Anxiety and school refusal in teens

an amateur guide

I received a message over the weekend from my friend Annie T about her son. Annie T is one of those people who has a guy for everything. A guy who will do your drains, a guy who will do the roof. A guy who cuts hair at home. A guy who will steam-clean upholstery.

And now she has an EMDR guy. EMDR stand for Eye Movement Desensitisation and Reprogramming and it sounds very Clockwork Orange, but Annie T was evangelical. Her son has a debilitating needle phobia and he has been cured with this process. Cured, do you hear?

Her EMDR guy is called Adrian Radford-Shute and Annie says he is very good with children and adolescents with anxiety and phobias of all descriptions.

I’ve been thinking about general anxiety in teens and the proliferation of school refusal recently, so this was timely.

Here are some things I’ve picked up about this issue, just anecdotally. I’m not an expert in this - though I did miss out the whole of my own Year 4 (I was 8) because I had such bad anxiety, so I relate very hard to school refusers.

1 Treat anxious feelings as lightly as possible. Matilda Gosling, who is the author of Teenagers: The Evidence Base, says that your teen will look to you as to how worried they ought to be about their own worry. A bit like you study the stewardess’s face on an airplane if it’s a bit bumpy.

The message from you ought to be that this is normal, most people experience anxiety, sometimes related to a thing - going through an airport, needles - but sometimes just a new and adult realisation that life is finite.

Even if you, as a parent, are catastrophising hard inside, (they will need to be medicated!!! they will drop out of school!!!), try not to let it show. What I’m saying is PRETEND that everything is normal. And, I’d like to reassure you, that it is actually normal. And the normal run of things in adolescents, whose minds are jerkily expanding and restructuring, is that brief periods of wild anxiety will abate.

2 Your brain creates your reality. In the brilliant book Complications, Emmett Rensin explains the reality that the schizophrenic brain can create for the patient. The mind creates the reality that your room-mate is plotting to kill you, or that you are otherwise in grave danger, and must defend yourself.

This is extreme but my point is that anxiety can easily create the perceived reality that any minute now a wild animal will burst through the door. For me, when I have bad anxiety, the anxiety world-reality-creation Boggart takes the form of an imminent phone call bearing extremely bad news. My mind creates a concrete reality for me that this is absolutely about to happen. My friend Katrina’s anxiety Boggart is that her husband will arrive home and say, “We’ve lost all our money.” We’ve all got an anxiety Boggart.

3 Breathing really matters. In through your nose and out through the mouth. Breathe out for longer than you breathe in. Short, panicked anxiety breaths will make you dehydrate, so stay hydrated.

4 Anxiety can create such bad nausea that you can’t eat. The trick is to eat whatever you can stomach as soon as there’s any brief let-up in the symptoms. For me it was always hot pitta bread with butter or hummus. Bananas are great, also containing traces of potassium and lithium for a small mood lift. Sourdough toast. Vitamin gummies. Berocca. Milk.

5 The associations that you make with the anxiety arc really matter. A maths teacher at a high-pressure private school told me this:

“With my anxious kids the thing I dread is their parents giving them a week off school. I know why they do it, they feel cruel sending their anxious children in, who are usually very ‘good’ students with devoted parents. But the thing is once they associate school with anxiety and home with non-anxiety, even if they are experiencing some anxiety at home, too, it’s very hard to go back to school. I’ve seen time and time again my anxious kids take a week off, then come back for a week, then can’t cope, take two weeks off and then eventually drop out completely.”

6 Re-frame what a successful day looks like. Tell your teen that success now looks like completing the day at school, even if they spent the whole day sitting on the medical room bed or in the Learning Support room. That’s okay, that’s fine. They need to associate coming out of a cycle of anxiety with still being at school rather than learning the instruction Anxious+GoHome=NotAnxious. Many schools are very brilliant with this, and let students lie down under a weighted blanket or play with Lego or Play-Doh or any other number of theraputic things.

In the run-up to my own dropping out of school there was none of this - the staff were just baffled, visibly irritated and sometimes unkind. If there had been the attitude that anxiety is normal and will pass, I probably would have stayed in school for that year, which would have been better for me and definitely better for my poor mother.

School refusal isn’t always a disaster - some parents tacitly rather welcome it and I have no doubt that some teens are able to thrive away from school. For other families school refusal is a catastrophe and must be avoided at all costs. Thanks to the pandemic, most families have a realistic idea of how well they would cope with home-learning.

7 Some screens are superior to others. Let them binge on a TV series but if you can, temporarily limit social media and scrolling in a mind-melting algo-loop. It’s not forever! Just until they feel better. They can go back to sludge-scrolling once they feel okay. Connecting with the narrative of a long-running show like Grey’s Anatomy or Gilmore Girls is distracting, soothing and harmless.

8 A psychiatrist once told me a very useful thing, which is: the brain tends to want to be well. It wants to get itself out of a hole and achieve equilibrium and it will, given some time and space.

9 Small, repetitive actions are very soothing with anxiety. For me, cleaning really works. Walking is great, but Lego, knitting, HAMA beads, colouring-in, jigsaws - these are all good, too. Teens, whether they are anxious or not, sometimes appreciate a period where they are permitted or encouraged to regress back to a pre-teen stage; reconnecting with slightly childish hobbies is usually quite welcome when they are feeling vulnerable. Being a teenager, having to “front” so hard, is pretty exhausting.

These are just things I’ve picked up along the way. I’m no expert. I am very interested to know if you have an anxious teen - teetering on the edge of school refusal or not - and if you have found any way through it, or anything to help.

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