Secondary-gain school avoidance:

Not all children and teens with school avoidance are anxious or shy. Some may simply find that it is more comfortable staying home than attending school.which is called secondary-gain school avoidance. "Secondary gain" refers to the bonus or positive side of something unpleasant. For example, although it is unpleasant to be sick, it may be pleasant to watch television during the day and to have mcals in bed. Another secondary gain of being sick might be not having to do homework or having the personal attention and care of a parent at home.

Secondary-gain school avoidance often starts with an illness that lasts for a few days and causes the student to miss school. The student may get behind in homework and begin to think about how hard it will be to catch up. To avoid the hard work ahead, the student may stretch out the illness a bit longer. Receiving the secondary gains of sympathy, the care and attention of parents, and the pleasure of watching daytime television can contribute to school avoidance. Lenient parents or parents who do not view school as important can contribute to secondary-gain school avoidance.

Sometimes students exaggerate symptoms or claim to have symptoms they really do not have (such as a sore throat or leg pain) just to avoid school.

How Is School Avoidance Diagnosed?

School avoidance is diagnosed when a student has repeatedly missed school due to aches and pains or other symptoms, and a careful checkup by the doctor has found the student to be in good health. The doctor will check for school avoidance by evaluating the pattern of symptoms and asking about stresses. The doctor may explain how stress can cause certain physical symptoms and may have the student keep track of symptoms by writing them down.

Ben's doctor asked him about recent worries he had. Ben mentioned that since his parents had divorced the previous year and his dad had moved across town, he had started to worry about his mom being lonely. He had seen her cry a lot this year, and it made him sad. He sid he missed his dad and wished they could be a family again, but without the arguing. Although he looked forward to the weckends he spent with his dad, he was sad that his mom had to spend weekends alone. Ben's doctor explained how people could get stomachaches from stress and sadness. She asked Ben to keep track of his stomachaches in a diary, and she told him to go to school anyway. She gave Ben and his mom the name of a therapist who would help Ben talk about his feelings and about how to adjust to all the changes in his family.

How Is School Avoidance Treated?

The first step in treating school avoidance is to help the student get back to school as soon as possible. The longer a student avoids school, the harder it is to return. Students with anxiety usually need reassurance that they are in good health. Students and their parents are helped by taking a "yes bur" approach. Yes, the symptoms are real, but they are not a reason to miss school. Parents are guided about what symptoms are grounds to stay home and find ways to help their student attend school despite discomfort caused by aches and pains. The treatment often includes a plan for what to do when the student begins to feel ill at school. The plan may be for the student to go to the nurse's office to lie down for 5 to 10 minutes and then return to class, but not to go home. Psychotherapy and behavioral techniques to cope with school-related stress are often helpful.

Another part of treatment may involve working with school personnel to solve problems that are causing anxiety, such as bullying or lack of privacy in bathrooms. Students who have separation anxiety or generalized worry may benefit from counseling to learn to cope with painful feelings or loss. The usual treatment for students with secondary-gain school avoidance is also to return to school right away. Clear limits, appropriate expectations, and support for regular school attendance are critical factors for successfully addressing the problem.

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