My daughter has high social anxiety, refuses school and now refuses medication to help.

[Ali75]

I just am so stressed and frustrated and sad. My daughter is flat out refusing school most days. We have tablets for her to start taking but she is scared about taking them. Im really worried about her.  And don't really knoe what to do anymore.  She has seen a psych but doesn't talk. 

[Ali75]

Hello Tmas, 

Thank you for sharing. I was in sessions with her at her request. She didn't want to be alone, found that very stressful. She would say she wouldn't say anything to her that she wouldn't say to me. She just didn't have the right connection I think. She has high social anxiety maybe even phobia. I just wish she would get on the meds at from talking to others they help immensely. she has a very negative mindset. Which has just become habit. So everything that was presented to her as tools, she said doesn't work. 

What you said is right "but maybe she's avoiding specific side affects (or feeling mentally stuck and afraid of change)." It's like she doesn't want to try and get better but maybe just afraid. 

So from your point of view, how do I get her to take meds or does she need to reach this on her own. 

Ali

[Guest_1055]

Hi, I was a little similar to your daughter in some ways. Is she at that "trying out independence stage maybe?

When younger I had trouble speaking also. Is she a better writer do you think? I know I was and am. It's a challenge to communicate verbally. Social anxiety type stuff.

Also when I was young I was the middle girl in my siblings. Always felt not noticed. But not understanding why. 

Now know I was needing attention from my parents an emotional connection to them. 

What is your daughter interested in doing, hobbies, fun things etc. I would just have some fun time with her, spending time doing the things with her she likes. No pressure on talking. Just simply enjoying each other's company.

Also homeschooling is an option ..maybe she would prefer that.

[Ali75]

Hello Guest_1055,

She could be at that trying out independence stage. A wise friend of mine, said to try and give her a choice where I can, so she can still feel like she has the power. Not always easy though. She is only one of two and does get a lot of attention. We do a lot together. It is just social anxiety when the focus could be on her with peers. She is fine at an event in public but not at school. I do not want to home school. This is what she wants but I don't have the means to do that and I don't think it would help, just due to avoidance. Thank you for taking the time to answer, really appreciate it. 

Ali

[Summer Rose]

Hi Ali

I’ve read through the thread and just want to add a few thoughts on medication…

My daughter also fell sick at age 13 and didn’t want to take medication for her anxiety/OCD. My view and the advice of our medical team was that it was essential.

We talked a lot about how there is no difference between a mental and physical health condition. If you’re sick, you’re sick. And if the doctor says medication can help it makes sense to take it.
Ask your daughter if she would refuse medication to treat a heart condition, eczema or diabetes? Ask her why she thinks this situation is different?

Let her know that if she decides to take the medication it will be kept 100 per cent confidential. Remind her that she has nothing to lose by trying—if it doesn’t help after an agreed period (I suggest 3 months, as they will take about 6 weeks to kick in) then you’ll support a change in approach.

If she is steadfast in her refusal, ask her what’s the alternative? Given she won’t speak with the psych and doesn’t want medication ask her to share her thoughts on how she’d like to work on her recovery.

I would also explain to her that all medications have possible side effects and openly discuss them, so she is well informed and doesn’t lose trust in you (the first anti depressant my daughter was prescribed did not help, it made her worse).
You two have a long road ahead and trust and negotiating boundaries to protect her privacy are really important. You need to be a solid team.

Who will manage her medication? After our first experience with our GP (which was a disaster for a variety of reasons) I engaged a paediatrician. Much more knowledgeable than a GP and far less scary than a psychiatrist.

Kind thoughts to you

[Summer Rose]

Hi Ali

Back again with some thoughts on school… 

I should disclose that my experience comes from a private school environment and support for a student with anxiety & OCD. Your experience could end up being different.

Our school required evidence of a mental health condition. This took the form of a letter from my daughter’s psychologist that explained her condition and how it impacts on learning and academic performance, and then a follow-up meeting with me and the psychologist at the school.

