Boston Globe: Anxiety-fueled school refusal

Anxiety-fueled school refusal
Posted on 06/12/2024
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MIDDLEBOROUGH — There’s no single reason why 11-year-old Hunter Scanlon refuses to go to school. It’s the panic, and the headaches. It’s the racing thoughts. It’s the nausea. It’s the dread and the skin crawling and the self-loathing and the worry.

Those feelings, a tumbling snowball of anxiety, have kept the fifth-grader out of class and at home since October. Over those many months, he’s received little to no education. 
“A lot of people don’t realize how bad it is, and how easy it is for the kids to fall through the cracks,” said Hunter’s mother, Sabrina Scanlon. “It’s something that needs to be talked about.”


Hunter is part of a troubling trend — seen recently in the case of 14-year-old Braintree student Samantha Frechon — in which debilitating anxiety is keeping kids from school for months at a time. It’s a form of chronic absenteeism that’s often misunderstood by public school systems, whose staff typically don’t have the training or capacity to meet kids’ mental health needs, and that, according to clinicians, has only worsened post-pandemic. 

“The acuity of the kids is just so much more profound,” said Meredith Elkins, a licensed clinical psychologist and co-program director of the McLean Anxiety Mastery Program at McLean Hospital in Belmont. “And consequently, we’re seeing a lot more school refusal and a lot more entrenched school refusal, meaning kids who haven’t been able to regularly attend school for years.”

“What schools are telling us is that it’s getting harder and harder to help students understand what’s behind their anxiety, or what might be going on, because they’re not coming to school,” said Kate Tetuan Parent, associate director for school-based programs at Boston Children’s Hospital Neighborhood Partnerships.

There’s no way to quantify what percentage of student absences are due to mental health disorders, but experts say they at least contribute to high chronic absenteeism rates. Through March of this school year, nearly one in five Massachusetts students had missed at least 10 percent of scheduled school days. At that rate, those children will be absent at least 18 days — more than three weeks of school — by the time classes end this month.

In dozens of interviews and survey responses, parents described myriad reasons for their children’s school-related anxiety. Some have been bullied. Others fear falling short academically. A number of them don’t seem to have specific reasons why. But for many kids, including Hunter, the anxiety seems to be all-encompassing, parents said. Reflecting on the pandemic’s toll, Scanlon is not surprised children in her son’s generation are struggling to see the value in attending class. “They have so much access to information, and they see so much of what’s going on in the world, that of course, they’re gonna be like, ‘Well, what’s the point? The world could shut down tomorrow. . . . Why am I going to school?’ ” she said.

There are no easy solutions to school refusal, especially for kids with compounding disabilities, such as autism. Parents can seek “homebound” educational services through their districts, but in-person tutors are in short supply and virtual options often fall short. Private therapeutic schools, meanwhile, can offer smaller class sizes and more individualized support, but they’re extremely expensive — some, more than $100,000 annually — putting them out of reach for most families. 
Federal law requires districts to cover the cost of private tuition when they can’t meet a special education student’s needs in-house. Faced, however, with declining enrollment and the end of pandemic-relief funding, districts across the state are in the throes of budget turmoil and have fewer dollars to spend on out-of-district tuition costs. What often emerges, the Globe found, is an adversarial dynamic between parents — who believe schools bear responsibility for reengaging students — and administrators — who have historically relied on the legal system for truancy enforcement .

“It’s not fair for the schools to be asked to do this work without training,” said Ellen Chambers, founder of SPEDWatch, a Massachusetts advocacy watchdog group. “But they are, and the kids are the victims.”

Anxiety, the most common mental health condition in the world, can show up in children before they’re old enough to verbalize how they’re feeling. One way to think about the disorder, said Kate Sheehan, managing director for the UCLA Child Anxiety Resilience Education Center, “is like you have a faulty internal alarm system that needs to be recalibrated.” “It is going off way too often, like an oversensitive car alarm that will go off when a tree lands on it, but also if someone brushes against it while they’re walking their dog,” she said. Nearly one in 10 children ages 3 through 17 in the United States had diagnosed anxiety between 2016 and 2019, according to the Centers for Disease Control and Prevention. Studies have found rates of anxiety symptoms in children doubled over the pandemic.  What’s at risk for these students is more than lost learning time: Children with severe anxiety are more likely to develop depression and substance abuse.

In Middleborough, Scanlon, a single parent, has been pleading for help.

