years after treatment, those who still had the disorder drank alcohol more days per month and were more likely to use marijuana than those whose disorder had resolved.

Children with school-refusal behavior may have (a) separation anxiety (i.e., a fear of being away from their moms and dads), (b) a social phobia (i.e., an inordinate fear of being judged), or (c) a fear of being called-on in class or being teased. A specific phobia (e.g., riding the bus, walking past a dog, being out in a storm, etc.) may be present as well. Other kids are depressed, in some cases unable to get out of bed.

Because many children complain of headaches, stomachaches or other physical symptoms, it can be difficult to tell whether anxiety, or a physical illness, is to blame. (Note: Anxiety-fueled ailments tend to disappear magically on weekends.)

Autistic kids with school refusal may complain of physical symptoms shortly before it is time to leave for school or repeatedly ask to visit the school nurse. If the youngster is allowed to stay home, the symptoms quickly disappear, only to reappear the next morning. In some cases, the child  may refuse to leave the house. Common physical symptoms include headaches, stomachaches, nausea, or diarrhea. Tantrums, inflexibility, separation anxiety, avoidance, and defiance may show up, too.

Starting school, moving, and other stressful life events may trigger the onset of school refusal. Other reasons include the youngster’s fear that something will happen to a parent after he is in school, fear that she won’t do well in school, or fear of another student. Often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age kids. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school. Kids who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.

What Can Parents Do?

The most important thing a mother or father can do is obtain a comprehensive evaluation from a mental health professional. That evaluation will reveal the reasons behind the school refusal and can help determine what kind of treatment will be best. Your youngster’s pediatrician should be able to recommend a mental health professional in your area who works with kids on the spectrum.

The following tips will help you and your Aspie develop coping strategies for school anxieties and other stressful situations:
  • Arrange an informal meeting with your youngster’s teacher away from the classroom.
  • Emphasize the positive aspects of going to school: being with friends, learning a favorite subject, and playing at recess.
  • Encourage hobbies and interests. Fun is relaxation, and hobbies are good distractions that help build self-confidence.
  • Expose kids to school in small degrees, increasing exposure slowly over time. Eventually this will help them realize there is nothing to fear and that nothing bad will happen.
  • Help your Aspie establish a support system. A variety of people should be in your youngster’s life—other kids as well as family members or educators who are willing to talk with your youngster should the occasion arise.
  • Learn about your Aspie’s anxiety disorder and treatment options. For more information about school refusal and kid’s anxiety disorders, type "anxiety" and/or "school problems" in the search box at the top of this page.
  • Meet with the school guidance counselor for extra support and direction.
  • Talk with your Aspie about feelings and fears, which helps reduce them.
  • Try self-help methods with your Aspie. In addition to a therapist’s recommendations, a good self-help book will provide relaxation techniques. Be open to new ideas so that your youngster is, too.

Treatment—

Cognitive behavioral therapy (CBT), in which clients learn to change negative thoughts and behavior, is the main treatment for school-refusal behavior and the anxiety disorders that often underlie it. The primary technique is exposure therapy, where children gradually face and master their fears.

CBT is very effective. Recent studies have shown that about half to 70% of children with anxiety disorders treated with CBT will have a significant improvement in function and decrease in their symptoms. Some specialized school-refusal clinics have success rates that are even higher.

Antidepressants such as Zoloft (sertraline) or Prozac (fluoxetine) are often prescribed for kids with anxiety disorders, although their use in kids is controversial.

Psychologists stress the importance of seeking treatment quickly—after as little as two weeks of missed school. The longer they've been out of school, the poorer the prognosis.
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