Severe anxiety school refusal

I think the GP is probably thinking that exposure will help but in my experience if anxiety and overwhelm reach crisis level then more exposure will make it worse. And you first need to take a step back, recuperate and calm down before if necessary slowly exposing yourself to what is causing anxiety. I like to think of this analogy- imagine you have someone who cannot swim and is scared of water. They need to ideally learn how to swim but it would be very hard for them to do so whilst drowning in deep turbulent water. You would first take them out of the water and then gradually practice maybe at a shallow safe place before ultimately working your way up to the deep water once ready. I don’t know your son etc but I think it is naive to expect it just to get better by keeping things as they are. Unless they make major changes at school is there any way you could reduce his hours or home school- at least for awhile? It doesn’t have to be permanent but my instinct is that in this severe state of stress , more exposure to school will not help and may make it even worse.

My son has anxiety with getting into school. After lockdowns and not having to go, it took until the last term last year for him to get in every day. He is now Year 11. My son has the added problem of a lower ability than most, so part of his problems have been the actual work, some teachers that did not understand his needing very clear instructions and also registration. I don't know whether for your son it is knowing what to do, not liking to ask or just the environment. 

Ask him what things he finds difficult, is it entering school with lots of people, registration, assembly, moving around busy corridors, noisy dinner hall, break and lunch times, using the school toilet (strong smell if he has hyper sensitivity), discomfort of uniform, changing for P.E. ( my son wears PE shorts under his trousers) or specific lessons/members of staff. Is he used to telling you when things are difficult, but not have anyone he feels he could tell at school if overwhelmed?

I have listed below some things that might help to get him into school and be happy to stay.

A reduced timetable or part time school for a while, gradually increasing.

Can he register in Learning Support if that is easier than form?

Can he arrive after others or before, or arrange to meet one or two others so he is not entering with a crowd alone?

Can he go to Learning Support or somewhere else if he feels overwhelmed?

Can he have an agreement to leave to change class before or after others if the busy corridors are a problem?

Do the school have somewhere he can go to do something quiet at lunchtimes? Ours have a lunch club for those who can't cope outside.

Can he decide where he sits in the room for each lesson? Would he feel more comfortable sitting at the back?

Do the school have a card system where they can use it to leave the room if overwhelmed?

I feel that the school should be helping to address the issues here. The SENCo saying she doesn't know what to do isn't really good enough, in my view - whilst understanding that SEND provision may be under-resourced in some schools, nonetheless she should be able to come up with some ideas. 

I see some views here that all school is a problem for all children with autism. I understand why a lot of adults would hold that view, I think it used to be a lot worse, but it should not, need not be like that now. 

Your son doesn't want to go to school for his own reasons, presumably school-related. If you know what those are, maybe that's a way in to go back to the school and work on a plan to help him. 

Some general ideas- if there are lessons he struggles with, can he get extra support? Does his school have LSAs who could help with this? If some learning environments are challenging for your son, can the school provide an alternative? Most schools have pastoral spaces, some have dedicated SEN spaces. Could the school work on a plan with your son to do some of his lessons in class as a starting point - the subjects he enjoys best, to begin with, and go from there? Are there social problems for your son at school? Anything like that should hopefully have been picked up on by the school already, but obviously teasing, bullying, exclusion, are things that may discourage your son from attending school. 

I don't know if any of that helps, but thoughts, at least. 

Schools are very overwhelming and challenging environments for autistic children. 

I despair with the attitude of your GP. How many times does a child have to be dragged kicking and screaming into school to 'deal with' their anxiety. Can they not see that it is having the opposite effect, as every traumatic experience only adds to it. Autistic children often have a very real and rational basis to their anxiety, such as sensory overload, lack of structure, bullying etc.

I would suggest you seek out the book 'Avoiding Anxiety in Autistic Children' by Dr Luke Beardon. His famous equation is autism + environment = outcome. The school should be able to put adjustments in place to make the environment more tolerable for your son. For example staggered start and finish times, reduced hours, having a safe quiet space to escape to, etc.

Some useful online articles and resources:

https://www.autism.org.uk/advice-and-guidance/topics/education/attendance-problems/parents

https://www.jodiesmitten.co.uk/school-attendance/

https://www.jodiesmitten.co.uk/2022/11/26/the-wrong-environment-for-a-child/

https://theautisticadvocate.com/2018/01/an-autistic-education/

Thankyou Martin for your response, I dont think any autistic people like school either. It just seems to me schools are not catered for looking after those on the spectrum and school as a result becomes a place of pain.

Unfortunately, mainstream school is not a pleasant place for most autistics. I have yet to meet an adult autistic who positively liked school. I know I hated all my schools, from four and a half to eighteen years of age (though 6th form was less unpleasant than the rest). One of the best things a school can do is to have a place of respite, the library for example, available and to ensure that the teachers are aware that your son has to be able to leave class at any time he needs to. Anxiety is a major part of autistic problems with school, but the anxiety is often triggered by the environment, unpleasant interactions with other children and teachers and sensory problems with noise, lighting, smells etc. There are many resources online and elsewhere, plus teachers have notes they work from that can be converted into teaching aids. If your son had access to a place of respite that was calm and not challenging to the senses, where he could access teaching material, so he could continue learning during any 'down time', I think that his challenging behaviour could be eased.

Thanks so much for your insightful response! much appreciated. I am just looking at PDA now, I have come across it before but not fully looked into it. It does explain a few things. Thankyou!

I admit I have no idea how well this will work for you and your son, because I have the advantage of being an adult with a lot of practiced self awareness, but I learned if my meltdowns had anxiety either in the trigger, rumblings, or expression, then the solution was to allow for escape, get out of ground zero, find a quiet place and then treat it like a panic attack with anger, pacing, and stimming, and using the same grounding techniques as a panic attack. It takes parctice and doesn't always succeed in the early days because you're literally using your last ounce of self control to try catch and stop a speeding runaway train (brain).

He must know punch and kicking is unnaceptable because it can hurt people, but also it's a product of the fustration in a meltdown, the safest thing is to let him get on with it somewhere quiet where he can't hurt others and work it out of his system.

Does he have PDA? because sometimes I also found it helped reduce anxiety by allowing myself the option of not doing it, I find I feel calmer and more likely to do a thing that isn't obligatory. Also PDA may be a total misnomer in my opinion as with anxiety the need to control things so you feel safer is quite normal imo.