By Andrew Feinstein
Jonathan is a bright young man, raised by a loving couple in an affluent suburban neighborhood. He always was easily distractible and rather high strung, but not so severely so as to undermine his high B/low A average. Yet, when he entered high school last fall, he faced increasing difficulties getting out of bed and going to school. His diligent parents tried rewarding him to attend. They tried punishing him for skipping school. They tried force, remarkably unsuccessfully. They took him to the best-regarded adolescent psychotherapist in the county. Jonathan’s grades plummeted. He started feeling terrible about himself. When pressed, the therapist opined that Jonathan had a Generalized Anxiety Disorder 300.02 (F41.1).
The Diagnostic and Statistical Manual, Fifth Edition, (DSM-V) has a six-part test for GAD. First, excessive, nearly constant worry in various settings. Second, the individual cannot control the worry. The anxiety is manifest in at least three of the following symptoms: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disorder. Fourth, the anxiety or its manifestations causes significant impairment in day-to-day functioning. Fifth, the disturbance is not caused by drugs or another medical conduction. Finally, other physical and psychological disorders, such as social phobia, obsessive-compulsive disorder, or trauma, do not better explain the anxiety.
Jonathan’s parents went to his local public school to secure the services and protections of a special education designation. The school officials rebuffed them, explaining the three-part test for special education: first, that Jonathan had to have one of the thirteen listed disabilities, second, that disability had to substantially interfere with Jonathan’s ability to access the general education curriculum, and, third, that by virtue of that, he required special education services. While a truly severe anxiety disorder might qualify under the Other Health Impaired or Serious Emotional Disturbance labels, Jonathan’s school-avoidance did not rise to that level. If Jonathan would just show up, he would have no problem accessing the curriculum, as he had in middle school. And, Jonathan exhibited no learning difficulties that would require specialized instruction. Rather, the school broadly hinted that the parents should stop being so permissive and stop coddling Jonathan.
Jonathan is not alone. Anxiety disorders and school-avoidance have skyrocketed over the last two years. As a special education lawyer in Connecticut, I see it in my clients. I hear of it from school district special education directors and from pediatric psychologists. There appears to be no research data explaining this mini-epidemic or even documenting its existence. Still, the substantial increase in the incidence of this type of dysfunction can be understood through three lenses.
Anxiety is a highly genetic condition. Anxious parents create anxious children. We are not talking about anxiety as a pathology, in the DSM-V sense. Rather, in an increasingly competitive world, parents are legitimately worried about their children’s future. In 1972, when I graduated college, I could easily secure a minimum wage job ($1.60 an hour at the time) and, with that $200 a month, rent an apartment, buy food and clothes, and afford to go to the movies. The current college graduate is hard pressed to find work and a minimum wage job will permit the kid to pay a little bit towards the cost of his or her room in the parents’ basement. The old notion of working for the same employer for an entire lifetime is gone. The Bureau of Labor Statistics says the average American will work in ten jobs by age 40. Parents are justly worried about when and whether their children will launch.
Parents know that success in school usually leads to success in the workplace. So, to allay their fears, they push their children harder and harder in school. Indeed, the imposition of the Common Core, a rigorous set of national academic standards for elementary and secondary schools, can be seen as a societal manifestation of this same fear response. How often do we hear exhortations to work harder, to succeed, to learn the skills needed for tomorrow’s jobs? Living in this high-pressure environment, anxious kids become the norm. In some, that anxiety spirals out of control.
The second trend is reinforcing. Schools used to be a warm, safe nurturing place. No more. In the wake of Columbine and Sandy Hook, public schools have become little fortresses, with locking doors, metal detectors, police in the school, and frequent lock-down drills. If fear of the future is one cause of anxiety, studying in a fear-driven physical environment is another.
Beyond the manifestations of physical security, the nurturing, understanding, individual focus of teachers has largely disappeared. It used to be that teachers worked with the students in their classes and assessed their performance against what was taught. We have now moved to an era of nationally-written, high-stakes tests. The connection of the student to the teacher has been weakened. The feeling of safety and security that comes from that connection has been lost. Indeed, many teachers now say that teaching has become illegal. Their job is to administer a curriculum and test frequently. Data-based education is the current watchword. Students are less individual human beings and more data points to demonstrate a satisfactory level of annual yearly progress.
Finally, and closely related, is what has happened to society as a whole. America is a land of fear. Some of the fear is an understandable reaction to Columbine and Sandy Hook, 9/11 and Las Vegas. But a good portion of the fear has been stoked by politicians who understand that popular fear enhances their own power. This pervasive fear has led inexorably to a rending of social fabric. The sense of American community has eroded. Neighbor cannot count on neighbor for protection and support. America has become a land of anxiety. The safety that the community used to provide is no longer evident. If society as a whole is exhibiting anxiety, it is no surprise that some students are suffering from debilitating anxiety.
What is to be done? Mental health professionals aver that cognitive behavioral therapy can effectively address anxiety in individual students. One noted psychologist says, “the key is to be proactive early, during the emergent phase of the anxiety, before the permutation to avoidance. Intervention has to be twofold: both academic with inherent building of regular success through an appropriately drafted set of services and outside therapy (problem solving/cognitive behavior strategies) to change negative thoughts, fears, and avoidance/ dependence styles. The typical ‘counseling’ in school that involves checking in and how are you doing, only serves to fuel the problem as they are unable to articulate it and actually find it more anxiety provoking. Once the avoidance occurs, the trust with the staff in particular and the building in general becomes associated with failure and negativity. Daily attempts at driving the student up to the school and trying to talk them into coming into the building becomes more anxiety provoking and negatively reinforcing. Once school avoidance is embedded, it is difficult to turn around within the school setting.”
And Jonathan. What becomes of him? Anxiety-ridden children become internalizers or externalizers. Internalizers become depressed, sullen, and, eventually perhaps, suicidal. For them, school-avoidance is the only path they can take. Attending school exacerbates their fears, makes the pain more intense. They are usually ignored by schools until their problems become so severe that they are hospitalized. Externalizers act out. They seek relief in drugs and alcohol. They lead others into antisocial behavior. For externalizers, attending school makes no sense. It is a place of extreme discomfort and minimal relevance.
What is clear is that the typical school reactions to anxiety-driven school avoidance are wrong-headed and often counterproductive. Initially, school officials tend to blame permissive parents for kids who refuse to attend school, while, in reality, it may well be parental pressure to succeed in school that catalyzed the avoidance in the first place. Then, school officials offer counseling to the student. Such weekly check-ins often become an additional source of anxiety, where the student is prodded to explain his or her nervousness. Finally, school officials impose behavioral support plans which reward students for school attendance and, consequently, punish them for school avoidance. All too often, such plans add a whole new layer of anxiety and further dilute the perceived safety of the school environment.
The only antidote to fear is safety; the answer to anxiety is dependable, non-consequential support. In the face of pervasive societal fear, there is only so much schools can do to address individual student anxiety. But making school a safe harbor, a place where the student is valued whether or not he or she hews to school norms, maybe the best answer to the growing epidemic of anxiety-based school avoidance.
Andrew Feinstein is an attorney in Mystic, Connecticut, whose practice focuses on representing students with disabilities and their parents in seeking appropriate educational services.