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

I would imagine there are quite a few children of her age who mysteriously forget how to wash up and find almost everything their parents do is wrong.

My grandmother told my mother when she was a teenager that she hoped she had a daughter as vile as herself one day.

I did my best to oblige.

With anxiety that extreme there's the risk, if she's repeatedly sent back into the situation, of developing trauma.

OP have looked to see if there are already exist any HE groups in the area? If you could find one acceptable to you, you may not have to do it yourself. Or have you talked to your council about what other provision could be made if she cannot return to school? I think a small group or a smaller school might make all the difference.

Hi Nettles

I don't really have any advice and I have no experience of a child with a chronic physical illness but my year 8 DD has school refused since she was in infant school. When she was small enough to carry we would leave and run, but once she reached junior level it became increasingly difficult, culminating in our decision to home-ed.

DD's anxiety presents in a similar way to your DD and her experience of a term in secondary school resulted in much crying, hysteria and ultimately complete refusal. She simply says school and formal environments make her feel incredibly anxious to the point where she fears she will break down or walk out - and the subsequent attention and embarrassment are more than she can live with.

DD is very articulate and doesn't suffer fools - she wouldn't tolerate the MAST worker who tried to get her to fill in a 'feelings chart' - i remember her saying to her 'seriously is this the best you can do?' - she was 9 at the time. She has pretty much refused to engage with all professional support since then - although ironically being out of school doesn't make her happy either. She has finally agreed to see a CAMHs mental health worker - I just hope they pitch the therapy at the right level.

Your situation has many more layers than ours but I just wanted to offer support - you sound like you are doing an amazing job holding it all together. I sometimes feel at breaking point just dealing with a child with anxiety who is neither happy in or out of school and is at that age where she is unapologetically self-centered and doesn't care who else suffers. The extra dimensions to your DDs life - her illness and her father- mean that you have shouldered so much. Seriously you're doing so well to still be standing - you sound like a great parent.
Good luck to you both.

Oh what an awful situation, I really feel for both of you. reading the first part of your post I thought you were someone I know (you aren't) as the situation is very similar - 13 yr old DD with CF who is suffering anxiety and depression and doesn't want to go to school. It must be such a massive amount to take on board for a child with CF entering adolescence with an increasing awareness of the implications of their condition.

My instinct, Very strongly I must admit, is to let her be home ed if that's what she wants and needs. But then I would say that - I took my DD out of school two years ago because she wasn't thriving and happy, so I'm a bit partisan there!

I just think that school is an intense and pressured environment - not just academically but socially, mentally, physically; lesson after lesson, short break times filled with social stuff or extra activities, constant moving from class to class. For some children that's great and they thrive on it, for some it's ok and they tolerate it, but for some it's overwhelming and exhausting, even when nothing particularly bad has happened, or when the teachers think they're doing fine - they're managing to hold it all together to external appearances but at a huge cost to their wellbeing and mental health.

Your daughter has a massive amount to cope with both physically and mentally, and that isn't going to get much easier for her, nor is her CF and all the resultant treatment something that she has much control over. It sounds as though she desperately needs and wants to have some control over aspects of her life, and if she's telling you that she wants an alternative method of education, is that not something that you can let her make a decision on? At least temporarily?

I know home ed must seem like an insurmountable task if it isn't something that you're familiar with, especially when it sounds as though you have a massive amount on your plate and no support. I promise you that it is doable though and there are lots of options from a fully structured online school, through to autonomous education, with everything in between. I'm happy to give you more information if you want, as would anyone on the home ed MN boards.

My experience was that DD wasn't happy at school. She seemed so taken up with and frustrated by the social side of things that she wasn't particularly interested in learning. She came out of school every day hyped and angry, and didn't want to go into school much of the time. I had a vision of taking her out and her rediscovering the joy of learning that she seemed to have lost. Well I wouldn't quite say that that happened - it's still an ongoing battle to get her interested in anything other than minecraft BUT she's a vastly happier, calmer girl with a genuinely good friendship group. The difference in her has been immense. She's been diagnosed with Aspergers this year which explains a lot of the problems she was having with school. We've decided to give her a try at secondary next September, (although I must admit I'm worried that I'm taking her from a lovely social group and throwing her to the wolves) and we'll see how she copes. If it's all too much stimulation and pressure for her, I'll have no hesitation in taking her out and finding a way that works for her, at her pace - these two years have given me the confidence that home ed at secondary is doable; I've seen enough HE kids doing well at that age to convince me!

