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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now we continue our week-long series on teen mental health by turning to a specific issue plaguing kids, parents, and educators across the country. It's been called school refusal. Do you wake up every morning wondering whether today will finally be the day your child goes back to school, or if you're a teacher, maybe you find yourself worried about the kids on your roster who are rarely in your classroom?

If so, it's not just you. According to NY1, for example, nearly 40% of students in New York City were chronically absent from school in the last school year, meaning chronically absent, defined as missing at least 10% of school days. It's not just New York City. Rates of chronic absenteeism, estimated to have doubled in the United States since the days prior to the global pandemic that shook the daily routines of all school-aged children.

Here to delve into this issue, and to take your calls and stories and questions seeking advice, is Ari Fox, psychotherapist, and the founder and director of Cope With School NYC, a therapy practice specializing in school functioning. Ari, welcome to WNYC. Thank you for joining us.

Ari Fox: Happy to be with you, Brian.

Brian Lehrer: To kick things off, could you give us a further understanding of what school refusal is? How is it different from just playing hooky in an old-fashioned sense, or wanting a mental health record there?

Ari Fox: Sure. What school refusal is, it's when a child or teen has a pattern of missed school days. It's an aversion to school, there's really a significant amount of anxiety or distress about attending school, about staying in school. It's not what we've thought of as truancy, which is, they're skipping out on school just to do something pleasurable. This is a real aversion to not wanting to be in school. It's really fueled by anxiety and depression. We're seeing quite a dramatic increase in calls about school refusal. It was there pre-pandemic, but it's increased exponentially since.

Brian Lehrer: Listeners, of course, we invite your calls on this with your stories or questions. Are you a parent of a child who's been refusing to go to school? Are you a teacher or school administrator dealing with increased absenteeism in your classrooms? Perhaps you're a student listening, right now at 11:00-something in the morning, because you're not in school and you'd rather listen to the Brian Lehrer Show. We want your ears, but maybe not under the circumstances. We want your stories, your struggles, and your questions. 212-433-WNYC, 212-433-9692. Well, you said it's been increasing, since the pandemic, what's the relationship to the pandemic?

Ari Fox: Well, I think that there's a multitude of reasons for that. I think the isolation, it is a big factor. There was so much control just in certain ways, not control over obviously, a lot of things with the uncertainty of the pandemic, but the control of being home with parents, the outside became more of a scary place and more of a scary phenomenon. After being insulated for so long, I think it is hard to reemerge into the outside world. That's one aspect.

I think for a lot of children and teens, there was just so much loss and so much uncertainty that there's a fear of what's going to happen from some level when you're not home. I think some kids have a sense that if I'm home, I could control things, whether it's true or not, but if I'm at school, something might happen, someone might be ill. I might not be able to know what's going on.

The other factor is that schools are overwhelmed and have been in survival mode for a long time. Some school refusal just wasn't identified. The schools were just trying to hang on during the pandemic.

Brian Lehrer: Would you have predicted this at the beginning of the pandemic? So much of the conversation during the period when schools were shot was, these kids want to be in school, they need to be in school, they need to be among others to be mentally healthy. Would you have predicted that there would be a meaningful percentage of kids who felt more comfortable at home and then less comfortable going back to school rather than kicking the doors down to get back in the real world?

Ari Fox: It's interesting because we see both sides of that coin. I think going back into when students were starting to go back to school, it was probably the first time I ever heard students eagerly anticipating going back and it's mostly to socialize and see their friends but for so many kids, and some are prone, before the pandemic, to depression and anxiety. You mentioned the CDC study on the program yesterday that those numbers were climbing even before the pandemic.

I think that trend does make sense. School refusal is so tied to depression and anxiety that we saw those numbers just increasing more and more during the pandemic and needs weren't being met. I think they've only continued to that effect.

Brian Lehrer: Are you seeing it more among any particular demographic groups, boys, or girls, or girls or boys, or non-binary students for that matter, or by race or by income? Any of those things?

Ari Fox: Interestingly, Brian, we are seeing a greater developmental span with school refusal than we had before the pandemic. Whereas we saw this a lot more with adolescents, now we're getting calls even from kids in preschool, up through high school, even some college students that were not going to class. Identifying many reasons, but pandemic, among them.

