It is all too easy to be cynical when it comes to teenagers. We treat them with the distrust and hostility we usually reserve for politicians and their ilk.
You're late because the bus broke down? But of course, and I bet you had to catch a flying pig the rest of the way. You have to sit out geography because you're feeling unwell? What a shame; this has nothing to do with the fact that this is the only lesson you're failing, I'm sure...
Sometimes the cynicism is well founded. However, on other occasions, what seems unbelievable can be true.
A medical condition called "school refusal" falls into the latter bracket. Any child unwilling to attend school is likely to be labelled a truant, but they may actually be suffering from this genuine illness. The condition renders a student so anxious about school that they cannot physically bring themselves to go. It affects about 2 per cent of school-age children, although some estimate that the figure could be as high as 5 per cent.
The acute anxiety at the root of the problem can stem from several sources, including social fears, emotional or health problems and bullying. Symptoms include frequent complaints about attending school, tardiness and unexplained absences.
These symptoms are, of course, similar to the behaviour of someone playing truant, so identifying genuine cases of school refusal is difficult.
Assessment is in any case a complex matter. As Mary B Wimmer points out in a paper for the US National Association of School Psychologists, because school refusal may be the result of many factors, assessment has to include extensive sources of information, ranging from interviews with the child to questionnaires for teachers, parents and other students, as well as academic, attendance and behaviour reports.
This takes time and schools are often left for a long period with little guidance on how to proceed. So do you assume that every student is a potential truant? Or that they are suffering from school refusal?
Having supported children with the condition, I can say with some confidence that you will spot when the anxiety is genuine. I have witnessed young people crying, kicking and screaming; withdrawing from those around them and showing reluctance to speak or engage; and suffering from physical symptoms such as headaches, stomach aches and nausea.
Of course, these symptoms can be faked. But if you have even the smallest suspicion that the problem is genuine then you have to support the student until you have medical proof either way. These tips will help you to do that.
1. Make staff aware of the situation
A lot of damage can be done by an uninformed teacher who pushes a student into attending a lesson before they are ready, or bypasses an agreed plan.
2. Find ways for them to learn outside the classroom
Students may be anxious about having to attend lessons full time. Designated facilities for them to learn one-to-one with a tutor, or as part of a smaller class, can help to ease them back into the mainstream.
3. Give extra support at break times
For some, the unstructured playground environment can be very stressful. Finding alternative ways for these students to enjoy their break times - perhaps in a quiet room or with a few trusted friends - will allow them the breathing space they need. They may also find arriving and leaving school at the same time as everyone else difficult: consider whether they could time their day slightly differently.
4. Expect fluctuations in progress
Students often suffer a setback after the weekend or a school holiday. They need reassuring that this is normal and that things will improve.
5. Provide small, frequent rewards
These students are already anxious about attending school; punishing them for this is likely to make things worse. Agreeing a reward programme with them, with plenty of opportunities for success, can help. For example, they might earn an early lunch pass on Friday if they have come in all week.
6. Find ways for students to express their anxiety
These young people often struggle to voice their fears. Ask a teacher the student trusts to be their key worker at school, or get the child to indicate when they are uncomfortable by using non-verbal signals such as cards.
7. Make sure students have a chance to socialise
If students are taking time out of normal lessons, it is important for them to continue to see their friends. They could have lunch together or be encouraged to attend an after-school club.
8. Believe them
Underpinning all these strategies is the assumption that you believe that what the student is experiencing is real, and are prepared to try to understand their anxiety. In my experience, many students and their families feel that they are not listened to or believed. This exacerbates the problem because students lose trust in their teachers and fear being pushed into something they are not ready for.
Naomi Message is a qualified teacher and works at the charity Romsey Mill (www.romseymill.org)
Wimmer, MB (2004) "School refusal: information for educators", National Association of School Psychologists.