School refusal and self harm - help!

[WhoisRebecca]

Dd, 15, has had a lot of issues with school that started after the first lockdown and got worse over the second lockdown. She had friendship issues - best friends one minute, spectacular falling out the next and complained about other students being nasty to her. A lot of the issues were exacerbated by dd being reactive and she seems to struggle to maintain friendships.

Her behaviour at school was always good, though she’s not particularly academic- but at home she became more challenging. She started self harming, superficial scratches on her arms and was saying she wanted to die. I took her to the GP who suggested we go private for help or contact a local charity for support as CAMHS were so stretched. We got some limited support from the school counsellor and then the charity.

Then at the start of this year, her sleep pattern became more erratic. She was up at night and struggling at school. I told her she would have to give me her phone at night and she became so distressed and angry at this, she started screaming and then took around 10 paracetamol, which she had found in the house.

We took her to A and E and she was seen by the duty CAMHS team who then referred her for assessment. She was taken on by CAMHS, who saw her very quickly and offered DBT to help with emotional regulation. Her therapist suggested she could be autistic and she has seen been put on the autism and ADHD pathway, but who knows how long that process will take.

Meanwhile she became more and more anxious about going to school. We asked school for support and they created a timetable that allowed her to access a quiet space and she was able to drop some GCSE subjects. Friendship issues rumbled on and there were some issues with an intimidating girl who was dealt with by school.

She would frequently text from school saying ‘I hate everyone’ and ‘I want to die,’ but she was attending regularly. Then one day she refused to go and her dad (who doesn’t live with us) told her over the phone that she must go in. He was quite strict with her and said she would lose her PlayStation/phone etc. She went off as if to go to school, but rode her bike around the park instead and then came home and took some paracetamol that she had managed to hide in a drawer.

We had another A and E visit and the duty CAMHS team did not think she was actively suicidal, but rather that she wanted to avoid school.

I got signed off work for a week, got school to agree to a flexible timetable and got her to go in for half days, with me dropping her off and picking her up.

However I’m back at work now and while she has been going in for some half days, at other times she has point blank refused. Sometimes she won’t even get out of bed till 11. Stepdad is home with her, working - but he can’t put too much pressure on her and given that she threatens to harm herself, I’m reluctant to do so either.

She went in for a half day yesterday and then scratched all her arm when she got home. She said it’s my fault she does that, if I make her go to school. I don’t make her go, but I do try to persuade her.

She went for a half day today and had to do a science exam. She ripped the exam paper up and then asked us if she could come home, so she ended up coming home early. I didn’t want to leave her in school because I don’t want her being put off going again.

We are still seeing CAMHS and we’ve enlisted a private psychiatrist who also thinks she’s autistic- though no official diagnosis as yet.

I don’t know what to do and I’m desperate. Feel like a terrible parent and I don’t know how to support her.

Needless to say, there is no paracetamol in the house dd can access and I’ve carried out a search of her room.

The issues seem to be very much triggered by school, though she does find any extended social time exhausting.

My dd is exactly the same and also 15 and diagnosed asd with mh and anxiety.. although I am lucky to get her in to school at all..today it was just over an hour yesterday 42minutes... Monday she didn't get out of bed till 2pm.

Camhs are finally seeing her after a 2 year wait and we are trying new medication starting today. Parents evening tonight...her grades have slipped from 7,8,9's to 3&4's... school just say she needs to attend more...and when I do finally get her there...they call me to come and collect her...

It's very very hard, make sure you are also looking after yourself.

Thanks @twinkletoedelephant. It is so hard. CAMHS suggested some form of blended learning, but I know from lockdown that she will not engage with learning at home. I think she’s anxious about failing and would rather not try at all. I can’t believe there isn’t more support out there. Even the psychiatrist doesn’t seem to know what to do yet.

I think the diagnosis might be the turning point for you.

You are doing all you can in keeping her safe, getting her help, working with the school to help her reduce her timetable. You are in the eye of the storm right now OP, but it won't always be like this.

I work in a school and have seen and dealt with 4 overdoses in the last months, and bandaged many self harm cuts. It is very sad to see our kids struggling with the world. We have so many systems in place, reduced timetables, quiet areas, pastoral support and counselling, CAMHS who come in, and the school nurse. But they have to meet half way. The help is there, they just have to reach out and grab it, but that isn't easy for a teenager.

Love her, hug her, tell her she won't always feel like this, and you will find a way together to get her through this

Having said that, whilst the school support (for our school) is good, the external help is hard to find. My son was suicidal 2 years ago and was referred to CAMHS but as he hadn't attempted it yet, he went on the long waiting list. By the time they got in touch many months later, he had found himself in a better place through talking and researching things online.

Covid has increased mental health problems, and the services are already struggling.

It’s frustrating for me, because dd has been given loads of support in school but she’s not going in enough to access it. What do I do? Do I keep trying to persuade her to go in? How much pressure do I put on? How do I balance this with her mental health? And how on earth will she do GCSES next year?

Just wondering if anyone had any thoughts? I’m desperate at this point and wondering where I’m going wrong.

You're not going wrong. No child comes with a manual.

Can you ask these questions of the school? Just say exactly what you've said here, that you don't know what to do or how much pressure to put on. Try no to worry about next year, one day at a time.

I'm not a parent but I am autistic. I'd prioritise her health right now. She can't learn effectively while she's so emotionally unstable anyway. Education can get back o track when she's able to engage with it.

Is there a way to work with her to establish routines that feel manageable for her? With the intention of giving her back as much control as possible.

So she agrees a plan for how she'll spend the days and when she'll go in to school as a set structure that recognises that she can't manage full time at the moment.