On a recent warm morning, a box fan whirring by the front door, Scanlon perched on the family’s sectional sofa, laptop in hand. She works there, as a quality assurance tester for a health insurance company, rather than at her bedroom desk, at her son’s request. Hunter, with a view of the couch from his own room, feels anxious when he cannot see her. Hunter’s anxiety first became noticeable in the third grade, along with depressive symptoms, when he started refusing to leave the house for school. His anxiety worsened in the fourth grade following a string of illnesses. After an appendectomy last spring, he finished the school year at home. In the fall, fifth grade started off well — he attended school for nearly the entire month of September. But then Hunter became physically sick again, triggering the anxiety, and Scanlon couldn’t get him to go back.

Hunter’s pediatrician, noting his extreme anxiety, signed off on the boy receiving a homebound education from Middleborough Public Schools, which, at minimum, according to the state, must include “the instruction necessary to enable the student to keep up in his/her courses of study and minimize the educational loss that might occur” while away from school. To comply with its responsibility, the district offered Hunter virtual tutoring.

But Hunter, who had a poor experience with virtual learning during the pandemic, hasn’t been willing to participate. It’s difficult to keep up and he doesn’t like having his camera on, he said. Scanlon has asked repeatedly, according to emails viewed by the Globe, for an in-person tutor, but the district has been unable to find an available teacher. Scanlon also requested in-home therapy sessions, but the district said Hunter didn’t qualify. It wasn’t until the end of January that the district offered Hunter a seat in its Therapeutic Learning Center, or TLC, program. Hunter, intrigued by the promise of a therapy dog, agreed to go. On his first day, he stayed for an hour, which to Scanlon represented a huge accomplishment. But when a staff member encouraged Hunter to try staying longer the next day, he fell apart.

“That’s all it took for him to shut down again, to be like, ‘I’m not good enough,’ ” Scanlon said.

Desperate, Scanlon then enrolled Hunter in a day program at a psychiatric hospital in Rhode Island, but the nearly hour-long commute each way, in addition to the full day at the hospital, proved to be too much for the boy, she said. He lasted there for just over two weeks. Scanlon ultimately found a private therapeutic school not far from her house that she said would meet Hunter’s needs. But even if she could afford its $70,000 annual tuition, Scanlon couldn’t enroll him there. The school only takes referrals from districts, she discovered. Middleborough has not proposed Hunter receive an out-of-district placement“I don’t know what accountability they’re held to,” Scanlon said of the district. “Like, if something doesn’t work, shouldn’t they be offering something else?” Middleborough Superintendent Carolyn Lyons said she could not discuss Hunter’s case due to student confidentiality law, but said the district has created a “comprehensive mental health system” including a director of student services, a districtwide outreach counselor, and a team of behavioral professionals to assist students at school and home. The district conducts social-emotional screenings at all grade levels and helps connect families to private mental health counselors when needed, she said. “Please know that regardless of the intervention or plan put in place for any student, it is only as effective as the support and collaboration provided by families who are willing to work with their school district,” Lyons said in an email. 

Meanwhile, Scanlon is paying $80 per month for Hunter to access a virtual fifth grade curriculum not affiliated with the district. Hunter has As in all of his courses, which include prerecorded instructional videos. But with summer fast approaching, he’s nowhere close to finishing. In English Language Arts, he’s only completed 7 percent of the year’s coursework. “We’re trying,” Scanlon said. “But he hasn’t gotten an education. It’s crazy.”

Kevin Simon, Boston’s chief behavioral health officer and a pediatric psychiatrist at Boston Children’s Hospital, has seen families in similar situations. “The reality is, as a parent, it’s pretty difficult to take an 8-year-old or a 12-year-old and force them to do something that they don’t want to do,” Simon said. “And a lot of times, unfortunately, school systems may not be as well equipped to understand the dynamics of somebody that has now developed a diagnosable anxiety condition.” According to the Department for Elementary and Secondary Education, districts are implementing a host of practices to support students with anxiety, from providing mental health screenings to training staff. Additionally, Governor Maura Healey’s administration recently announced a $13 million investment in an in-school program for supporting students who’ve fallen behind academically because of mental health challenges. It’s the first time the state has provided funding for such programs.

