Episode Transcript

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

With summer coming to an end, it’s time for a new school year. Although this is exciting for some kids, being back in the classroom can also be nerve-racking. So how do you make sure that school anxiety doesn’t turn into school avoidance?

This week, I spoke with returning guest Dr. Anne Marie Albano, co-clinical director for the Center for Youth Mental Health at NewYork-Presbyterian and a child psychologist at Columbia. She talked about the reasons behind school avoidance and the best steps for supporting children when school refusal becomes an issue.

Faith: Dr. Albano, thank you so much for joining us.

Dr. Albano: It’s my pleasure to be here. Thank you.

Faith: Would you talk a little bit about school avoidance? How, how early does it start?

Dr. Albano: This is a big thing and I wanna put it out there as avoidance of almost anything that would be reasonable and typical for a child’s age, with school avoidance being the number one thing we see in kids, starting at about five years of age all the way through college. School avoidance happens to about 5% of youth for reasons of anxiety or depression.

When it comes to anxiety or depression, school avoidance is the inability to go to school, or stay in the classroom because your internal feelings of feeling hopeless, uh, feeling depressed, feeling anxious, worried, scared, are overwhelming to you, so staying home relieves you of those feelings. And so kids start to, first they ask to go to the nurse, whatever it is to get out of class because whatever is happening, test anxiety, it could be worry about what other kids think, it could be fear of failing tests, could be such a range of things.

Faith: And what about bullying?

Dr. Albano: Now I always have to say, Faith, that we do have to listen carefully for bullying — active bullying and peer rejection, humiliation experiences, things like that will contribute to a youth’s wanting to avoid school.

And when it becomes bad, they are staying home. The parents might fight with them for a bit, but the older the youth gets, the harder it is to get them in.

It really is a problem that’s been on the rise since the pandemic. It’s always been there, but it’s gotten worse and we struggle with early identification when kids are young to try to work with parents to turn it around when they’re young, cuz it’s much harder when they are older.

Faith: And you said parents could see this as early as five when kids are going into kindergarten?

Dr. Albano: Yeah. The things we want parents to watch for always is avoidance behavior. Does your child avoid separating from you to stay with a babysitter or even another, a relative, the grandparents, anyone? Do they not wanna separate to go to school?

And you find yourself bargaining with them and also the school personnel. Well, mom or dad is gonna sit in the cafeteria while you’re in school, there’s so many different things that parents do to accommodate this to help their child, wanting to get them into school, but it can break down over time because it’s driven by their internal anxieties and we need to know what those anxieties are so we could help treat them.

Faith: And it sounds like sometimes they don’t even know, they wouldn’t even be able to name them unless we help them.

Dr. Albano: That’s right. I was at a panel back in the fall, a youngster with school avoidance behavior had had it from the time he was seven years of age, six years of age. He said he didn’t have the words to express when he was younger, what he was experiencing.

He knew he wanted to go to school. He got there, but then he froze because of various kinds of social anxieties, but he didn’t know how to express that. And that became so frustrating to him. He didn’t get early intervention is the point, that sometimes we need a professional to help work with the children, to be able to identify the things that they are afraid of or the things that they are upset by in the school and then get them help.

Faith: What does intervention and help look like in this case?

Dr. Albano: It’s a collaboration between the therapists, the parents, the school, and the child. And here, intervention helps your child to develop age-appropriate skills for managing uncomfortable situations in behavior.

We teach them how to manage difficult emotions and physical sensations, and develop real good coping resources. Problem-solving, communication. At the same time, we’re helping the parents learn how to approach behavior, reinforce for the child self-regulation of these feelings, but then going into the situations and learning how to manage them for themselves so the parents become real good coaches and also cheerleaders for engaging.

I just wanna say the school and the parents working together on this is quite important. And we have ways that we work with them and do sort of a, a plan for making it a little easier on the child until they get used to it a little bit over the course of a couple weeks, and then the child is on their own in school and things should be sailing a bit better.

This is why when it comes to things going on in the schools, whether it’s bullying that leads to school avoidance or school avoidance by itself for whatever reason, it is so important that the school personnel partner with the families to listen to the kids and then to think about, okay, what solutions are real and meaningful here for this child?

Faith: Could you offer us a script for adults who want to start a difficult conversation with their kids, but maybe don’t know how to begin?

Dr. Albano: One of the things we say is you’ve gotta catch them at a moment when they’re just sitting quietly somewhere and just sit down and just say, “How have you been doing?” You might get nothing the first several times you ask it. Or you might get like, you know, a cold shoulder in some way, cuz they might not be used to that. Just be calm. Just say, okay, give him a pat on the knee and move on, but do it again at another time.

Faith: If your kid is saying something that’s terrifically hard to hear, what are some helpful ways to respond in those, in those super high stakes, devastating situations?

Dr. Albano: So when your child comes back at you with an emotionally charged response, “I hate you, you don’t understand, leave me alone.” What you have to do, first thing is you really have to stay calm inside and out.

You have to breathe through that and you just, you’ve gotta look at them and you have to say, “I’m sorry you feel that way. I’m sorry you feel down on yourself.” Or you know, “I hear that you’re angry at me.”

And by saying, “I, I’m listening. I hear that you’re angry at me,” you are giving them permission to express the emotion. You’re not getting defensive. You’re not telling them how to feel. You’re allowing them to express themselves, and that’s the surface expression that they have in the moment, and it’s gonna give them permission to talk about what got them to say that, that they’ve not felt understood or they’re embarrassed to tell you things that have been going on, or that they feel they’re failing left and right, whatever it may be. It’s important just to reflect back what you hear. That opens the door for them to give you more.

And if you are non-judgmental with your youth as they are growing, you will hear about higher risk situations. They’ll be more comfortable telling you about this, so then you can, as a family, as parents and youth, you can talk about how to manage better and not be in such risky situations and take care of yourself.

Faith: Dr. Albano, thank you so much for sharing these insights with us.

Dr. Albano: My pleasure to be here.

Our many thanks to Dr. Chiti Parikh

I’m Faith Salie.

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