Areas of Specialization - Children and Adolescents
School Refusal
Emma is a nine year old
girl who continuously has
had difficulty attending school.
Her behavior has significantly
worsened since beginning fourth
grade. Emma cries and pleads
with her mother every morning
before school to stay home
and she becomes angry and
physically aggressive toward
her mother when she insists
that Emma get dressed and
eat her breakfast. Her tantrums
have frequently caused her
to miss the bus and she has
been late to school more days
than not. When Emma arrives
in her class she immediately
complains to her teacher that
she has a sore throat, headache
or stomachache. Consequently
her teacher sends her to the
school nurse who permits her
to call her mother. Emma's
mother usually picks her up
early from school approximately
two times a week because she
frequently feels guilty that
Emma may be sick or she is
suffering emotionally. When
Emma returns home early from
school she watches television,
plays with her toys, or accompanies
her mother to lunch with her
friends. Emma will call her
mother's cell phone throughout
the day when she does not
pick her up early from school.
The phone calls typically
last only a couple of minutes
with Emma checking in with
her mother that everything
is okay and nothing bad has
happened at home. At her last
parent-teacher conference,
Emma's teacher expressed concern
that she had missed a significant
amount of class time resulting
in incomplete assignments,
unfinished homework and poor
test grades as she has fallen
behind her classmates.
Nicholas is a 15 year old
boy who missed 37 days of
school since beginning high
school. On days that he stays
home from school, he sleeps
late and spends the day on
the computer or listening
to music in his room. Nicholas'
teachers report that when
he is in class he seems distracted,
he never raises his hand or
interacts with his classmates.
He is usually late for school
as he avoids hanging out with
other students before class,
frequently cuts gym class
and he never eats lunch in
the cafeteria since he spends
this time in the library by
himself. His teachers additionally
report that they notice a
pattern of absences on days
when a test or oral report
is scheduled. Last week, Nicholas
had detention because he cut
his Spanish class on the day
the teacher gave an oral quiz.
Nicholas' parents have already
grounded him for failing grades
last quarter but this did
not result in improved grades
or increased school attendance.
Nicholas' parents have requested
that he receive home tutoring
as they are concerned about
his grades and their effect
on his college applications.
They wondered whether he should
be transferred to a private
school but question whether
the school is the problem
since his truancy dates back
to the start of junior high
school. |
Although several behaviors characterize
children and adolescents who refuse
school, a few variables serve
to cause and maintain this problem.
Psychologists (Albano and Kearney,
2000) explain school refusal in
terms of principles of reinforcement.
Children and adolescents may refuse
school to avoid or escape something
unpleasant- negative reinforcement.
For example they may avoid situations
that create anxiety, depression,
or physiological symptoms or escape
uncomfortable peer interactions
or academic performance situations
such as playing sports or taking
tests. Referring back to the case
examples, the reason for Emma's
crying in the morning is her fear
of riding on the school bus. When
Emma has a tantrum she accomplishes
her goal of avoiding the distressing
experience of riding the school
bus. Nicholas is another example
of negative reinforcement as he
escapes uncomfortable social interactions
and aversive tests by refusing
to attend school. In addition,
children and adolescents refuse
school as a means of gaining attention
or rewards – positive attention.
Emma, like many youngsters, uses
her school refusal as a means
of having her mother provide her
with extra attention and closeness.
Similarly, Nicholas partially
avoids school because it is more
fun being at home playing on the
computer and listening to music
than doing work. Thus it is crucial
that children and adolescents
who are refusing school receive
a comprehensive evaluation to
understand the multiple emotional
and behavioral difficulties contributing
to this problem. Once a clear
diagnostic picture is established,
an individualized treatment plan
can be developed to address the
positive and negative reinforcers
that are associated with the school
refusal and any emotional/behavior
disorders.
Describe
treatment >>
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