The New York Times recently published an important and timely story highlighting the growing absenteeism in our schools. In particular, the story cites the COVID-19 pandemic as a driver of the increase in missing school, noting that before March 2020, only about 15% of children missed school on a regular basis, school refusal. Within a year, that number had nearly doubled, and has not changed much since.
The story, entitled “A Crisis of School Absences”, offers an intriguing parallel between school refusal and the enormous increase in working from home during the past few years. The theory seems to be that we have acclimated to being at home and found that we can get done what we need to get done without getting dressed and leaving the house, whether in school or at work. The article suggests that this phenomenon makes school seem more superfluous to more students and parents:
“But underlying it all is a fundamental shift in the value that families place on school, and in the culture of education during the pandemic.
“Our relationship with school became optional,” said Katie Rosanbalm, a psychologist and associate research professor at Duke University.”
This is the core argument the Times presents, that our relationship with school has become optional and families place a diminished value on attendance.
In part, I agree. Many students who had never considered missing a day of school, barring sickness or other emergency, are definitely more open to doing so in the wake of the pandemic. Thus the wildly significant increase in absenteeism, and what those of us in my profession call school refusal. In the Times piece, the idea that mental health might drive the lion’s share of absenteeism in school is effectively dismissed, not a focus of the article at all.
They got this part wrong, and this part is super important.
What’s really going on
The experiences of myself and my colleagues would suggest something very, very different has actually been taking place. And it started long before the pandemic. The differences are critical and worth noting.
First, families are absolutely not placing a decreased value on school attendance. That is not the phenomenon at play here, and the assumption is dangerously dismissive. In fact, I find that many parents and students feel an increase in the importance of school attendance over the past few years, a reflection of the anxiety they feel that they might be missing out or falling behind.
Instead, the pandemic just highlighted and amplified a long-standing situation we have been dealing with culturally and psychologically for years, well before March 2020, as anxiety and depression have spiked among our teenagers.
School refusal first showed up as a phenomenon and diagnostic category in my practice more than a decade ago. Before then, even the most anxious and depressed of my young clients were attending school on a regular basis, many of them struggling through those days just getting by. Many have shared with me that learning and socializing were distant seconds to simply surviving the day emotionally.
I would be remiss here if I did not note that I was one of those highly anxious kids a generation ago. In high school, I carried enough anxiety into classes that I missed the basic concepts of my Chemistry class altogether, amplifying my anxiety heading into that class the following day. I’ve had that anxiety reflected back to me by many, many teenagers in my therapy room in the decades since. It has not been unusual for me to work with a sophomore or junior in high school at 11 o’clock in the morning, because that child was out of school, home, and available to be seen.
The question becomes why. Generally speaking, I find my clients who don’t make it into school aren’t acting out of belligerence, oppositionality, or defiance. They do not find school to be superfluous or unnecessary. They are keenly aware of how critical school is, the enormous impact attendance exerts on their futures.
Instead, they are experiencing exceptionally high levels of depression or, more likely, anxiety. Sometimes they’re going through both. They sincerely believe that they do not have the grit, confidence, and resilience to make it through the day successfully.
Imagine that terror.
After the pandemic, the practice effect of getting to school day in and day out did begin to falter for a very large number of our kids. The idea that they could miss a day was on the table, when it was not there previously for most of them. Refusal to go to school increased from there.
The distinction is important. Parents and their kids are not finding school to be unimportant, or attendance to be superfluous. Again, in my experience, they all recognize how relevant making it to school is, especially after a pandemic, after which many kids felt they were falling behind on the learning curve.
Working from home, on the other hand, has become by and large an unexpected function of convenience, and perhaps a correction in a work-obsessed culture. Kids and parents together would agree that missing school, however, is wildly inconvenient, and a direct reflection of a child’s suffering.
When a child misses school on a regular basis, a number of adults need to get involved. Individualized education plans and 504 plans need to be implemented, creating a significant expense for the school district, as well as an immeasurable emotional expense for the family. Therapists are hired. Psychiatric drug protocols are considered. The cavalry of professionals who need to get involved can seem endless.
It’s a whole thing.
Further, kids who miss a lot of school are not feeling balanced and healthy. They are in fact wildly unhappy. Many of them cannot imagine making it through the school day without something emergent happening, without a deep depressive moment or a panic attack. For some, social anxiety runs so high that their interactions with peers becomes the sole focus of their day. For others, it is anxiety around social interactions that prevents them from feeling capable of attending. Many tell me that, as a result of these anxieties, no actual learning happens at all.
And I really want to be clear here. These kids are not ‘playing sick’ in order to get out of school like we might have done a generation ago. They are, on the whole, not overstating the degree to which they are suffering.
