By Professor Tony Attwood
There are many aspects of being at school that are challenging and stressful for children and adolescents who have autism. This can lead to school refusal, and a recent research study conducted in Norway has explored the risk of school refusal for students who have autism (Munkhaugen et al. 2017). The study, conducted over a 20 day period, included 216 primary and high school students of whom 78 had autism.
The risk of school refusal for the children who had autism was 42.6 per cent, while the risk for typical children was only 7.1 per cent. The students with autism also displayed school refusal behaviour for a longer duration than their typical counterparts. Many expressions of school refusal were observed, including verbal and physical refusal, pleading, clinging, crying, noncompliance, verbal and physical aggression and threats. School refusal was equally common in girls and boys who had autism, and occurred equally often in primary and high school.
School refusal will have a negative affect on academic and social development and can lead to a student completely dropping out of school. This will have consequences for future employment and create a need for social security benefits. The behaviours associated with school refusal are also stressful for parents and siblings, and of concern for the school and teachers.
While the Norwegian study confirmed a high level of school refusal for students who have autism, it did not explore in depth the reasons why school is perceived as so averse and to be avoided. From my extensive clinical experience there are several reasons a student might engage in school refusal behaviour, including:
- feeling alienated from peers who may be engaging in bullying, teasing and rejection
- being unable to achieve successful friendships, and thus feeling lonely
- experiencing an education curriculum and teaching styles that do not accommodate the cognitive and sensory profile associated with autism
- finding too great the contrast between the safety and enjoyable activities at home, and the anxiety, stress and vulnerability experienced at school
- developing effective behaviours to coerce a parent to agree to the child staying at home.
One of the most powerful reasons for school refusal is being tormented or rejected by peers. From the child’s perspective, going to school is like entering a war zone, where he or she will be ‘ambushed’ by predatory peers. There is probably a lack of acceptance and respect by peers, and the child is finding the acquisition and maintenance of successful friendships elusive. Thus, their self-esteem and self-identity becomes based on feelings of social inadequacy and rejection.
In class, the child needs a teacher who:
- knows their distinct thinking and learning style
- is calm and reassuring, especially when the student is confused or experiencing a meltdown
- manages the other students so that the child feels safe and can concentrate
- knows when the child needs to take a break or be alone
- prepares the child for changes and transitions in the daily schedule
- ensures that the other students follow the class rules
- understands the child’s perspective, experiences and motivators
- helps the child cope with mistakes and does not make the child feel stupid
The child will be very aware of the amount of mental energy they need in the school day to cope with the academic and social curriculum, and with their high levels of anxiety and sensory sensitivity. They may create a ‘mask’ at school to hide their distress, such that the school is unaware of the daily challenges they experience. They may well return home at the end of the school day mentally exhausted, their distress clear to the family, but have limited opportunities for energy refreshment before the start of the next school day. The child’s perspective therefore, may be, ‘why go to school?’, when they are not successful academically, socially or in sporting activities, and peers are toxic to their mental health. I am frequently amazed at the courage and determination shown by autistic students in actually going to school day after day.
The contrast between home and school is very clear from the child’s perspective, with home being associated with feelings of safety, relaxation and enjoyment of the special interest, (especially computer games), and time spent with pets. So the child, while possibly finding it difficult to verbalize to parents and teachers their experiences at school and motives for school refusal, may instead develop a range of ‘inducements’ to stay home. These can include threats, expressing extreme despair, emotional blackmail and physical and verbal aggression. Unfortunately, when they have avoided school for several days and eventually return, they have even more difficulty assimilating into class academically and socially and catching up with school work. This may make avoiding school even more likely.
A parent who insists on the child attending school may be perceived as mean and cruel, engendering deep feelings of resentment in the child. The challenges in coping with school refusal may be further amplified for a parent whose own school experiences were similar; they want to protect their son or daughter from suffering the same, potentially traumatic, experiences as they did.
Encouraging the child to go to school can also be exhausting for an already exhausted parent, and especially an exhausted single parent. The stress of encouraging school attendance can contribute to a parent feeling depressed and worried about the child’s future. There can also be concern as to how to accommodate the child at home and ensure they achieve an education. The situation becomes increasingly difficult with the increasing age of the child, especially during adolescence when the teenager is larger and stronger than their parent.
What can be done to reduce the risk of school refusal?
It is important for schools to focus on the social aspects of school, with activities and guidance in developing and maintaining friendships. We now have a range of resources on improving friendship skills that would be of benefit to all students, but especially those who have autism. There also need to be effective procedures for reducing peer victimization for students who have autism, and building their resilience, conflict resolution skills and self-esteem.
There also needs to be an assessment of the individual learning profile and personality of each student such that modifications may be made to the curriculum and teaching styles. It is important for all teachers at the school to have training in how to successfully include a child with autism in the classroom.
The child themselves may need support from a psychologist to cope with anxiety and stress at school, and to build their self-esteem. They may also need therapy to achieve closure for any ruminating thoughts of past injustice.
Parents also need support in encouraging school attendance by using an assertive and positive approach, and guidance in how to achieve this, and how to work constructively and cooperatively with the school.
The Norwegian research has confirmed the high level of school refusal among students who have autism; and clinical experience suggests reasons why such students are at risk of school refusal. The challenge now is to make school an autism friendly environment.
Munkhaugen, EK et al. (2017) School refusal behaviour: Are children and adolescents with Autism Spectrum Disorder at a higher risk? Research in Autism Spectrum Disorders 41-42 pp 31-38.