School refusal

[NettleTea]

Have put this in child mental health and secondary education, but I know this board so am putting it here too, as its really having an awful affect on the whole family.

Simple question, complicated background.

DD is in year 8. Last year she had a poor attendance, some was medical, some we learned in retrospect was school avoidance/psychological pain causing physical symptoms, most usually stomach ache/feeling sick. Refusal shows as complete hysterics, screaming, shouting, hiding, hitting herself, refusing to get out of bed, get dressed, etc, taking out anger and frustration on her younger brother. DD loved primary, which was a very small rural school. She was happy and popular. Move to secondary has triggered this, although her overall need for 'control' has been ongoing for several years, and started with her hiding food/refusing food/hiding medication/ refusing to do treatment/nebulisers, etc.

School avoidance, due to extreme anxiety - other issues - non compliance with medication/treatment for CF, possibly to cause hospitalisation rather than go to school. DD has had CAMHs involvement in past - successfully at age 6 and 8 to deal with my abusive ex and her fear/mixed emotions, and unsuccesfully at 10 to deal with medical non compliance.

Recently we have a specialist psychiatrist involved - had an initial assesment during half term, but she is in London and we are a long way away, so she is liasing with school and with an impending hospital admission, she will probably get 6 sessions during her inpatient stay, but that is not probably until mid december.

As a result of her medical issues she has access to e-learning but the school have said that it is for 'medical' use only and NOT for when she is displaying anxiety.

It is also worth mentioning that DD can be very adept at persistance to get her own way - this has been demonstrated in many different parts of her life and the huge lengths (often to her own detriment) she will go to in order to control an outcome or situation means that taking things way way beyond normal behaviour is not unusual. Much of the time I am able to stand firm in my decisions and she can be twarted in attempts to undermine boundaries I have set, but there are occassions where she has got the better of me and as a result she will push and push in the hope that I will give up. This makes a situation like school refusal very difficult to deal with, because she hopes that I will cave in and so, once she has managed to get a day off, it makes it near impossible to get her up the following day. The underlying medical condition also makes it difficult to know whether the symptoms are based in pathology or psychology. When she was put on different medication she found out about the side effects and suddenly she had them all when presented with a need to go to school. At one point last year she got so hysterical about how ill she was that I took her to the hospital and she had to undergo every test known only to show she was perfectly healthy, in a physical sense.

The school have allowed her access to the pastoral care, she can go there daily, and she has built up a good relationship with the councillor, who goes with her between lessons. She has also this week been referred to the school advisory service. I spoke to the school this week and raised the prospect of CBT, but they didnt seem keen - felt she was too young (despite the fact that she is very mature and prefers to mix/converse with adults) The schools stance is that she needs to attend, and that absences escalate the situation. This is all very well but I have the problem of actually getting her to school.

I am beginning to dread the mornings. They have always been difficult as she has always dragged her feet in regards getting up and dressed, doing her nebulisers/physio and leaving on time. But now its almosty an impossibility. If I physically get her dressed when I turn round she has taken her clothes off again and got back into bed. I have had to give up on getting her to do her medication/physio as there literally isnt time and I have to get my son to school too. The mornings are just awful, screaming shouting, doors slamming. I simply dont know what to do and feel like I have come to a point where I just cannot cope with it at all.

I dont know if this is real. whether she is playing us all in a huge elaborate thing because she doesnt like school that much and what she really wants is a combination of me home schooling her and access to the e-learning, and she is going to act the part to the best of her ability until she gets what she wants, regardless of the consequences for everyone else. I feel it is destroying my family, and its certainly causing a huge amount of frustration and (I hate to admit) anger on my part because I have missed work, messed up a whole year of college work, missed my own medical appointments, and been made to feel like a fool when she is allowed to stay home and then later seems to be perfectly OK, with only passing reference to the 'agony' that she is in.

This school year she has not missed any days due to stomach ache/anxiety related stuff although she was in hospital for 2 weeks. She seemed to be getting better. She was getting involved in stuff and seemed happier, and then last week (after discussing it with the CF psycologist during half term) it all seems to have cranked up a bit. I dont know why, there doesnt seem to be a reason. She is not being bullied. She is doing very well in class. She is making some new friends. Maybe the school councillor tried to pull back a bit - she seemed mighty put out that she was dealing with another child at one point, maybe she realised that this was it, and she was going to have to be going to school, but she has started having stomach ache again. And Friday she really refused and there was nothing I could do. She did 3 online live lessons, and she loved them, so now thats all she wants to do... All weekend she has been mentioning this 'painful stomach' and last night she freaked out because I said she would be going to school on Monday. This morning she seems OK, she is playing happily with friends now in the lounge - a cursory mention of the stomach ache so far, but I know by 6pm she will be back in full swing.