John Crocker, founder and director of the Massachusetts School Mental Health Consortium, lauded those moves, as well as district leaders who’ve prioritized hiring more mental health staff. But a well-oiled care system requires dedicated infrastructure, including a clinical leader — a position only employed by 30 percent of districts in the state, he said. “This is not something everyone is investing in equally,” said Crocker, director of mental health and behavioral services for Methuen Public Schools.

In cases of school refusal, Crocker said schools and families should be working collaboratively, engaging outside providers as needed. Telehealth services could be used initially, as care teams edge toward in-person work. “Without some bridge to the home, without some sort of services . . . I would be worried,” he said. 

Massachusetts law requires children ages 6 to 16 to attend school daily. In enforcing truancy rules, districts across the state have traditionally pursued a child neglect and abuse report, also known as a “51A,” named after the state mandated reporter law, or Child Requiring Assistance (CRA) court cases (formerly known as CHINS).  In Boston, where 7 in 10 students come from low-income households, the involvement of outsiders has bred mistrust, said Yi-Chin Chen, executive director of Friends of the Children — Boston, a nonprofit that supports at-risk youth and their families. And though schools have begun incorporating “mindfulness” practices into the day, such as meditation, not all educators treat student anxiety with compassion, she said. I believe that the kids will be much more likely to be willing to tolerate discomfort if they feel safe,” Chen said.

In Waltham, Melissa Shea’s 17-year-old daughter, Olivia, almost never manages to attend school five full days a week. Olivia’s school refusal began in the sixth grade, shortly after being diagnosed with anxiety and depression. The pandemic, which closed schools during Olivia’s seventh- and eighth-grade years, only made things worse, Shea said. Like other children experiencing anxiety, Olivia deals with brutal physical symptoms including a “brain fog” that makes it nearly impossible to concentrate, her mother said. “It’s difficult to pay attention and learn when you have all that going on in your body,” said Shea, a single parent.

Still, according to Shea, Waltham Public Schools said Olivia does not qualify for special education services — a decision Shea contests. (A child with an anxiety disorder can, in fact, qualify for a special education plan under federal law if their symptoms interfere with their ability to access an appropriate education.) Without specialized instruction, Olivia doesn’t have access to a sorely needed academic support class, Shea said.

“I don’t know what the answers are,” she said. “I just know what my kid’s struggle is. And I know that, at this point, I’m just trying to get her to graduate.” Stacy Deans, of Westford, can empathize. Her son, Justice, who requested the Globe use only his middle name to protect his privacy, started to refuse school in the eighth grade. Deans and her husband were bewildered.

“We felt like he was kind of just being this bad kid that didn’t want to go to school,” Deans recalled. “And we really, like, pushed him. Like, literally — physically taking him by the arm and putting him in the car and telling him, ‘You have to go to school. It’s not an option. You have to go to school.’ And yet, there weren’t any supports in place for him.” That year, Justice, who has autism in addition to anxiety, would miss 60 days of school. In the ninth grade, things got so bad the boy only attended school seven full days. Justice, 16, is now repeating the ninth grade, but he’s no longer struggling with school refusal. Through an agreement with Westford Public Schools, Justice now attends the Gifford School in Weston, a therapeutic day school where staff are trained to support students with varying mental health needs. Justice’s classes are small, just six to eight kids. He’s able to take frequent breaks, and Deans receives a weekly phone call from school staff about his progress. His grades have climbed from zeros to As and Bs.

“I feel bad for the public school systems because, obviously, there’s only so much room in their budgets,” Deans said. “But at the end of the day, these kids deserve to have a public education just like anybody else. And it is the school’s responsibility to do that, even if it means sending them out of district.” 

In Middleborough, Hunter is making hard-fought progress. He now opens the blue curtains in his bedroom, letting sunlight wash over his vast collection of Squishmellow stuffed animals. He spends time on the back deck, too, where he cuddles the family’s 100-pound dog, Charlie. He even walked, one recent afternoon, to the convenience store down the dirt road from his house — the first time he’d ever done so on his own. Beginning middle school next year, Hunter is hopeful for a fresh start. But Scanlon, who has filed a state complaint against Middleborough saying it failed to properly educate Hunter this school year, is grappling with her own anxiety over what comes next. “I see him getting better and doing better and then of course, I fear that he’s gonna fall into it again . . . that he thinks going to middle school will fix all his problems. Then I worry that he’s gonna get there and he’s gonna realize that that’s not the case,” she said, beginning to cry.

Mandy McLaren can be reached at [email protected]. Follow her @mandy_mclaren.