Podcast

When our children refuse to attend school or show other anxiety related behaviors, it can be difficult for parents to find that balance between properly supporting their needs without over accommodating for their fear.

 In this episode I am joined by Dr. Erica Miller, a licensed psychologist and director of Successful School Transitions. We’ll talk about the effect the pandemic and disruptions to their routine has had on children, what school refusal is and why it can be so triggering for parents, and how we can use techniques like coregulation to stretch our child’s tolerance for coping with challenging emotions and experiences.

 

Dr. Erica (00:00):

That shift, the child is like, wait, normally when I do this, my parent is up in arms. That shift, I think actually like pulls a rug from under the kids and helps to regulate them because they’re recognizing that my parents aren’t actually so scared of my behavior

Dr. Sarah (00:19):

School can be a confusing problem to deal with for parents, that fine line between supporting your child while also not over accommodating, their anxiety can be a really tricky balance to find. And after two plus years of interruptions to the school routine, you might be feeling a little lost in knowing when to help and when to push your child. Joining me today is Dr. Erica Miller, a licensed psychologist and director of Successful School Transitions. She specializes in school refusal, anxiety, depression, learning, and developmental disabilities, and provides comprehensive neuropsychological evaluations as well as evidence-based treatment for youth and young adults in this. So we’re gonna talk about what school refusal is, how it can manifest in children. Why perfectionism can play into this and what you can do if your child is expressing resistance or downright refusing to go to school each morning.

Dr. Sarah (01:17):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parent voice confidence and calm. This is Securely Attached.

Dr. Sarah (01:51):

Hi, welcome. I’m so excited to introduce you guys to Dr. Erica Miller. Dr. Erica is a neuropsychologist. She has just launched a new practice called Successful School Transitions and she specializes in helping families of anxious children who are, who are navigating school refusal. And I thought it’d be so helpful to have you on today to talk about kinda all things, anxiety and school.

Dr. Erica (02:17):

Thanks so much for having me, Sarah. This is like my passion. It’s been like my passion for a really long time. And I’m just so excited to get to, to talk to you and tell you and your listeners more kind of about this and how they can really help support their kids and also themselves kind of navigate their kids’ anxiety and school such important topics, such big things. Also coming back from possibly a year, two years with like kind of inconsistent, strange school experiences.

Dr. Sarah (02:45):

Yeah, I recently was reading something that like, it’s now the third year consecutively that school’s been interrupted for kids. So some kids, some kids who would normally be in like second grade have never had a normal school year.

Dr. Erica (03:01):

It’s kind of wild. Right. When you think about it, like, when I think about that, like that is crazy for some of these kids.

Dr. Sarah (03:06):

Yeah. And I think kids who have just at baseline struggle with adapting to new situations or have more anxiety kind of in general, like I am actually curious what your take is on this. Cuz on the one hand, I feel like some of those kids have sort of appeared to have thrived during COVID because they have not been taxed in the way that they normally might be in a typical world where like they’re having to go and do these things that make them uncomfortable and that’s activating a lot of their anxiety responses, but then now that they do have to do it and those muscles have atrophied a bit, it’s just really scary for them. Or they’re really lacking that confidence.

Dr. Erica (03:52):

You know, totally. They haven’t really practiced. So I think for there’s a group of kids that I know have really loved, right. Kind of getting to be at home, it’s really worked for them in, in some ways and you’re right. They haven’t practiced those skills. They haven’t had the opportunity to separate individuate, know what it’s like to go into the world and be with other kids and actually be in safe situations. Right. They just haven’t had that practice.

Dr. Sarah (04:19):

Yeah or even to tolerate not so comfortable things.

Dr. Erica (04:24):

Exactly. So I think there’s been pros and cons for some of these children and some families overall, you know, with that. And so are we just delaying to a certain extent teaching kids skills that they’re gonna need for now and for the future, right? Because it’s not likely to gonna be permanent where they’re not gonna, you know, have to go back into school right now. We’re seeing it. Kids are going back into school more regularly for extended periods of time. And now they’re kind of older and now have to really build that muscle and build that skillset at a point when the demands are higher. Right. So if these kids might have been starting that out in preschool or kindergarten, it might have been more okay, because the school is structured, their classroom is structured with the teachers who understand what that’s like. Now you’re talking second grade and teachers might not be so kind about some of these behaviors that they’re showing or the teachers might not be trained and how to manage some of these anxieties. They’re thinking, this is what we see when kids are in preschool, not when kids are in second, third grade.