All behaviour is communication, especially the self harming. It's communicating something about how she's feeling. She might not be able to articulate exactly what it is that she's feeling but some talking therapy to help to uncover what's going on might be helpful.

If she is autistic then all the disruption will have affected her more severely than her peers.

None of this might be helpful. Am just trying to imagine what she might be going through. You're not going wrong. Loads of people are struggling right now - it's been such a strange time.

I would take her out of school in a heartbeat. I say that as an autistic mother to an autistic teenager. Mental health is more important.

Not much to add but my DS has really struggled over the last year (a bit younger than your DS) and I have found it really really hard supporting him. CAHMS were hopeless, he wouldn’t engage with private counsellor and hates school too. It’s just so tough, but do take care of yourself first so you can care for your DD x

Sorry for typo, your DD

I’m not sure taking her out of school would help because she wouldn’t engage with learning at all and would become completely nocturnal. I think I perhaps need to ease the pressure I’m feeling for her to go in though and definitely take each day as it comes. I’m attaching a lot of emotion to whether or not she goes into school.

I just wonder what will happen to her. She doesn’t understand the importance of school at the moment.

She was able to cope with going in with key workers over lockdown in a small group, but she can’t cope with full school.

She’s also being very controlling with food at the moment and eating a limited range of mostly junk foods which are constantly subject to change. This is her attempt to gain control when the world feels out of control, I think.

Maybe she needs a full break from education for a while and in August or September start introducing education at home.

I would pull her out

She can become hostile if she’s pressured and her being hostile is a sign that she’s struggling mentally, so I’m always careful not to let it get to that point.

She knows I’m worried and sometimes uses that as a tactic ‘If you make me go to school then I’ll kill myself’ etc.

I won’t be able to educate her at home (ironically I’m a teacher) and I know from experience she’ll be resistant to it. I’m also reluctant to pull her out of school because while she’s in school, she’s their problem and they have to help.

Her therapist suggested we apply for an EHCP, but school are saying this is taking three terms at the moment and she doesn’t have a diagnosis yet, which might make it harder.

I think something has gone very wrong for so many students to be really genuinely struggling. My son was diagnosed with a panic and anxiety disorder. I think a lot of young people experience the distressing symptoms of panic attacks but don't understand what they are. Avoidance is main sympton. It's all well and good school offering a relaxed timetable and quiet room but that only works if you can actually get the student in school and to stay there, plus it only differentiates the students more and it is difficult for a young person to admit to their friends the reason they are sitting in quiet room is because they are suffering a panic attack, anxiety. There is unfortunately still a stigma.
Please look at Not fine in School forum, there are many thousands of parents in similar situation.

Do apply for an EHCP. If you don't have to appeal the process takes 20 weeks from start to finish, if the LA don't stick to the timescales you can force them to via Judicial Review if necessary. IPSEA have a model letter you can use on their website. EHCPs can also include MH therapies, and SALT and OT which may help, especially if DD has ASD.

Don't deregister, it is easier to get help when on a school's roll. Crudely, you are someone's problem. It is all too easy for people to brush you off and fly under the radar if you EHE.

If DD isn't able to attend school full time the LA have a statutory duty to provide education. This could be home tuition, online, hospital school, small group tuition. As DD is of compulsory school age you do not need an EHCP for medical needs EOTAS provision.

Please read up as much as you can and watch a lot of youtubes about autism and its presentation in girls and women.

Learn to see how she sees life, the universe and everything, learn why she reacts the way she does to certain situations, then from a position of understanding, you'll be much better placed to help her yourself and advocate for her when she needs it.

Has anything bad upsetting apart from lick-down happened to her or within your family in the last few years?

Try to avoid the erratic sleep pattern as it makes everything worse. This isn’t easy but even if she is not going to school she needs to get up and get busy, or get out and doing something physical. The phone at night will particularly destructive for her sleep habits if she still has it at in her room.

Could the phone have contributed to social problems and anxiety?

Is she eating normally and regularly? Not drinking too much caffeine which could exacerbate anxiety.

Has she had a test for vitamin and mineral levels?

This must be very worrying.

Don't know if they still exist, but when dd was a school refuser we had loads of support from the Education Welfare Officer. Dd started self-harming at secondary school and was extremely anxious to the extent she spent 10 days in hospital when she was 12.

I was in touch with Liz O'nions who said it sounded as if she had PDA. There is a PDA site, separate to the Autism Society one which may be helpful.

DD had high scores on the Cambridge autism assessment questionnaires. We tried to get a diagnosis but PDA wasn't known in France where we live.

She's now 24 and, thankfully, not my problem. Sounds horrid but we had 12 years of hell. My lateral menisces in both knees were torn from when she put me to the floor when I told her as her results were so bad she couldn't join in a school strike - she wanted to get a place at a hugely over-subscribed lycée and repeating a year would have made this impossible.

Wish you the best of luck and hope your EWO can help.

She doesn’t eat normally, she is very controlling about what she will eat - a specific brand of pizza, an expensive meal deal on the way to school. Mainly junk food. She was drinking energy drinks in the morning, but thankfully the shop have stopped selling them to under 16s and I’ve been encouraging her to drink sparkling water, which she likes mixed with cordial.
She usually refuses the family meal, saying she doesn’t like it.
There’s no way DH (stepdad) can get her up if she doesn’t want to - so getting her up and about early is easier said than done.
The last time I tried to remove her phone at night she took an overdose and the CAMHS therapist suggested she keep it at night. It’s so hard and so worrying.

Her grandma died earlier this year, but her issues predate that. There’s nothing specific that has triggered this - some friendship issues at the start of year 9- but otherwise nothing. We moved area two and a bit years ago, so she started a new school in year 8.

I’m just feeling extremely anxious about it all. I don’t know where to turn.