When your child refuses to go to school, here’s how to respond

 

The start of the school year is full of firsts, including the first dreaded back to school virus — or is it? Often a child’s complaints of illness can be attributed to a physical cause, but sometimes when a child is complaining of a headache or a stomach-ache, that pain could be the physical manifestation of his or her stress and or anxiety. This is the case for up to 5% of children each year who refuse school. So how do parents determine if that stomach-ache is the result of a bug or the result of anxiety or other emotional concern?

The connection between mental and physical health is well documented. The cause of an ailment such as a headache or stomach ache can sometimes be purely physical or purely mental, but it's more often a little of both. Research has shown that stress in children and adults can contribute to physical symptoms as well as the exacerbation of current ailments. It is estimated about 10% of children will complain of pain or illness during the school day, and stress-induced ailments in adults have continued to increase.

In psychology, the term somatization describes how emotional causes contribute to physical symptoms in both adults and children. It’s fairly common; Think about the last time you had a bad day at work and came home with a headache, or were really nervous before a flight and felt stomach pain. Additionally, when experiencing minor discomfort, some individuals may hyper-focus on the discomfort, which can exacerbate those symptoms. For example, a child may be experiencing the usual “butterflies” in the stomach associated with the first day of school, but he or she may become so focused on that sensation that the severity of the symptoms increases.

So, how can you tell whether your child refuses school because of a purely physical ailment, or if there is an emotional component contributing to that ailment?

First, always rule out a medical concern. Remember that a child’s description of their physical pain is real and should not be discounted, but try to further explore its cause. Ask your child questions about school, their friends, teachers, their upcoming math test, who they sit with at lunch, and who they play with at recess. Additionally, write down the times and events when your child is complaining of pain and illness — is it in the morning before school? Are there complaints on the weekends? If your child is refusing school, it may also be helpful to speak with the school psychologist to further explore an underlying emotional issue.

Also, try to determine if your child is contributing to his or her ailment by ruminating over it —often, the stories we tell ourselves can contribute to our anxiety about an illness. If you’ve ever consulted “Dr. Google” for a physical ailment and started to think about all of the potential causes, you’ll understand that children have similar thought patterns. It’s important to determine with your child if that is the case, and clear up any of these fears with developmentally appropriate information. If you think your child may be experiencing pain due to nervousness, be sure to normalize that pain and explore with them potential causes.

Lastly, there is a delicate balance between reassuring your children that they are safe and well, and providing so much reassurance that it begins to feed the anxiety. Children who constantly ask to go to the doctor for minor ailments, or insist they have some sort of disease (when you have ruled out that they don’t) may be engaging in reassurance seeking to decrease the anxiety. This practice may initially decrease anxiety for the short term, but ultimately results in feeding a vicious cycle of increasing his or her anxiety. Acknowledge your child’s physical sensation, help them identify the emotions around them, assure them they are safe, and then engage in other activities in an attempt to distract. They will take your lead. If you are anxious they will be anxious.

The origin of pain and illness is complex and can often have emotional components at their roots. By helping your child identify what is truly a physical ailment, and what is a physical response to stress is or anxiety, can help them cope with their stressors in healthy and productive ways.

Jessica Glass Kendorski is an associate professor and chair of the department of school psychology at the Philadelphia College of Osteopathic Medicine (PCOM).

Jessica Kendorski, PhD, NCSP, BCBA-D | @DrJessKendorski | healthykids@philly.com

PERSONAL HEALTH : The Crisis in Youth Suicide

 

Too often, suicide attempts and deaths by suicide, especially among the young, become family secrets that are not investigated and dealt with in ways that might protect others from a similar fate.

By Jane E. Brody

The death of a child is most parents’ worst nightmare, one made even worse when it is self-inflicted. This very tragedy has become increasingly common among young people in recent years. And adults — parents, teachers, clinicians and politicians — should be asking why and what they can do to prevent it.

In October, the Centers for Disease Control and Prevention reported that after a stable period from 2000 to 2007, the rate of suicide among those aged 10 to 24 increased dramatically — by 56 percent — between 2007 and 2017, making suicide the second leading cause of death in this age group, following accidents like car crashes.

“We’re in the middle of a full-blown mental health crisis for adolescents and young adults,” said Jean M. Twenge, research psychologist at San Diego State University and author of the book “iGen,” about mental health trends among those born since 1995. “The evidence is strong and consistent both for symptoms and behavior.”