I dont know what to do tomorrow. I need help. Tomorrow I KNOW is going to be impossible. I need advice. I am contemplating taking her to my mum's and getting her to take her in, to give me a chance to ask for some outside help to see if they will come to the house and physically take her in - is this even something?? Or am I ignoring a serious issue. I am in a real situation with a child who has a history of crying wolf and is very very smart and I am desperate.

May be worth adding, for this board, that she has supervised access for a couple of hours every 2 weeks or so with my ex. Who was abusive. And most probably NPD. I dont know if that has relevence. Some of her behaviour mirrors some of his, and she didnt witness it. Is it genetic?? How do I deal with this

[whitesugar]

You are going through a very tough time and I feel for you. I don't have any personal experience of this issue. One of my daughter's friends behaved like this when she started secondary school and it got to the stage where she refused point blank to go. Her family had been through a traumatic time. I don't know any of the details other than social services became involved and she got a home tutor. After a year or so of home tuition she went back to school. She is now doing her GCSEs and is perfectly happy to go to school. We live in NI so things could be different here. I hope things improve for you.

[NettleTea]

I had hoped that we might be able to organise some sort of gradual introduction back. I had said to the school councillor that from what I had seen there seemed to be years spent to-ing and fro-ing with CAHMS and at the end of the day there was a gradual re-introduction into school.
I suggested that we just jumped straight to the final point and went with the gradual, with some CAHMs help such as CBT. With the elearning maybe we could develop a programme where she gradually attended and did some home stuff, to build her confidence.
Councillor arranged a meeting with her head of house, who literally spent 2 mins saying to me that she needed to come to school, end of. He had 1300 pupils in the school and didnt have the time to be messing about like that. thanks for coming in.

[perfectstorm]

I don't think a kid her age, with her traumatic early start, and a serious, incurable and life-limiting illness is going to be planning a grand clinical strategy to extract exactly what she wants from those around her. I think it's far more likely she is fighting for something that she feels is essential to her emotional survival, for whatever reason - and that she needs help to function more usually.

Is she seeing a psychologist or psychiatrist - not just a counsellor? They do valuable work, but an experienced adolescent psych professional sounds like they would be more use here. You need professional advice and guidance on what to do and how to proceed, because happy and settled kids don't behave as she is, and you need support in moving forwards. I have no idea whether forcing her to deal with things is best, or if she needs more specialised treatment and support, and in all honesty I doubt anyone here will either.

As to your ex and her behaviour being genetic: it is clinically impossible to diagnose anyone under 21 with a personality disorder because many of the criteria are normal in adolescents - self-obsession, dramatising everything, insecurity and need for reassurance while being rude and contemptuous, belief that they're somehow special and the rules shouldn't apply to them. It's abnormal in adults, but if every selfish and petulant teenager had a PD then they'd outnumber the mentally healthy. It's grossly inappropriate for adults to behave like Kevin the Teenager, but developmentally appropriate for teenagers. So don't let that haunt you.

I do realise this must be hell on wheels for you and I'm so sorry, but I think it must be even worse for her. She sounds a very unhappy kid.

[lljkk]

I do have personal experience so please have . Schools are surprisingly powerless & unsupportive, aren't they?

All I could think with your story was to look at every possible barrier/source of anxiety in the mornings (write a list with tick boxes, maybe) & see if you can address even one of them (or maybe many if you're lucky). Could be as simple as getting her bag with nebuliser packed the night before. Partly teaching them they can solve their problems and partly making your own life easier.

[piedpiper4]

I've had this with my dd since she was 4, she's 9 now. Two things have helped. School started letting her go into school early at the start of this year and she no longer goes out to play, this has massively reduced her anxiety. Secondly, we had her assessed by an OT and realised she has sensory processing disorder. Basically we've come to understand that school is difficult because of all the sensory stuff going on: noise, smell, touch etc. Understanding this and then working round it has helped a lot. Before this was suggested by dd's consultant in the summer, I would never have thought of it, but it has certainly given us an understanding of what's happening. Good luck, I know how hard this is.

