DS won't go to school - again.

[ToffeeWhirl]

DS1 (12) has a diagnosis of Tourettes, OCD and social anxiety. He also has some ASD traits. He has a history of school refusal (because of anxiety issues) and last year I took him out of his primary school to home educate him because he was so unhappy. The plan was always that he would attend secondary. After years of not having any support, getting a diagnosis finally meant the professionals took notice of us and stopped blaming us, so we have had plenty of support in getting DS back to school. He was put on fluoxetine to help with his anxiety and is seeing a CBT counsellor. An Education Outreach Worker helped him settle in at his new school by giving him extra visits there before term started, introducing him to his teachers, etc. He is allowed to leave class at any time he feels panicky and sit with a designated person (his house manager). He is also in a special-needs class, which is smaller than regular classes and with more support.

It was all going fairly well, although he did have quite a few days off over the first term. However, he went in most days and - thank goodness - made two new friends that he began to socialise with outside school.

However, by the end of last term, he was exhausted and kept sending panicky text messages to us. I went in one day at lunchtime - in response to one of these messages - and found him looking ill with exhaustion. I took him home and kept him at home for the last two days of term. Then it was the holidays. At the start of this term, he came down with a virus, which meant he had five days off. After that, he went in for two days - and that was it. He said he couldn't go in anymore. I suggested he go in for one lesson a day, which he managed on two days, but now he can't even do that. He also refuses to take his medication anymore because it makes him feel sick.

He complains that school is too noisy and crowded. He feels panicky during every lesson, so he often can't concentrate on the work.

Some people might think it's a no-brainer - home educate him. And I will if that's the right thing to do. But I do feel that school offers him opportunities that I can't offer him. It's a really good school and they have been very supportive about all this. Also, school has provided him with the opportunity to make friends, whereas he became quite lonely during his time being home educated.

Sorry, this is much too long. Well done to anyone who made it this far. I just need some of the MN collective wisdom as I feel completely stuck.

Is there anything medically that can be done with the medicine to help him not feel sick when taking it? (Like take with food or a slug of that stomach lining antacid stuff). My husband suffers from an anxiety disorder and he's had to play around with different tablets(don't know anything about suitability for children though) to get the ones with most benefit against side effects. He doesn't read the packet and was getting very sick with one lot that were meant to be taken after food. If hes just stopped the tablets then the anxiety is no doubt all over the place.

It sounds as though things were moving in the right direction, albeit slowly, but progress is progress (my eldest is fairly severe ASD so I do get progress at a slow pace). Don't loose track of this or the efforts you took to make it - it doesn't sound as though you have.

Mine are younger (8, 5 and 1) and so still reward focused is he too old for rewards/ targets?

Thanks, ANT. I'm just back from a pretty disastrous CBT session (DS walked out because he was in such a state), so it's nice to get an encouraging message.

I'm not sure there's anything that can be done to alleviate the sickness with fluoxetine - I presume the psychiatrist would have told us if there were - so a change of medication is the only answer. I have left a message for her asking her to ring me back as a matter of urgency.

You are right about the rewards. He isn't too old for them and, in fact, I had promised him a sleepover with his best friend if he managed to get to school - even briefly - each day this week. Unfortunately, the anxiety is out of his control at present. I am also being strict about no computer time during the day, unless it's schoolwork.

Thanks for helping me to remember that we were making progress and that this is probably just a temporary setback. There was a time when nobody was helping us; at least now I have a psychiatrist that I can ring and she takes the issues seriously, rather than assuming we are just overprotective parents (as has happened to us in the past).

You don't sound at all overprotective at all. I am a secondary teacher and over the years have met a few students who have really struggled. School can be a very stressful place.
He has had such great success. Well done so far! Is there anywhere in school he could work and be out of a whole class setting? (Some lessons may well be louder and more difficult for him than others.)

Thanks, Wolfie. I believe school will be arranging a meeting for us and DS if he doesn't return to school soon and we can discuss him having a quieter place to work then. I'm not sure if that is a possibility, but the school are really going out of their way to help as much as they can so it might be.

I have emailed the school telling them that he won't be in until this is sorted out. The pressure on him (and me) is too much and he quite clearly isn't capable of going to school at the moment. I will ask the psychiatrist if she can write him a sick note.

The GP or a pharmacist should be able to tell you about alleviation of side effects if you can't get hold of your psychiatrist. There can be withdrawl side effects with some of these things, but I'm sure that the psychiatrist will treat your call with appropriate urgency if this is the case.

If he's off the tablets are all bets off? Is it reasonable for him to achieve certain targets like making it into school i.e. has he in recent times without the anti anxiety meds?

Could you arrange to go into the school library each day together to get books or similar just to get him there and keep him exposed, in a very minor/ hopefully not threatening way to the environment?

The psychiatrist advised me, last time we spoke, that it was OK for him to come off fluoxetine because he was on such a low dose that he was unlikely to suffer withdrawal symptoms . We have a fantastic local chemist - I could ask them as well tomorrow. I wish the psychiatrist would ring me back.

DS hasn't been into school without anti-anxiety meds since the beginning of Year 6, so I don't think it is reasonable - especially seeing how he is now - to expect him to go until he's on new meds. To be honest, I wouldn't even be able to get him into the school library at the moment, but that would be a good place to start when he's capable of it.

Am planning lots of tlc for the moment.

TLC sounds like a plan. A good chemist is worth their weight in gold - in mainland Europe they are so much better at using them than us in the UK.

Keeping my fingers crossed that your psychiatrist calls you back soon.