Kylie Peters walks confidently through St. Viator High School’s halls, which buzz with a jangly adolescent energy.
Talking with friends en route to physics class at the Arlington Heights school, she makes the encounters look effortless. But for this bright 17-year-old, just being in school is something like planting a flag atop Mt. Everest.
“The first week was pretty scary,” confessed the junior, who required medical assistance to start her first two years of high school. “For a while I thought I’d have to go back to the hospital. But somehow, this time, I found the determination.”
Peters suffers from school refusal behavior, usually a symptom of a serious anxiety disorder. For these youngsters–about 5 percent of the student population, according to the American Academy of Child and Adolescent Psychiatry–the mere thought of entering a classroom is so distressing that they will do almost anything to escape.
As the U.S. searches for answers to its perplexing high school dropout rate–which hovers at about 30 percent–attendance is just starting to be recognized as a more complex issue, sometimes requiring therapeutic rather than disciplinary action, experts say.
Skeptics may dismiss such conduct as a scam allowing children to languish on the couch playing video games and requiring no more specialized treatment than a swift kick in the pants. But clinicians say this is different from regular truancy. These youngsters aren’t cutting class to do something fun; they suffer from debilitating anxiety.
“It looks manipulative, but it’s not,” said Andrew Eisen of the Child Anxiety Disorders Clinic at Fairleigh Dickinson University in New Jersey.
“These are kids who promise to go tomorrow; they beg to be home-schooled, anything to stay home,” said Dr. Tahseen Mohammed, a psychiatrist at Northwest Community Hospital in Arlington Heights, the only medical facility in the country to have a program addressing the disorder.
The recent rash of deadly school shootings has exacerbated their problem, he said. “The news definitely has an impact. … It heightens kids’ anxiety, making their symptoms even worse,” Mohammed said.
Waiting list for program
In his program, the first few weeks of the academic year typically are quiet, but by October the 16 slots are full, and there’s a waiting list. The majority of clients are referred by nearby high schools, but some have come from as far as Lemont and Aurora. It is not unusual for students in the program to pile up 50 absences a year; one teen had not set foot in a classroom for two years.
“Kids are miserable, and parents are frustrated,” said Maggie Hahn, the program’s clinical coordinator. “No matter what parents say or do, it doesn’t make any difference … and they don’t know where to turn.”
“School phobia” first started appearing in medical literature during the 1960s. By 1990, school refusal behavior became the preferred term.
Typically, it starts with physical complaints such as headaches, sore throats or stomach cramps. Children may seem fine on the weekend, but by Sunday night the ailments reappear, and the battles–the pleading, bribery and threats–start all over. Left unchecked, such anxiety can trigger other problems, including dropping out of school and social isolation.
“This doesn’t get better on its own,” Mohammed said. “There are short- and long-term implications, which is why it requires aggressive treatment, not punishment.”
The condition may start in early childhood with excessive clinginess sparked by fears of abandonment or that “something bad” will happen while they are away, Eisen said.
But the condition is more serious and hits hardest in early adolescence, when youngsters leave the nurturing elementary school environment, hormones go haywire and self-consciousness is at its peak.
For Peters, the oldest of six girls with a streak of perfectionism, anxiety enveloped her as she moved from grammar school–“where I had known everyone since kindergarten”–to St. Viator. In her freshman year, the honor-roll student lasted one month before entering treatment at Northwest.
“I wanted to come–I really did,” Peters said. “But I found myself crying in every class almost every day. My parents would threaten to take away the computer. The phone. But I didn’t care. Nothing could make me go.”
The change took its toll on the entire family, said her mother, Kitty.
“I’d get angry. I’d scream. Eventually, I just had to tell myself that this isn’t Kylie, but some outside thing. … I’d tell her, `You can’t let “it” win.'”
As a sophomore, Peters lasted a mere week before returning to the hospital program.
“I wished I had cancer because people would feel sorry for me … and that’s something everyone would understand,” she said.
In Northwest’s intensive, three-week program, people did understand. For the first time, Peters said, she was surrounded by peers–preps, goths, punks–who “got it.”
Those who are aggressive or suicidal stay in the hospital; the others are outpatients. During the first two weeks, teens put in an 8 a.m.-to-5 p.m. day. Two teachers keep them current on homework.
Individual and group therapy and instruction in relaxation techniques are designed to help them get out of the house. Three evenings a week, parents join their offspring for mandatory family therapy.
By the third week, the kids start to wean themselves off the program, spending their mornings at their schools before returning to Northwest in the afternoon. The goal is to develop coping skills through exposure to manageable challenges.
“The coolest thing is when we have new kids who can’t even imagine going back to school and they see these kids who have already been there all morning. It gives them hope,” Hahn said.
Peters is one of the program’s success stories, yet this year hasn’t been a breeze. Some days, Peters would watch the clock on the wall tick so achingly slowly that she was convinced she could not make it through the next hour. But now she has the tools to deal with those feelings.
“I hung on,” she said proudly.
This year, when she felt the walls closing in, she used coping skills–such as blowing out 10 imaginary candles, one at a time–to keep her thoughts from overwhelming her. She also credits medication along with the St. Viator staff for helping relieve the stress.
But Northwest’s own data provide a reminder that recovery is fragile: Of 45 students discharged from the program, half had six absences or fewer after 90 days while half had more, typically when families start getting lax about bedtime and waking routines.
It’s a cliche, but Peters is taking it one day at a time.
“It’s always going to be a struggle,” she said. “But I told myself that if I went to the hospital this year, I’d probably have to go next year … and the year after and every other time I faced something new.”
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brubin@tribune.com