[NettleTea]

Thank you so much for the advise. I really get what you are saying PerfectStorm and it is so good to hear it from an outside view - the fear of being 'played' is probably a huge trigger from the many many ways I was abused and manipulated by her father and so it is something I am on such high alert for. I can certainly see where it is my issue and that it can be compounding the full story.

[NettleTea]

She is not seeing a psychologist at present - we had an assesment with her CF related one 2 weeks ago, and they have been in contact with the school councillor. We are hoping to move things on with her, although she is in London. CAMHs were not very forthcoming. She needs a specialist one, one who understands kids with CF, as if she has an inkling that they are talking down to her, or dont understand where she is coming from, then she refuses to engage.

[PurpleRayne]

Have you thought about posting on the Home Education board too? There are other families with similar experiences who may be able to contribute advice.

[NettleTea]

I have contemplated HE, but just dont know if I have the time, resources, and actual patience to do it. I feel I would be run ragged and dont know if it would benefit anyone. DD is also very bright, and I seriously would not be able to afford the fees for her to sit exams. This is why I desperately want her and the school to work together to keep a foot in the door. But I am not sure if this is a possibility. I need my space alone as well. It sounds really awful and selfish.

[ChazsBrilliantAttitude]

NettleTea
I replied on the Secondary Education thread but as this seems more active I've copied my post to here

Serious question - does she actually have to be educated in school? Are you in a position to home educate?

I am not an expert in this at all but I wonder if the focus was taken off going to school for a bit that might help? She gets a lot out of refusing to go to school - your attention, the counsellors attention etc. If that's added to the fact that she feels unwell and anxious and is perhaps now old enough to understand the significance of her illness better but perhaps not old enough to deal with the worries she may have. It feels a bit like a pressure cooker situation.

I wonder if the best way to take the heat out of it is to park the school issue for a while.

I do think you need some specialist help with this too.

[ChazsBrilliantAttitude]

Talk to the HE people. Some of their children study at home then go to college when they want to sit exams but its driven by the children themselves. As it is their choice to go then refusal isn't going to be a problem.

[Matildathecat]

This sounds so hard. Seems like school needs a kick up the backside and there needs to be a proper meeting with everyone involved to ensure a consistent approach. I wonder if a CAF would be helpful? Have you tried the SS disability team or the inclusion team? I know there definitely is such a thing as getting a person in to get your dd to school although if she is as clever as you describe with using illness as an excuse I can see how hard this would be.

Is it the school itself? Are there alternatives? My ds went to a very small independent school and a boy joined who had been school phobic for some time. He spent two whole terms sitting with the ladies in the office but did veery slowly eventually join his class. It was different because he had been badly bullied at his previous school. But, he did have to attend.

Sorry to be thick but what does your dd actually say about why she wont go?.I agree that home ed would be a nightmare. It would all be on her terms

If your dd has been going all term it does sound positive. I hope you don't have a hideous evening. And yes, getting your mum involved sounds a good plan.

[perfectstorm]

Has your GP been helpful? I ask because I interpreted your reference to CF to mean cystic fribrosis, and it's not unusual for kids with serious illnesses to struggle emotionally as well - nor their parents. It's stressful and painful (in every sense) for the whole family, when a child is living with something like that. The Cystic Fribrosis Trust have a specific page on that, and say adolescence is often a tough time. If you have a supportive GP you could go through all the issues with them in confidence and say she is rapidly becoming beyond you, and you think an emergency referral to an adolescent psychologist would be massively helpful, in that your DD would have someone expert to support her and you would have advice on how to proceed from someone in a position to really offer that advice. She's been through hell, and so have you, and it's ridiculous that you both struggle on when the NHS has services available, albeit underfunded, to support you. Don't be scared to overegg the pudding - her education, and her ability to get through this stage of life, is important and it will reduce problems later if she can learn to deal with whatever's the issue in a more constructive way.

I do think the school sound like they're treating this like any school refusing kid, not that any such situation is easy but a serious illness plus father such a fucking nightmare he's only allowed 2 hours supervised contact a fortnight (I'm sure you know how rare that is as a long-term arrangement, and I am flinching to realise all you must have endured as a partner and mother, for CAFCASS to recommend that) is more than the usual problematic adolescence. I think she, and you, need and deserve really good professional intervention and talking bluntly to your GP about the history might obtain it. They have thousands of patients and unless you book a double or even triple appointment and sit down and set it all out, and that you are at your wit's end, you'll be put on the end of a waiting list. You need help sooner rather than later, and I think it's one of those squeaky wheels getting oiled situations.

