Well before the pandemic, Ray Renshaw knew the danger of letting students get into the habit of avoiding school.
“We were sitting in [individualized education program] meetings with all these kids who didn’t want to come to school,” said Renshaw, the director of special services at the Westwood Regional school district in New Jersey. “And then, if they were coming to school, they’d sit in class, just beside themselves with anxiety, and they’d leave. They’d go to [the guidance office] or they’d go hide in the bathroom,” Renshaw said. “It was really challenging to educate these kids and keep tabs on them.”
Renshaw and his colleagues have spent the last five years finding ways to help middle and high school students in special education work through the anxiety and depression that gets in the way of schoolwork. In the process, they stemmed a significant source of chronic absenteeism in the district: refusal to go to school.
“School avoidance has been a growing problem for years before the pandemic,” but periodic school closures, social isolation, and growing academic and anxiety issues have created a perfect environment for adolescents to balk at school, said Jayne Demsky, the founder of the School Avoidance Alliance, a nonprofit group that works with parents and educators on student mental health policies.
Studies suggest 1 percent to 2 percent of all students experience school refusal at some point in their school careers, and students with specific disabilities can be particularly at risk in middle and high school.
“The transitions to different schools, different peers, all the fears and the differences in workload all become big issues,” Demsky said. “School avoidance is usually attributed to a mental health disorder or undiagnosed learning difference, but they’re often co-occurring with other things happening in a child’s life,” like school and family disruptions.
Donna Volpe, the director of special services for the 2,600-student Ramsey, N.J., school district, said she has seen “a higher intensity of problems” for students with emotional disturbance, also called “emotional dysregulation” in the last few years.
“Our students who were already dysregulated have had … more school refusal, more difficulty transitioning back to the classroom,” she said. “We’ve had to be very creative with some of our students, because the worst thing we could do is keep them out of class—because then it just becomes harder and harder for them to return.”
Federal civil rights data suggest even before the pandemic, more than 1 in 5 special education students were chronically absent in middle school, and more than 1 in 4 special education students missed school frequently in high school—rates more than 6 percentage points higher than their general education peers. Unlike more general absenteeism, research suggests the majority of students who refuse to attend school have one or more depressive or anxiety disorders.
“School refusal severely hurts the trajectory of kids’ lives and stunts them, but a lot of schools miss it,” Demsky said. “They don’t believe it or they might interpret it as kids being oppositional, defiant, or manipulative. And a lot of that is because schools and teachers weren’t trained to understand anxiety signs and symptoms.”
Christopher Kearney, the director of the School Refusal and Anxiety Disorders Clinic at the University of Las Vegas, has found chronic tardiness, withdrawal, fatigue, crying in class, and even physical symptoms such as stomach pain or headaches can be warning signs even before students start to actively miss class. And the more class students miss, the more anxiety they can develop about falling behind and out of touch with peers.
“With school avoidance and anxiety, as it builds and becomes more entrenched, it’s harder and harder to break out of,” Demsky said. “So it behooves the school to intervene early and work with parents to create a plan with a feeling of empathy and kindness. When schools do that, they have so much better outcomes than when a school is acting punitively.”
Making school a ‘hangout spot’
At Westwood, that meant building an environment to ease fears about school for students with anxiety or depressive disorders, while also providing academic remediation and disability services.
“We had to dig out the root cause of why these kids weren’t coming to school,” said Jessica Gluck, Westwood’s assistant director of special services. “These students are all [academically] at or above grade level, but … they didn’t feel comfortable, you know, navigating the hallways, being in the cafeteria, or being in those classrooms and having to speak in front of their peers. For these students, the environment was just too much and too overwhelming for them.”
Now, high-anxiety students come to the TEAM (Targeting Emotional Aptitude Mindfully) Day School, a special school-within-the-school made up of two classrooms decked out in couches and bean bag chairs instead of desks, holding classes of five to six students at most.
“We wanted to create an environment that looks more like a hangout spot than a school, which has really helped students who need that home base,” Gluck said.
Students in the program come to school an hour later than the main start time and leave 25 minutes earlier to avoid crowds. They also stay in the same classroom, taught by a handful of teachers and a clinician, rather than changing classes. But the students also take part in regular counseling groups and a social-skills class, in which they learn techniques for managing stress and performance anxiety, and practice leading class discussions once a week.
“Usually our students coming in as freshmen don’t want to leave the room at all—they don’t even leave to go to the bathroom or eat lunch. And then by senior year, they’re just in there for English and P.E. and they like it as a home base for their study hall, but they’re really coming and going and doing all the other electives” in the general education classes, Gluck said.
When the program started in 2017, Westwood’s overall chronic-absenteeism rates were 6 percent on average in middle school and 9 percent in high school, with special education students disproportionately at risk. By 2020-21, even amid spreading chronic absenteeism nationwide, Westwood had only 1.5 percent chronic absenteeism on average in high school and just over 2 percent in middle school.
The difference for special education students in particular was extreme: The current cohort of students missed between 57 and 121 days each in the year before entering the program; a year after participation in TEAM, their absences ranged from 1 to 22 days.
Renshaw, the district’s special-services director, said even during school closures, all special education students continued to come in person for half days to keep up both their mental health support and academic habits.
Keeping parents involved also can be crucial, particularly for middle school students on the cusp of adolescent disengagement from family. For example, the Ramsey district holds parent evening academies to help families of students who are experiencing symptoms of depression, anxiety, or other emotional disturbances, according to Volpe, Ramsey’s director of special services. The district also now screens all 8th graders for depression, and those with significant symptoms are referred to in-person or telehealth therapy.
While high schoolers have made up the bulk of students in the Westwood TEAM Day School, it has expanded to middle school students in the last few years. Students with the most severe anxiety attend the standalone classroom. The district also contracts with local mental health clinicians to conduct home visits and on-site therapy sessions with middle school students at risk for school refusal.
“There’s much more flexibility at our middle school where we could come up with unique schedules. We meet them where they are, so the student might start with one period they’re the most comfortable with and then build through to go to another one,” Gluck said. “So there’s accountability from the clinician to work with parents as well as the students to increase their time at school.”
Renshaw stressed that schools that want to develop a similar program must commit both separate physical space and a team of teachers and clinicians to effectively support students with severe anxiety and school refusal.
“You really have to have training for teachers to understand mental health,” Gluck said, “because these kids are wonderful kids and they have got a lot of strengths, but when they’re having a tough time, they’re having a really, really tough time. So you really have to have people who understand anxiety and understand how to adapt mindful approaches to learning and have therapeutic support within the classroom, not just from the clinician.”
Coverage of students with learning differences and issues of race, opportunity, and equity is supported in part by a grant from the Oak Foundation, at www.oakfnd.org. Education Week retains sole editorial control over the content of this coverage.
A version of this article appeared in the October 26, 2022 edition of Education Week as Addressing the Link Between Anxiety, Depression, And Student Attendance