Predictable stages
While children can have trouble with anxiety at any time during their school lives, there do seem to be certain ages that routinely pose more difficulty than others. The first problem time is often in Grade 1. The transitions both from half-day at school to full-day, and from running around and playing to sitting at a desk, are exhausting for many children. Almost all kids in the age group go through periods of being difficult, cranky and overwhelmed.
Another potential trouble time is Grade 7, when children typically move away from their elementary schools. At this point, more of the problems are social rather than academic. "Often it is related to something really unpleasant – not necessarily bullying but being ostracized, teased, not fitting in, having a terrible hurt with respect to someone of the opposite sex," explains Janet Morrison, a child psychoanalyst in Toronto. "Children between 12 and 15 are so intensely and painfully self-conscious. They think everybody is judging them all the time-the whole world is looking at them."
Morrison has known children who have not been able to go to school for days because of a skin breakout or because their clothes aren't cool enough. "The rules are changing," she says. "It's not just about doing what your mother or your teacher tells you. It could be specifically about not doing what they tell you. You're not known as part of your family anymore. You have to be able to cut it on your own." The challenge – and it's enormous if you're a 12- or 13-year-old is to be uniquely important and to stand out, but to stand out in just the right way.
But in Morrison's mind, it is the 14-year-old who has it the worst. It's the culmination of self-consciousness and it's the beginning of real pressure to be dating and to be cool. "Everybody feels the pinch to be having a kiss, to be having a joint, to be having a beer," says Morrison. "Kids who are busy can ignore it for a couple of years, but by 14 you really can't."
On top of all of the social pressure for many kids are concerns that may be difficult to pinpoint. Sharon Dembo is director of the Toronto-based Child Psychoanalytic Program. Recently, she saw a teenager who was a high achiever at school but who became increasingly less able to get herself to school every day. As a result, she was unable to do the work required of her and was in danger of failing high school. "I wouldn't categorize that person as anxious per se," says Dembo, "but at that teenage level I saw it more as an unwillingness or fearfulness of growing up, of becoming independent."
"Don't undermine the symptoms, rather, address the issues."
In fact, school refusal can often be a side effect of an anxiety around something happening in the family. That may occur during a divorce or around a parent's illness, which may make the child reluctant to leave home. It may also happen after a prolonged period of togetherness as a family, including summer holidays, or following a stressful change such as a move or change in school. One teenager Dembo treated simply folded because of the overwhelming amount of work that was required. "These can be very, very bright children; they just get overwhelmed with the workload they have so they can't commit to finishing anything," she explains. "They're at risk of dropping out if they're not supported." And of course bullying may be at the root of school anxiety and refusal.
The ultimate transition for many kids is between high school and university. And as Morrison says, it's often the kids who have 'behaved' the best and who have had a seemingly smooth school life who have the most difficulty making the change "They haven't developed any independence at all," says Morrison. "They haven't rebelled. They have no idea who they are." Being on their own for the first time can be very stressful for kids, particularly for those who haven't developed an identity separate from their parents.
