My 12 year old DS has developed extreme school-based anxiety and is now on sertraline, which is helping to an extent. In his case, they believe there is underlying autism which was unrecognised in primary. Could this be possible in your case?
Our son has always been a bit anxious and has struggled a bit with friendships, but we put this down to family history of anxiety and the friend group he was stuck with (and limited through Covid bubbles) being quite toxic. We queried autism specifically with his primary school support staff and they saw no signs. We’ve been told it’s quite common for girls and intelligent boys to be able to mask so successfully that traits aren’t detectable until high school, where the uptick in social demand and sensory demands shoot up and they can no longer cope.
We’ve been fortunate to access a private psychiatrist who has helped us navigate seemingly having a different child over the course of a few weeks. She urged us to focus on the anxiety as a mental illness which may be underpinned by autism - so the thing we need to focus on is the anxiety , but understanding there may be sensory / neuro developmental aspects may help understand the nature of his difficulties and why standard responses (ie just toughen up) may not work.
On forcing, she said avoiding did make things worse in terms of anxiety and that it should always be on the table that today we go to school. However in cases of extreme anxiety just pushing though can be more harmful, especially if there is ND underpinning, so she encouraged us to avoid forcing but continually encourage. This has worked for us as he has been able - with the support of medication - to start setting his own goals and working though them. So we are his supports with recovery - we’re both fighting the anxiety instead of fighting against each other to force him in.
We’re very lucky to have a supportive school managing a partial timetable and providing a lot of support within the school, and I can’t imagine the pressure if school weren’t taking this approach. I really feel for your situation.