Hang on in there. You got her (almost) free of him, which must have been quite a court battle and shows your maternal mettle, and you've got this far with her and a happier and more hopeful life. You've already done wonders. She's having an especially sticky adolescence but she's bright, she has friends, and she has a lot going for her. This too shall pass.

[NettleTea]

mum is coming tomorrow to get her up and ready for school, and to take her. I have not got involved in talk about school today.
I want her there tomorrow so that I can talk to everyone I need to speak to for help without her listening in. will call CF psychologist, and school, and see what they say. Have never had dealisngs with SS and I think in this area inclusion doesnt kick in until 14.

She just says she hates it. When questioned she says she feels like she doesnt fit in. on individual subjects she says its not the kids (tho sometimes, more recently, she has claimed to be 'terrified' of them) its not the teachers (some she has said are lovely, but in general she 'hates them all') its not the lessons, its not bullying. Its going to school. She has had so much time off in dribs and drabs that it isnt surprising that she feels left out. She seems scared of the cliquey popular girls as they can be quite bitchy, though aparantly not directed at her, just in general. There are planty of non cliquey kids.

I am not entirely sure that the school itself is an issue, I think the same may well happen elsewhere as there hasnt been anything that has triggered it beyond the shock of transition. This school is 200yds from our house. Next nearest school would involve a long walk and a bus journey. Given her difficulties in getting up and out at the best of times, I really cant see her doing it, and little brothers primary is in the opposite direction.

[NettleTea]

will also try the GP tomorrow too. He is good, but most of her stuff is dealt with by her consultant who, to be fair, referred us to CAMHS who were bloody patronising and dismissive

[lljkk]

Not being able to afford exam fees is a very good reason not to HE; I know HErs who find this an issue, too.

Does CF = Cystic fibrosis?

[Loopyloulu]

I took CF to be Chronic Fatigue.

OP- you need more support from outside agencies. This is a terribly complex.

I just wonder if it's anything to do with school? Have you considered school is the punch bag or the scape goat and that this is an extreme form of teenage rebellion? I am not an expert but I have taught children with emotional issues.

It just seems that the more you want her to do something the more she rebels. It's also very attention-seeking behaviour and quite empowering for a young teen to have so many people focusing on her.

I'd love to know how she would react if you pulled the rug from under her feet and said' ok, fine, don't go to school if you don't want to'

Just a thought to give you another angle.

[perfectstorm]

I wondered because non-compliance with medication resulting in hospitalisation is actually a known issue with kids with cystic fibrosis, and I'm not sure it is with Chronic Fatigue, is it? I wasn't aware a drug regimen was effective with the latter, let alone the cause of hospitalisation if not complied with.

[Matildathecat]

OP mentions meds, nebulisers and physio so strongly suspect cystic fibrosis.

I know CF kids can be quite physically small. Is that becoming more of an issue at all? Moving from small school to school with 1300 kids, many of adult size does sound terrifying. May even be quite subconscious. Agree to get GP to make referral but I would also be getting school to take this seriously. Maybe the SENCO could assist? Is the counsellor in school full time?

Glad you have tomorrow sorted.

[BalloonSlayer]

I'd think if you need nebulisers and daily physio it's cystic fibrosis.

[Loopyloulu]

You may be right but I picked up on the mum saying they didn't know if her issues were physical or psychological at times and C Fatigue is almost impossible to 'prove'. And the inhalers could be for asthma.
Hopefully the OP will say.

[ommmward]

[Loopyloulu]

some people with chronic fatigue do take meds- such as tricyclic ADs etc for pain relief and need physio. I wondered why the need for CBT if its a cystic Fib, issue- CBT is about changing behaviour, some of which is related to pain management. Anyway- all speculation until the OP says which!

[sarine1]

Re Home Education - there's a good argument for saying that you don't 'velcro' a child with anxiety related issues into their home. They are finding the outside world hard to deal with, but if you provide everything in the home, then they have no reason to leave it. So does this then help them overcome their anxiety or does it reinforce it and make it worse?

I do understand that some children are more fragile than others but often these children have a core of self determination at the centre of things - it's about their ability to control things - even when these things may be harmful to them.

Some of the HE forums are fantastic and really helpful - while others have a more vitriolic attitude to schools, Local Authorities and the education system which makes it harder to find a balanced view.