Thanks for the help.
DD is now about to be admitted to hospital in London for 2+ weeks. We have stepped back from school atm and are concentrating on her health / MH and I basically told the school that although she refused point blank to go to school, she is happily accessing the e-learning and will continue to do so until everything is back on track or for as long as we are able to. The councillor said she was happy with that (dont know if head of house will be!) and sent her love and best wishes from the school. At least the e-learning allows them to monitor it and keeps her on the register/ not absent so OFSTED off their back.

Being in London will enable her to work with the specialist psychologist in the CF unit, who will work towards looking at a longer term strategy with her, before presenting that to the school at the end of her admission. She will continue the e-learning during her inpatient stay.

The psychologist confirmed what I felt - her anxiety is quite possibly transferred onto school as it is easier to cope with than the bigger picture, and with that in mind she should not be treated the same as your 'average' school refuser, so forced attendance may well exasperate the situation until she has done a fair amount of psychological work. She would recommend the e-learning route initially, moving forward to a graduated re-introduction if and when its felt the time is appropriate.

She is hoping to find someone to work with her locally, but is coming up with blanks as many of the services she thinks will be suitable wont take kids under 16. Its looking like monthly trips to London. Plus remote conferance calls /skype and CBT.

Nettle that does sound a lot more positive than it did a couple of days ago, and I am so pleased you seem to have accessed some support for her of a decent and specialised calibre.

I hope you're also looking after yourself, and trying to make sure you're okay. You're doing amazingly but it must be so, so hard. Are you accessing support of any kind, too?

Oh nettle, I can't add anything to this as I don't have any experience, but know that i'm thinking of you all and send my love!

Couldnt put anything on FB Hissy because we dont want her dad knowing she is going into hospital a long way from home......

Although saying that Ive literally just seen photos that, without any ambiguity, show that he has apparantly just got married in Egypt and didnt bother to tell DD. Whether he is coming back or not, we dont know. If he does he will no doubt deny it.

Poor kid - all her health issues to deal with and a twatty dad like that too!

Everything else sounds positive OP - it's great that the psych is on the ball and that she can continue with the e-learning for now. I don't know whether you've heard of flexi-schooling? It's more or less what you're doing now by necessity anyway, where the student attends school but not full time, remaining on the school register but down as receiving education elsewhere for part of the time (as you mentioned the school are doing already). It would allow you to get the advantages of home ed (more flexibility, DD learning at her own pace and not forced to cope with school when it's all too much for her) with the advantages of school and keeping your foot in the door, so to speak. From what you've said it sounds as though the school haven't been very sympathetic with the anxiety and school efusal, but if you can get a psych report detailing that this is part of her medical condition and intimately connected with her CF and its implications, then I don't see how they could object (without leaving themselves open to accusations of disability discrimination) to her taking all the time off she needs as long as she's keeping up with the e-learning.

One thing I wiuld suggest is finding out about local home ed social groups and taking her along to see whether she makes any friends there. In my experience home ed kids are generally quite an accepting, un-jaded lot and it might do her good to have some social experiences away from the school that's causing her so much anxiety. Otherwise, if she's just not attending school and doing the e-learning alone, I think she risks becoming isolated.

Best of luck and hope it goes well with this psychologist. Keep us posted!

If I could get a flexi-learning programme going with this school it would be fantastic, but I am not quite sure how feasible it would be, as I know that with the new rules many schools are reluctant because of the codes they need to use for the education recieved outside. However the e-learning does counter that, as its an officially sanctioned LEA approved service, and we have already had some very positive feedback from the teachers who have said she was enthusiastic and produced exceptional work.
I know we have 2 HE groups round here - one seem nice, the other is a bit stridently political with some quite scary parents and extrememly unruly/precious kids. I do know a few HE parents though who are not part of the groups, and have had friends offered to take her to things like the craft guilds.
Flexi schooling would be wonderful. Just dont know if it is realistic.

Well you know you can PM me anytime eh? don't think twice?

i doubt he'll be back for a good while, and good tbh, he'll be busy over there. Poor cow. I used to HATE thursday nights and Fridays over there with all the wedding celebrations. I'd think, another poor lamb to the slaughter.

When you have seen what women over there have to put up with in the main, and they think that this IS what it's supposed to be, so sad. So hopeless.

Mine at least isn't on FB, don't hear from him unless I ring him.. rare.

Information about flexi-schooling and codes:
edyourself.org/articles/flexischooling.php

I'm so glad you got some support for her. Your psychologist sounds spot on. It really does sound as though she needs to get her own space for a while and certainly specialist help as this is clearly different from the usual stroppy teenager thing.

The CF issue is not something that can be minimised, her dependence on you is something that she will want to move away from, as all teenagers do. However as you know she needs to stay healthy. I hope they can help her to gain that independence and a certain ability to take control of her medical needs.