The anxiety behind school refusal for teenagers and its relation to attachment issue

Due to the COVID-19 pandemic, schooling was suspended for a few months and students were staying home to study and attend online classes. Some of my teenage clients experienced high level of anxiety when they knew that schooling was resumed by end of May to mid June. One of my teenage clients had intense anxiety about going back to school. She had sleep disturbances for the whole first week of schooling. She even froze when her teacher questioned her about the missing temperature measuring sheet on the first day of school.

This client of mine had developed social anxiety during the pandemic. In fact, she had very poor self-image and unstable self. She tended to see herself as very ugly and thin. She also thought she was very weird and most of her classmates dislike her. As a result, she felt very anxious about going back to school after the pandemic as she worried her teachers and classmates would negatively judge her. After going back to school for a few days, she refused going to school. 

Adolescence is a stage critical for the development of self-identity and positive self-image. The process of identity development starts from childhood. If during childhood, a sense of security exists in the attachment relationship between the child and the caretaker, the individual will develop positive self-image and feel good about oneself.  Brian Barber, a psychologist studying parental psychological control and identity development of adolescents, identified three crucial dimensions of adolescents’ identity development. First, a secure base developed from a secure attachment between the caretaker and the child facilitates the child to develop adequate social skills and view the world as a safe and predictable place. This is important for the adolescent to feel safe to explore the world for identity formation.

Second, the parents need to carefully monitor the adolescent’s behaviours so that the individual learned to act according to norms and conform in the society. In this process, if the caretaker is capable in developing a harmonious relationship through open communication and mutual understanding, the adolescent learned to cooperate and fit in with good social skills. Third, the caretaker needs to provide structure with flexibility, so that the adolescent is free to engage in self-exploration and at the same time maintain connection with the caretaker.

The client mentioned above is deprived of a caretaker who provides consistency of positive emotions and warmth. The mother of the client is very critical and absent from home most of the time. The interactions between the client and her mother were mainly related to conflicting viewpoints without compromise and persistent criticism from the mother. The criticism by the mother includes negative comments about the client’s appearance, moral standards and academic performance. It is not difficult to imagine that the client did not develop a good sense of self through her interactions with her mother. As a result, the social skills of my client was compromised and she had difficulty to develop meaningful relationships with her classmates. The client also had problem in exploring her life for crucial identity formation.

In the superficial level, the client seems to suffer from social anxiety and this leads to school refusal. The treatment in this level is to encourage the client to gradually expose to the school environment and deal with her negative cognitions underlying her social anxiety. In a deeper level, however, a long-term treatment on the attachment issue between the client and the mother is important for the possibility of helping the client to develop a healthy self identity.

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