Yes, to your question, LGBTQ youth threat are definitely at higher risk. Kids with IEPs are at higher risk. They've fallen behind. I think that greater attention has to be placed on at-risk populations. They're definitely prone to school refusal.

Brian Lehrer: Perhaps with a story along those lines, here's Molly in Maplewood calling in. Molly, you are on WNYC. Hi, there.

Molly: Hi, Brian. I'm so thrilled to be talking to you. Thanks for taking my call. I'm a parent of a neurodivergent child who's not currently experiencing school refusal, but I know that a lot of other neurodivergent kids do. What I really see this that and they've been experiencing school refusal for a long time, and school can really be an anxiety-producing, unkind place to brains that are differently wired.

What I'm really seeing this as for the schools now that the anxiety might be maybe due to the pandemic shifting and to also neurotypical kids experiencing it is an opportunity for schools to implement universal design and make it so school's not scary, not anxiety-producing, asking questions, how can we meet the needs of all of our kids who are not feeling safe and not feeling affirmed and comfortable at school?

Brian Lehrer: Do you have any recommendations along those lines, Molly, of how or are you just raising that as a concept that they should be trying to make it comfortable for every child of every kind?

Molly: Yes. I think that the schools really needs to take stock of the kids' needs and see that, things that I think have often and for a long time been read as behaviors, non-compliance, are really just students' needs. Needs to move, needs to speak, needs to be quiet, needs to take a break from the room, needs to eat, maybe when it's not time to eat, just things that can make people feel more seen and comfortable and less of a compliance-based paradigm.

Brian Lehrer: Molly, thank you very much. Important call. Let's go next to Sherry in Manhattan. You're on WNYC. Hi, Sherry.

Sherry: Hi. Thank you, Brian, for taking my call. I have a senior who goes to one of the largest schools in Brooklyn, specialized school. He's a great student, very social. Coming out of the pandemic, what happened was the teachers all looked at black boxes. None of the kids were on camera. I think what it did for the kids was just not give them a sense of community. Now that they've been back in school over a year, they don't talk to each other. The teachers sometimes don't show up. I've heard so many of the teachers either quit or have a lot of absences themselves. The kids just don't connect. He's in the other room, doesn't want to go to school today because he says, "What's the purpose, mom? All the AP classes and the tests have taken place, and none of the kids talk to each other." It's really, really disappointing to know that there's not a lot of support in school for that.

Brian Lehrer: Ari, can you help Sherry and her kid?

Ari Fox: Yes. Sherry, this is a really common issue that we're seeing, and especially at a big school where I think it's hard to find your way and connect. I think that really, really seeing that kids are not-- they have lagged. They haven't picked up on some-- they haven't had the experience that a senior might have had pre-pandemic. They're avoiding these situations that are anxiety provoking.

Sherry: Even in the group, they do, I found I always knew don't the kids' names. They don't connect at all. He doesn't know most of the kids' names. How is that possible after a year being in advanced classes with a teacher and an instructor in a school that's supposed to be a five-star school and yet they don't know each other's names? I just don't understand how that happens. I'm sure it adds to their anxiety and their lack of social skills.

Brian Lehrer: Ari, are you hearing that, that much isolation?

Ari Fox: Yes, I think proactively-- It's probably just not a great answer for a senior. I think to get involved in extracurricular activities as much as possible and really push to make connections with other students outside of school and find your way, and learn how to tolerate that discomfort. I think for so long, we could turn the camera off and not have to face others. I think that's something that has to be pushed through. If you could do that in a more tolerable way, even if it's-- Some kids don't do well in a big group. You can find something with some mutual activity, mutual interest, and be in a small setting where you can build confidence. I think that that can be really helpful.

Brian Lehrer: That's interesting. Maybe a small group extracurricular activity that the student is drawn to. Sherry, I hope that's at least a little bit helpful. Let's take one more--

Ari Fox: Even a one-on-one just to encourage your child to go out and-- It's not something that they might push themselves to do, but they might need a little encouragement.

Brian Lehrer: Rob in Summit, you're on WNYC. Hi, Rob.

Rob: Hey Brian. Hi Ari. Thanks so much for doing this. It's amazing to always listen to my favorite radio station. Today, while dropping my daughter home too early from school because she wasn't feeling well. You're already helping by doing the topic, but it's really been difficult for us. She's got fibromyalgia, our daughter. It's made it really hard. We've got her into an IEP program. That was a big hill to climb. With only three hours a day in school, there's still a whole lot of absences. I'm just curious if there are other services and specific suggestions that you can share with all of us for both the parents and for our kids.

