Autism, anxiety and "school refusal"

I strongly dislike the term "school refusal", simply because it implies that the child who is not accessing school has a choice. Have you heard of the "stress bucket analogy" ? Everyone has a "bucket" which represents resilience. This resilience or vulnerability varies from person to person. So you could say that some of us have bigger buckets than others! Stress represented by water flows into the bucket. When the bucket overflows we reach the point of too much stress, it all becomes too much. Coping strategies, that we use to help us manage our day to day stress, are like a valve or tap that we use to drain water out of our bucket, therefore increasing our capacity. Autistic children and children with other SEN often turn up to school in the morning with a bucket that is already full up. It doesn't take much to exceed their bucket's capacity. Anxiety and other mental problems are particularly associated with autism. While stats vary, what is clear is that autistic children and adults are much more likely to experience mental health difficulties than neuro-typical individuals. "School refusal" occurs when :

"stress exceeds support, when risks are greater than resilience and when "pull" factors that promote school non-attendance overcome the "push" factors that encourage attendance." (Thambirajah et al. 2008. p. 33).

In other words, the child's bucket overflows and it all gets too much. They are not choosing to not attend school, rather their capacity has been exceeded. Autistic children are at high risk of withdrawing from formal education. There are currently many autistic children and children with other SEN, whose needs are not being met by the education system. Refusal is never the core issue. Rather, these children are highly anxious and emotionally drained from trying to fit into a world that is designed for the neuro-typical. Inclusion should not be about SEN children adapting to fit into the system and frequently feeling like a failure. True inclusion should involve the system making reasonable adjustments to meet their needs. When terms like "school refusal" are used, it places the responsibility for the problem on the children, who, along with their families are left isolated and forgotten. Local education authorities focus on the symptom, ie non school attendance rather than the underlying reasons, often blaming parents. We need to change our perspective! These children are not refusing to go to school. Their capacity has simply been exceeded, their buckets have overflowed. We need to look at the reasons behind the stress experienced by the child, make the right adjustments and alleviate that stress.

This is not always as easy as it sounds, in a system strained by budget cuts with often dedicated teachers and teaching assistants themselves stretched to maximum "bucket capacity". In addition, many children often mask or camouflage their difficulties bottling them in until they return home. Again the bucket analogy is useful here with the school day being like the drip, drip of water filling up their bucket until the capacity has been breached! Some are unable to recognise the signals from their body which would alert them that they were stressed, whilst others experience delayed processing, only processing stressful events at a later date. There are many simple strategies, both for home and school that can help, which I will go into in more depth, in later blog posts. I would particularly recommend schools using a sensory profile checklist to assess underlying triggers. Another fantastic free resource is the school stress survey available at https://www.tes.com which helps to identify the stressors for the child. The simplest and most effective strategies though are a willingness to see the way that the child views the world. Be a detective and work out what is going on! It is sometimes easy to forget that flexibility and empathy are so easy and cost nothing. They can make an enormous impact to the autistic child, struggling to access school.