For many parents it’s back to school this week, a time of mixed emotions. I’m sure that I am not alone in feeling a sense of relief (thank God I’m no longer responsible for them 24/7 or for organising who will be responsible for them 24/7), sadness (how the heck did they get this big? A minute ago I was wiping their bottom) and anxiety (how will they get on with their new teacher?).

The “Back to School” prep has all been done. This year, thanks to a last minute job application form that was due, the majority was delegated to Banker. For the first time, he braved John Lewis alone with the kids to battle over the last Size 3 Geox, AND he ironed on all the name labels on the new uniforms. This latter he did correctly this time as last year when he was assigned this task he spent an hour ironing on sticker name labels (used for books and pencil cases etc) rather than the iron-on name labels (used for clothing). They obviously didn’t stick and I had an absolute barney as I had to repeat the task. This year all was done to standard, which goes to show that these parenting tasks need not be the preserve of mums (if we are happy to tolerate a hiccup or two)! All I did was get Lil Bro his back-to-school haircut and then they were set.

As soon as my kids saw their friends they were off without a backward glance.

I toddled off to the shops. It was with sadness that on my return from the shops, a good hour after the school bell had tolled that I saw a mum and her son outside the school gates. I heard a snapshot of their conversation “Just go in and talk to the others. It’ll be fine.” It occurred to me that for some families, “back-to-school” is not just a logistic nightmare of name labels, new shoes and haircuts, but a return to a battle-ground and heartache.

As an autism specialist, it is not uncommon for my clients to loathe school and in extremis to refuse to go to school. Anxiety is the most common co-morbidity in children with autism, and it is also the most common mental health problem in primary school aged children. So here are a few pointers on school refusal:

Try to find the cause for anxiety

• Encourage your child to feel safe to talk to you about their problems. This requires a non-judgemental attitude and a guarantee of confidence and that they will not get into trouble. They will also need to know that they will be taken seriously, and that you will have the resources and strength to help them. Many children I see in clinic do not disclose bullying to parents as “it will worry them”, “they won’t believe me”, “they will only confront the situation and make it worse” or “they won’t be able to do anything”.
• Often it is not sufficient to ask your child why they will not/ do not want to go to school. Persistent badgering on this question may cause more harm than good if it is not forthcoming given encouragement. Sometimes your child may not fully understand their own emotions or the cause of their emotions and therefore cannot tell you even if they wanted to. In this instance, it is up to you to speak to teachers and friends and come up with your best guesses. Discuss these hunches with your child in a non-judgemental way: “If I were in your shoes, I’d be a little scared of your new teacher…” and see whether any of them chime with your child. This is a favourite child psychiatrist strategy of mine as usually one of your guesses will be correct and when you see a child’s face respond to you verbalising their darkest emotions, you can tell that you’ve got to the heart of it and work can begin.

If you find a cause then dealing with the cause will be your next step. Some common causes for school refusal in primary aged children are:

• bullying/ social ostracisation by peers
• bullying/ fear of a teacher/ fear of being told off
• anxiety about a particular subject: fear of failure in an academic subject, fear of being ridiculed in P.E.
• anxiety about leaving the parent (separation anxiety) for fear something may happen to the parent.

Sometimes, there is no one-single cause and anxiety may be generalised or the sum of minor anxieties that can overwhelm. Working through each one, however minor, can be important.

Dealing with the cause should always involve:

• Working together with the school. The natural parental instinct is to do your utmost to protect your child which can mean confronting the school staff or the parents of other children. Try to stay calm and keep an even head – whatever happens, getting other parents and teachers on side will lead to better outcomes for your child than making adversaries.
• Supporting your child. As well as in relation to the identified cause, increasing your child’s self-esteem, resilience and social skills will always help.

Avoid pitfalls:

• Sometimes, parents will allow children to stay off school due to school refusal. It is important to remember that this can inadvertently encourage problems as you are in effect teaching your child that crying and fussing will lead to a day off school. Sometimes it is impossible to get a child into school, but if this is the case, then schoolwork should be done at home rather than a pleasurable day at home watching TV and playing computer games. An incredibly boring or taxing day of chores at home may lead some children to the conclusion that school is preferable!
• If at all possible, get children back into school as quickly as possible because the longer that they are off school, the harder it will be to get them back.