Brian Lehrer: Can I ask you one question before Ari gives you some advice? What does she say to you about why she's skipping school a lot?

Rob: It's a combination of words, Brian. Sometimes it's the word fatigue, sometimes it's the word migraine, sometimes it's, "I couldn't sleep last night." Just so many different reasons that are combinations of both physical and psychological.

Brian Lehrer: She's 15. Was she experiencing any school refusal before the pandemic?

Rob: No, sir.

Brian Lehrer: Ari?

Ari Fox: I'm really glad that you bring this up because the way school refusal manifests so often is through these somatic and physical complaints. We're constantly hearing about kids go to the nurse with headaches, with stomach aches, with pains. That really increased during the pandemic. I think it's important. Brian brings up a really good point, I think, to ask your daughter what was going on when she started to have the pain or the symptom, or what the trigger was, and to really start making the connection.

Not everybody can do that right away. It's a skill that you have to build. This is true with adults too. I think sometimes you have to really connect the mind, body, and start to realize that the pain is real and you're not making it up. It's something that's really affecting you. What's going on in your life? Maybe there's a fear. Maybe there's perfectionism. Maybe there's bullying at school. Maybe there's an undiagnosed learning issue.

I'm just throwing out different things that it might be, but just learning how to really pay attention to the body because it's giving us a lot of clues, and really just try to connect to what's going on and what might be setting it off. Then once you know that, once you have a better assessment of what's going on, then you can really troubleshoot and can talk to the school. You can learn how to calm the body in different ways, and to pay attention. I think that's a skill. It takes time but, ultimately, an incredible life skill.

Brian Lehrer: There's something called a 504 that's different from an IEP that maybe could help some of the families who've called in or others. Would you explain that category? People might be interested.

Ari Fox: A 504 is something a mental health professional can make a recommendation to the school. It could be a host of different accommodations. 504 can be something, if a child is anxious and they have test anxiety, for example, a 504 accommodation can be that they take a test in a separate location.

The difference between the IEP is a federal mandate, and it carries more weight in a different way, but it's also a bigger process and it's-- You have to go through the DOE and have a meeting. Whereas a 504 can happen a little more quickly. You can work with the school. Schools will often work with you, and usually with the help of a mental health professional, a therapist, a psychiatrist. I've heard of pediatricians doing that as well.

Brian Lehrer: There's another category, parents, that if you didn't know about it might be helpful in some cases, a 504, which Ari says is sometimes easier to get implemented than an IEP. IEP stands for Individualized Education Plan.

Rob, let me ask you one more question, if you're still there. I'm curious. I don't expect your situation to represent millions of people. Does your daughter, while she's school averse, do the work at home? Is she work-averse or just in-person averse?

Rob: It's such an interesting question that you brought up, Brian, because with all the missed days and all the missed hours, the teachers are often marveling at her brilliance and ability to still get good marks, get good grades, and pass the tests. It's the aversion. I won't use Ari's word refusal, but it's the aversion to physically getting up at-- You could probably do a whole new show about, are we asking him to go to school too early every morning?

Brian Lehrer: Oh, yes.

Rob: It's the aversion to get in there and being in the classroom, and the inability to stay for too long. She's able to get through the work.

Brian Lehrer: Thank you. Thank you. I'm glad I asked that follow-up question. Also, Rob, you'd be interested to know that on yesterday's show in this series our guest yesterday, the expert on this, Lisa [unintelligible 00:20:01], talked about how teens need about nine hours of sleep a night, don't usually get it in so many cases in this country. Yes, I know I was never happier as a teen. Then when I was on the year and my school we went on a 10:30 to 4:30 schedule because the school was on shifts.

Ari Fox: The schools are slow to adopt this but yes, I know a growing number of high schools that are finally keying into this and starting the day later, which is incredible. I hope more schools will follow that lead, starting in middle school where kids need so much sleep.

Brian Lehrer: Yes. Do you hear Rob's story a lot where the work is actually getting done, it's just the avoidance of being in-person?

