The students who attend school the least are often those who school psychologists, pastoral care and other wellbeing staff spend the most time on. Due to a lack of consensus on a definition of school refusal, prevalence data is hard to find; however, it has been estimated (e.g., Kearney, Reference Kearney2008) that the rate of school refusal is similar to that of depression and anxiety, and other emotional and behavioural disorders. The defining characteristic of school refusal, as opposed to truancy or parental withdrawal, is the anxiety and distress associated with the prospect of attending school, which tends to increase with the amount of time a student has been absent. One of the major difficulties with overcoming school refusal is that often by the time the student's absences have been recognised as school refusal, the avoidance behaviour has become entrenched with inadvertent reinforcement.
The stress caused by school refusal on the student, their family and the school is acknowledged by Joanne Carfi in her book Overcoming School Refusal: A Practical Guide for Teachers, Counsellors, Caseworkers and Parents. Using straightforward language, the book is directed to parents as much as school staff and other professionals, offering context for the management strategies we as psychologists often suggest. While identifying factors such as bullying, conflict, learning difficulties and developmental disorders that can underpin the anxiety that leads to school refusal, Carfi focuses on strategies to enhance the student's ability to manage anxiety. The exception to this is in discussing school refusal in students with an ASD diagnosis, where the strategies largely relate to modifying and managing environmental factors. Schools are good at making environmental adjustments and accommodations, but there may be less confidence when it comes to the mental health aspects of school refusal. Grounded in neuropsychology, Carfi outlines simple relaxation strategies, which are recommended as preventative, not just reactive, measures. Mindfulness is a strong feature of Carfi's strategies, which will resonate with the many teachers and wellbeing staff who have embraced mindfulness in their schools.
Throughout the book, Carfi employs composite and individual case examples that are used to illustrate the aetiology of school refusal rather than a full treatment pathway with a positive resolution. For some parents it may be hard to see how their child will ever get back to school, and this hopelessness can compound the issue. ‘[I]t is crucial for parental anxiety and distress to be addressed BEFORE we attempt a return to school’ (p. 51); this point is especially salient, as with chronic school refusal, it can often be the parents we work with directly, more so than the child.
The main strength of Carfi's book is the way it outlines the logic to the strategies recommended, while gently reminding the reader that there is no quick and easy fix. If recommending this book to families, it would be wise to discuss after reading, to help them reflect on the strategies and how they might apply to their child.
