[LUM#5] When School Is Scary
The very idea of going to class makes them literally sick, to the point that they sometimes end up dropping out of school. To help these children suffering from “anxiety-related school refusal,” the Montpellier University Hospital is offering a groundbreaking treatment program.
After a weekend of feeling great, your child suddenly feels under the weather just as it’s time to go back to school. Headaches, stomachaches, nausea. While this “I don’t want to go” syndrome may seem fairly common, it can become a serious concern for some children, to the point where they no longer feel able to pick up their backpack and go to class. A fear of school that can even lead to dropping out and leaves parents feeling helpless. “We refer to this as ‘anxious school refusal, ’”explains Dr. Hélène Denis ( Anxious School Refusal, in Enfance et psy, 2005). At the Montpellier University Hospital, the child psychiatrist has developed a unique approach to treat these children and gently but surely get them back on the path to school.
“We’re not dealing with poor students or children who don’t want to go to school,” explains Hélène Denis. “On the contrary, most of them are hardworking students who want to do well and really want to go back to class.”And if they can’t manage it, it’s because they’re overwhelmed by anxiety. The majority of young patients treated in the CHU’s child and adolescent psychological medicine department are between 11 and 16 years old, “the age when major anxiety disorders typically emerge.”
Performance stress
What scares these children?“Anxiety can take many forms,” replies the child psychiatrist. Some suffer from separation anxiety; they have a hard time being away from their parents, even just to go to school. Many also admit to being afraid of judgment from those around them and avoid school to avoid facing the stares of others.“We’re also seeing more and more children who experience performance anxiety and put a lot of pressure on themselves regarding their academic performance,” explains Hélène Denis, who notes that many of her young patients come from private middle schools where the pressure to perform is often greater.
Experts estimate that school-related anxiety affects 5 to 28% of children and adolescents during their school years. This figure has been rising in recent years. According to the child psychiatrist, “this is indicative of a society that is struggling and becoming a source of anxiety. From a very early age, we send children the message that they have to work hard to get a job—what pressure! Parents themselves are often under pressure and stressed, which doesn’t help matters.”Finally, the specialist points the finger at the teaching methods used in middle schools today: educational approaches designed for everyone, but which don’t necessarily suit everyone.“Some children don’t fit in, and that exacerbates their anxiety.”
Cognitive-Behavioral Therapy
For children whose anxiety prevents them from attending school, Hélène Denis and her colleagues have developed a specialized program.“When children can no longer attend classes, their schooling takes place within the hospital, where they receive instruction from a certified teacher.” At the same time, the medical staff works with them on specific cognitive and behavioral therapy.“The goal is to help them understand how anxiety works and teach them techniques to better manage it.” Relaxation, breathing exercises, and role-playing are all methods that allow them to gradually come to terms with their anxieties so they can better face and overcome them.
Regain confidence
Although these therapies are still rarely used in child psychiatry, the method has proven effective. Over the past 10 years, Hélène Denis’s department has treated about 50 children, all of whom returned to full-time school the following year.“The return to school happens gradually after 2 to 6 months of therapy. We work closely with the school to facilitate the transition,”she explains. The transition is a smooth one: the student is accompanied by a nurse from the unit, returns to the class of their choice, sits in the seat they prefer, and is assured they will not be called on for oral questions. They gradually reintegrate fully into their class.
“The students don’t even have to repeat a grade because the classes offered by the program have helped them stay on track and, in the case of ninth graders, even pass their middle school diploma exams,”explains the child psychiatrist. The students continue to receive follow-up care throughout the year to build their self-confidence.“Little by little, they’re rebuilding normal relationships with school—that’s what success looks like,” says Hélène Denis with delight.
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