Along with suicides, since 2011, there’s been nearly a 400 percent increase nationally in suicide attempts by self-poisoning among young people. “Suicide attempts by the young havequadrupled over six years, and that is likely an undercount,” said Henry A. Spiller, director of the Central Ohio Poison Center, who called the trend “devastating.” “These are just the ones that show up in the E.R.”

Had any other fatal or potentially fatal condition leapfrogged like this, the resulting alarm would surely have initiated a frantic search for its cause and cure. But too often suicide attempts and deaths by suicide, especially among the young, become family secrets that are not investigated and dealt with in ways that might protect others from a similar fate.

“We’re at a point now where this issue really can’t be ignored,” said John P. Ackerman, clinical psychologist and coordinator of suicide prevention at Nationwide Children’s Hospital in Columbus, Ohio. “We invest heavily in crisis care, which is the most expensive and least effective means of preventing suicide.”

He proposed instead that more time and money be spent “on identifying kids who are most vulnerable, helping them respond effectively to stress, and teaching them what they can do in a crisis. And we need to start early, in the elementary grades. We haven’t even begun to use the resources that we know work. We have to be proactive.”

In Ohio, he said, “about 40,000 students have been screened for depression and suicide risk, and hundreds of kids have been linked to services. It’s not putting ideas in their heads to ask directly whether they’ve had thoughts of suicide or dying. That doesn’t increase their risk. Rather, it’s relieving. You actually reduce the risk if you help kids talk through these difficult feelings.”

Although no one can say with certainty why suicide has become such a crisis among the young, experts cite several factors that parents, schools and others might be able to modify or control. Dr. Spiller, for example, attributes the rise in suicide attempts largely to the effects of social media and how teens and young adults communicate with their peers.

“Kids now never disconnect,” he said. “They’re connected 24/7. They go to bed with their smartphones. It may be cyberbullying. It may be envy. Maybe many things are going on here.”

One thing the research didn’t find was a link of teen suicides to the opioid crisis. Instead, in school-age adolescents, it found a rise in suicide attempts during school months — September until December, then again January through May — that doesn’t happen in adults.

The rise in attempted and completed suicides by young people correlates directly with their access to smartphones, Dr. Twenge said. “Developmentally, these ages have always been difficult, but that’s been taken to the next level by smartphones, social media and the constant pressure to be online.”

“Eighty-five percent of teens are looking at social media,” she said. “There’s less face-to-face time spent with friends. It’s now the norm to sit home Saturday night on Instagram. Who’s popular and who’s not is now quantifiable by how many people are following you. Kids are spending as much as eight hours a day on social media, where there’s a lot of negativity, competition and jockeying for status and unfiltered access to sites that tell them how to harm themselves.”

Dr. Ackerman, who noted that “young brains are less adept at dealing with complex situations,” likewise believes social media plays an important role in the suicide crisis among the young. But he sees the problem more broadly and said there is a need for schools to help counter it. Staff can be trained and screening done within schools, he said.

“Ultimately it’s a combination of economic, social and technological factors that come together along with family and school issues, and kids are less equipped to tackle these problems,” he said.

Sleep, or rather, not enough of it, is another issue undermining the resilience of today’s teens.

Several studies have found a link between “problematic internet and social media use and sleep disturbance among youth,” and that “these associations contribute to depressive symptoms in this group,” Dr. Twenge and co-authors reported in the Journal of Abnormal Psychology.

“Two surveys have shown that teens are not sleeping enough, and having a smartphone in the bedroom results in less sleep and poorer quality sleep,” she said. “It’s too tempting to stay up late looking at the phone, and the blue light it emits keeps the brain thinking it’s daytime. Almost everything done on devices is psychologically stimulating. The brain can’t slow down and relax.”

Her advice: “Avoid looking at devices within an hour of bedtime, and buy an alarm clock. It’s not the technology itself that’s the problem — it’s how we use it. We have to use it more mindfully.”

She urges parents to set reasonable limits about kids’ use of technology. Setting such limits is “not only good for kids, but they appreciate it in the long run,” she said. She noted that modern smartphones have parental control systems built in and parents can set kids’ phones to shut down at 9 p.m.

Experts also urge parents to check in with their teenage children regularly, asking how they’re feeling and whether they ever think about dying. “As early as elementary school, children can have responsible conversations about suicide,” Dr. Ackerman said. “We need to prepare young people to talk about their emotions early in life.”

He and others also emphasized the importance of controlling access to possible means of suicide, which they note is most often an impulsive act. Youngsters should never have uncontrolled access to guns, drugs or other substances that can result in a fatal overdose.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources​.