Dr. Sarah (05:22):

Right. Right. Are you seeing that a lot right now? Like in your practice more, like I feel like what my practice partner and I have been talking about, we’ve been noticing a lot is that we’re seeing kids who normally might be what in psychology speak. We say like subclinical, meaning like they’re, they’ve got a little flavor of this anxiety or this, you know, behavioral stuff, but it’s not, it’s not hit a level where it’s interrupting their life much. And we’re seeing a lot of these sort of normally subclinical kids kind of cross over that clinical line. Yeah. And like start to really, like, they can’t get through the day as much.

Dr. Erica (05:59):

Cause they haven’t had to. Right. And I think we’re seeing that both with some of the younger kids, but then also all the way up, I would say even to like college age kids. Just because some of those individuals were like, this works for me being at home. I like learning in, in this way. I feel safer with my parents or I don’t have to deal with, you know, I’m in New York City, the noise, the subway, the crowds, even just at school. Right. The loudness of other kids. And now we’re saying, Hey, you have to go back to this. And they’re sort of saying, well wait, do I really why I was able to learn at home? Why do I actually have to go back? So it’s such a tricky time.

Dr. Sarah (06:35):

Yeah. Yeah. So like in working specifically with school refusal, first of all, can you explain what school refusal is? I think that’s a, can feel like a vague term and I bet you people who are listening right now, like I don’t even know what school refusal really is.

Dr. Erica (06:47):

Yeah. I mean, cause listen, we all wanna mental health day sometimes and wanna stay home from school. Right. I am like the first that was guilty of, you know, every so often really just being like, Ugh, I wanna avoid this. But school refusal is really this persistent pattern of behavior and avoidance. I really think about it for parents to think through. Do you have like morning meltdowns where you’re like going to bed every night and dreading what your kid is gonna be like in, in the morning is Sunday just like a terrible day for you and your family thinking about, oh my God, we’re about to ramp up and start the week again. And I have to go through this. And so do you feel like, as a parent you’re sort of having to pull your kid out of bed, convince them they have to go to school, right? Maybe they’re refusing to put their clothes on refusing to get outta bed refusing to get outta the car. And you really feel like you need your whole body weight right behind that. Both like physically, but also emotionally to really help your kid or kind of force your kid, sort of get out the front door and get to school every day. And so sometimes it starts off as like one or two days and it can really snowball into something much, much bigger. And so what we really try to understand is what’s going on for that kid? You know, why is this happening now? Because some of us have kids where this has always sort of been a thing. They’ve never been that person that’s been like loving school and wanting to get out and go to school every day. And some parents may find this is new behavior for their children or for their child.

Dr. Sarah (08:16):

And how did you, like, I wanna ask you more about this, but I’m also curious, like how did you get into this specific line? Like how did you, what’s your background that went from like general anxiety to being like, I wanna focus hone in on this school refusal piece.

Dr. Erica (08:33):

So some reason I have always worked with sort of really anxious depressed teens. And what I have found is that, you know, getting up in the morning when you’re a teenager is often challenging to begin with, let alone, when you’re anxious and depressed. And a lot of the research does say that the hours of the school system here don’t really, you know, mesh so well. But what I have sort of noticed, well, don’t mesh so well with how an adolescents brain is kind of functioning, right. And how that works. But what I’ve noticed over time is so this really big snowball cycle where the kids stay home one or two days when they kind of return to school, maybe it’s, you know, in the afternoon after lunch, they get met with comments from their peers and from teachers who are, who kind of might be sarcastic or do you know, you’ve missed the last two, two days or where have you been, or kind of, it’s so nice to see you. And that sets them off a little bit more so, right. And then they have all this makeup work to do and they don’t have the stamina. They’ve missed the lesson and they don’t know what to do. And so there’s both kind of a social consequence, but then also an academic consequence. And so it snowballs into, I’ve missed one or two days, often into so much more. And I felt from an outpatient perspective, I couldn’t really help these kids. Right. I was seeing them once, maybe twice a week. And they really needed support after school to get through their work. They needed support in the mornings cuz so many of their parents were reporting how tough the mornings were and their parents also had to go to work. Right. They couldn’t be there. And so that was really a huge issue. And I couldn’t be there either. That wasn’t the time conversely, when I worked in schools feeling like, oh you’re in the school now I can help. Well, I have meetings, I have other kids that I have to see phone calls, class observations. I still couldn’t be on the phone with these parents. Right. My really work as a school psychologist was inside the school building and how could I help these kids if they weren’t inside the school building? And so that’s really where this kind of idea came from of these are kids that really need support and yet no one is really able to adequately support them.

