Pediatric primary care

Ryan, age 12, has missed almost three weeks of school so far. He complains of nausea and headache most school days and has to be cajoled into getting out of bed, but his mother says he is fine on weekends. The mother, who is eight months pregnant, is frantic; she can’t afford to take any more time off work before she delivers. School refusal can have serious consequences. On the short term, the child falls behind academically, both the child and the family experience disruption and distress, and there can be legal and financial ramifications. Long-term consequences for school refusers include violent behavior, school dropout, early marriage, and unemployment. “The main goal of treatment is to get the child back to school as soon as possible,” says Lisa Hunter Romanelli, PhD, REACH Institute CEO and clinical psychologist. “Being absent from school is highly reinforcing.” Like many school refusers, Ryan presents somatic complaints. After you rule out physiological causes– not only for these complaints but also for any underlying conditions that can produce depression or anxiety–what’s next?