TikTok and school refusal
I can fully understand how the writer of the Times piece can find a quick and easy correlation between the rise of school refusal and the pandemic. But there was another phenomenon taking place during the pandemic that may have contributed more.
For a couple of semesters, our kids were typically home, and they suddenly had an abundance of time to spend on social media. And during the pandemic, the hottest new social media trend was TikTok, without question. Many kids would spend hours on this platform every day, watching dozens or more short clips and videos, some of the musical, some of them comical, and many of them related to mental health, and created by fellow teenagers.
This is something I admire in this generation of kids. If they are suffering from some emotional difficulty, they use the tools at their disposal to help their peers who might also be struggling. TikTok became an effective, efficient tool for reaching other kids who might feel like you do.
That said, many of my young charges would self-diagnose in the wake of the traveling down the TikTok mental health rabbit hole. If you watch enough videos about anxiety, you’re probably going to relate. By the time many teens were on my couch for their initial session, they were leading with self-diagnoses:
“ I’m a depressed person, Dr. Duffy.”
“ I have a terrible case of panic disorder.”
“ I have an untreatable eating disorder.”
“I just can’t pay attention to anything that’s going on at school.”
“I suffer from school refusal and social anxiety. How can I possibly make it to school?”
These are all sentiments I’ve heard in the therapy room in the middle of a school day. Again, these kids are suffering from real anxieties about the academic and social pressures of school. Your inclination may be to label them snowflakes, unwilling to experience any small degree of discomfort. But those of you who have been exposed to any degree of anxiety or depression know better. You know how very painful these emotional maladies can be. If the decision is between attending classes in order to forward your future, or mitigating these painful emotional symptoms today, protecting one’s mental health will win every time.
The symptoms are that uncomfortable.
And the more you learn about emotional disorders from TikTok or other social media outlets, the more you believe you are afflicted, the less capable you believe you are to get out there and take on the world.
What you can do to help
So, if your child is one of these kids who regresses, stays home from school, opts out of a lot of their commitments, and isolates in their room or down in the basement, here are some thoughts you need to consider.
First, please do not waste your time negotiating, bargaining, and coming up with punishments and consequences for your homebound child. It won’t work, but it will drive a deep divide between you. You will quickly become an obstacle to work around, and there’s no way you will be seen as an ally, guide or consultant while your child is suffering. If you want to see symptoms, amplify, focus on the behavior.
Instead, work on understanding your child’s why. Sit down with her and talk with her about what her daily experience is like. I promise you you’ll be surprised. You are not going to hear that she is just lazy and doesn’t want to go to school. And when she finally divulges to you what’s preventing her from opting out of her life, believe her.
Only then can you begin to problem-solve with her. Only then is it reasonable to set up a meeting with a therapist to begin to work through the anxiety and/or depression that might be keeping her from attending school, extracurricular activities, or social events on a regular basis. And in my experience, if things deteriorate emotionally far enough that your child opts out altogether, therapy is requisite. Find a professional who works with teenagers and is familiar with school refusal and opting out.
Why school refusal might matter to your family, even if your kids are going to school
The fact that your child attends school does not mean, in any way, that they are free of the anxieties of those kids who suffer from school refusal. All of our kids are anxious to some extent today, and many of them are depressed. The word I’m hearing most frequently from my teenage clients is hopelessness. So, that hopelessness sometimes shows up in the guise of school refusal. Sometimes it shows up through the use of weed or other drugs to numb out the pain. Other times it shows up in opting out of things other than school. Sometimes it looks like withdrawing from friends and family.
If you’ve got a teenager, I bet you see at least some of this in your family. And I’ll bet it breaks your heart.
Our kids are suffering, guys. They’re not skipping school and opting out because it’s convenient. This is not a newly established, expedient cultural norm like working from home. This is a reflection of our suffering children. And if we have some fundamental understanding of that, and they know we are on their side, we can help them through these difficult times. And I can tell you from experience there is nothing more satisfying than helping a teenager re-engage in their world. It’s where they want to be: out there, learning and connecting and thriving.
Your school-refusing child may tell you she just doesn’t want to go. But she does. She just doesn’t want to feel awful while she’s there.
Finally, I think it’s really important to note that school refusal is an extreme. But I am finding that all of our kids are experiencing some degree of depression and anxiety these days. Part of it may be due to the aftereffects of a pandemic. But most of it involves a variety of other stressors our children are confronted with every day. It’s tough to be a kid these days, wildly different than it was a generation ago. As parents and other caring adults in the lives of our kids, it is crucial that we recognize that and afford our kids the grace of our understanding.