The kind of supports that were discussed included:

• funding for, and provision of, an aid to help with organisation, staying on top of schedules and deadlines, etc.
• The option to take a lighter class load. While this can narrow academic choices and ATAR down the track (eg if you drop a second language) it does help to ease the pressure.
• Flexibility to apply for extensions when anxiety flares (as opposed to a million hoops to jump through and repeatedly having to explain yourself).
• Extra time to complete SACs and exams and a separate room to complete them in.
• Provision of a safe place of refuge within the school where my daughter could “escape” should she become anxious, overwhelmed or panicked (you don’t want your girl trying to leave on her own when she’s unwell).
• An agreement that there is no requirement to call the attendance line each day to report non-attendance (I found that ritual soul destroying). Absence due to illness becomes assumed. But you need to be on top of where your daughter is to keep her safe.
• An agreement that it is okay for your daughter to arrive at school when she can without penalty, as opposed to the pressure to be on time.

Ideally you, your daughter and your daughter’s psychologist should collaborate on the required support ideas. And this should include additional tailored classroom support. Hopefully once your daughter knows that school will be different next year her anxiety will lesson.

Once everyone has agreed on a support plan I encourage you to ask school to document the plan in an Individual Learning Plan (ILP). Ideally the ILP would be circulated to all of your daughter’s teachers before the start of the next academic year to ensure everyone is on the same page.

Kind thoughts to you 

[Summer Rose]

Hi Ali

I just had two more thoughts.

Firstly, I strongly suggest that you seek and obtain your daughter’s consent to make any disclosures to school. It’s her health and her privacy and you don’t want to betray her trust.

Secondly, have you considered changing schools? Could be a compromise outcome between the school she doesn’t want to attend and home schooling.

Kind thoughts to you

[tmas]

Hi Alison,

I also requested my mother sat in on sessions - I was anxious about one on one interactions (social phobia). I was young enough that I didn't know how to do stressful situations/doctors without my "protective shield" (mum), but old enough that her opinions no longer reflected my reality. Maybe therapy is too formal/intense for her at the moment. Has she tried doing therapy as video sessions instead? Zoom sessions were kinda great for me when the pandemic began, I could do what I needed to be comfortable enough to speak. I used to do them from my bedroom.

I understand the fear of enabling her - I've also been on her end of things and years of my life were agony because of people ignoring my distress. I don't fault them for it, but minimising a "child's issue" will always backfire, their distress is just as real to them as anyone else's. It's a fine line to tread, but exposure therapy needs a solid base to begin on. CBT and tools did absolutely nothing for me, and never have, different formats suit different people (unfortunately CBT is just what the gov subsidises bc it's seen as a quick fix).

I was heavily medicated for 7 or so years and this included probably 20 medications in the end. They made it physically improbable I'd have a panic attack (awesome), but they also made me agitated, gave me tachycardia and fluid retention, messed my digestion & hormones, kept me wired/drowsy. Skipping/changing the dose gave me huge mood swings. None of them solved the real issue at hand either, that's why they're generally considered conjunctive to therapy. Worth it? Absolutely, but I was at the whim of doctors and they got it wrong sometimes.  

Fainting at school from anxiety is quite alarming - panic attacks will 100% be causing any person to avoid triggers. I really hope she can get to the bottom of this. Please treat her with empathy - even if she says something you don't like or seems rude, maybe give her a chance to spell it out. A 13 year old isn't exactly eloquent, let alone one in survival mode. I can only imagine the stress you are under, I know I did it to my own mother, I felt a lot of guilt for it. But this isn't a battle against each other, show her you're on her team by listening. 

[tmas]

Just to comment on this, an ILP will involve lots of supportive staff and engagement with the school on everyone's part. While it may be good to have one in place, and (in my opinion) is very important for the school to at least know of her diagnoses of current condition, I think she should be involved in deciding what she wants the leniencies to be.

Chances are she wouldn't want anything that draws attention to herself, nor would she want to have to "sit down and chat" with particular teachers who all tell her something different and out of touch. I had and ILP in later high school and it seemed half the teachers didn't care and would treat me worse due to poor performance, or if I asked to "go to the bathroom" I'd get told no, without opportunity to explain the ILP.

For the half that did understand, they were mostly kind and I appreciated that. The most useful thing I got from it was permission to leave class and go to a particular office where I could be supervised when anxiety was too high. For me this was the counsellor's office - I could sit in the waiting room when I was recovering from episodes, if they knew I was there I wouldn't get detention warnings for disappearing in class for taking my panic attacks to the bathroom/fire escape. They might also recommend the nurses office or if there's a school office. 

It would maybe be good to have communication about her behaviour in class (if she's withdrawn some days, or they notice something shift), and especially so that they don't start changing her grades due to circumstances she isn't fully able to control right now. Besides, the best thing that ever happened for my mental health in high school was graduating.