Ari Fox: Yes, sometimes the work can get done but it becomes a vicious cycle. You don't go so the world keeps going outside of you but you're not connected to it. That's why we really have to step in quickly when there's avoidance or refusal, either way. [crosstalk]

Brian Lehrer: You wouldn't say homeschooling is the-- Should more kids be homeschooled? Should this be a learning moment for how to sort kids into ones for whom homeschooling might be appropriate, or is that a destructive response?

Ari Fox: I don't want to make a blanket statement because for some kids it's probably the only way or the best way to keep them engaged. I think for many kids they dig deeper into the hole and they're more isolated and it's just harder to, even if they're staying on top of their work, just to maintain social connection.

I think for the majority of kids, I recommend finding a way to get back, finding a way to connect, finding someone in the school who's an ally, even if someone can reach out to the child and say, "Hey, I haven't been seeing you lately, what's going on? How can we get you back?"

Brian Lehrer: One more. Here's a high school student calling in. Ellie in Middlesex County. Ellie, you're on WNYC. We really appreciate that you called us. Hi.

Ellie: Hi Brian. Thank you for having me.

Brian Lehrer: You want to talk about--

Ellie: I'm actually [inaudible 00:22:37]--

Brian Lehrer: Yes, your situation. Go ahead.

Ellie: I'm a 17-year-old. I'm a junior in high school right now. I'm actually supposed to be in school and I'm home right now. I have pretty bad school avoidance and I've had it consistently since I started high school. I started high school after the pandemic. I had several interventions with my teachers, with the principals. I have a 504 plan and I started making a little bit of progress recently, but it's still really, really hard for me to show up and be there in person and stay there.

Brian Lehrer: How come?

Ari Fox: Thanks so much for calling, first of all. Yes, [crosstalk] more

Brian Lehrer: Yes, go ahead. You're going to answer how come?

Ellie: I'm part of the LGBT community. I also have mental health issues and severe anxiety. For me, I go to a smaller school. It's really hard to deal with social situations because I'm not very popular. People don't really talk to me and when they do, it's not in a nice way. It's hard for me not only to be within the student body, but the teachers also don't have a lot of empathy for me because I'm not really able to do the work when I'm missing the school. I find that the teachers treat me like crap and the kids do as well, so it just feels like a very negative environment for me.

Brian Lehrer: Ari, give Ellie a thought and then we're actually out of time [unintelligible 00:24:12].

Ari Fox: First of all, I'm so sorry to hear that you're going through that. You said that you've made some progress, which is great. I'm curious what has worked, and is there somebody in school that you can rely on that you can go to that's safe that can help you in the school?

Ellie: I just started going to a day program. They help me build skills to deal with and manage my anxiety, being around people and being in school. I also found that certain teachers, like I have a few teachers that are very open and very communicating, and they've really helped me catch up with the work.

Brian Lehrer: Ellie, thank you very much.

Ari Fox: I think that's great. I think-

Brian Lehrer: Go ahead, Ari.

Ari Fox: Yes, slowly building your confidence as much as you can and trying to stay in the moment and really celebrating your wins. You said that you made some progress. You don't have to do it all at once. Lean on the people that are there to help you. You don't have to be friends with everybody. Look for people that are going to be kind, and don't let other people bring you down.

Brian Lehrer: Look for people who are going to be kind. You sound really self-aware, Ellie, so I think you're head of a lot of folks. Good luck out there and-

Ari Fox: You're going to do great.

Brian Lehrer: -please feel free to call us again on this or other things.

Ellie: Thank you.

Brian Lehrer: To wrap up, I see you have an event coming up Ari that seeks to help kids dealing with school transitions. You want to tell folks about it?

Ari Fox: Yes. One of the things we do is to try to be proactive about school to help people feel safe. Cope With School NYC is our therapy practice. We're co-sponsoring an event with New York City Admission Solutions. It's May 24th at 6:00 PM. It's going to be via Zoom. The information is at our website copewithschoolnyc.com, C-O-P-E withschoolnyc.com.

We're going to have one of our therapists, a school social worker, an admissions expert, and as well as maybe most importantly students and parents who have been through school transition. You could come and ask them questions and learn some real concrete strategies about how to deal with transition starting a new school, for middle school, for high school. We're really excited about it and we hope you can join us.

Brian Lehrer: Psychotherapist Ari Fox, founder, and director of Cope With School NYC. Thank you so much for joining us today. We really appreciate the help you gave some of the callers.

Ari Fox: Thanks so much for having me.

 

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