Dr. Sarah (10:30):

And how is, what’s the youngest kid you, you work with in your practice when it comes to school refusal.

Dr. Erica (10:35):

When it comes to school refusal. I mean, we work a lot with those like families, I would say of kids in like the elementary school age. But definitely we see a huge uptick in kind of middle and upper school years. But parents are calling in all the time for some, you know, parent coaching and support around how do they help support their younger children into school?

Dr. Sarah (10:54):

I don’t imagine like there’s probably a lot more room to help a family when their kid is in elementary school and this is popping up. Then once we’ve hit the middle school, high school years, cause chances are those middle school, high school kids that aren’t able to get themselves to school and are really struggling with that anxiety. We’re probably showing some signs us at a younger age and so catching it kind of nipping it in the bud, so to speak or having an earlier intervention might be helpful.

Dr. Erica (11:24):

Absolutely given both families and the kids, the skills that they need to succeed. Right. And so, you know, we all kind of move away from them. Sometimes things are good for a while, right. We feel like we’re in a routine and then maybe something happens and it can be a small thing like a kid be nervous about a test or a presentation, or had a fight with a friend that may kind of trigger kind of old behaviors. But we’ve given parents and kids tools that now they’re better able to say, oh, we see a pattern emerging. We now know to act and we can act much sooner and feeling confident in that they’ve seen this before and they know what to do.

Dr. Sarah (11:58):

Hmm. So what would that look like? What would a, like, what would, if a parent, first of all, what would warrant a family really needing to work with you around skills to benefit that both a parent and the child and managing the anxiety that’s manifesting in like a school refusal.

Dr. Erica (12:17):

So, I mean, I think there’s no really one case that we sort of, or one typical prototypical client that we have. But I would say parents feeling like they’re at their wits end, the kid’s not going to school anymore. Right. And they feel like they’ve tried. Right. And that they’re just not getting through to their child. And really what it’s resulting in is a even bigger disruption in the parent-child dynamic. A neuropsych assessment can be really helpful, but a neuropsych assessment doesn’t really delve into the factors of why a child may be missing school per se. So right. Because there are a lot of kids that get neuropsych evals who are going is school just fine. Right. What we offer. In addition, we might recommend a neuropsych eval to see, but we offer a really specialized evaluation that’s a really in depth clinical interview and some rating forms and talking to teachers that really examine the causes, like what is prompting this child and what are the reinforcing factors? So why is the kid staying home from school and what is reinforcing them in staying home from school? Is it more time with mom or dad? Is there some avoidance of something that feels scary, right? That maybe they have social anxiety or they have OCD and they can’t use the school bathroom. So what is the reinforcing behavior happening here? We really work to understand that. And so how the parent dynamic at home may be, you know, contributing to an escalation of behaviors. What we do in addition is we offer coaching services, which can be done with us to really help families, you know, kind of pull it out of their dynamic. Cause parents have a lot of feelings when their kids don’t go to school. Right. Like, think about it. You feel like one of my big jobs as a parent and one of my child’s jobs is to have, ’em go to school and you feel really frustrated, I think. And out of control, like just get up and go to school. Like, you know, that oftentimes having the parents be the one isn’t the most helpful. I think about it, like with the homework war too. I don’t know if any, you know, I know your audience has some younger kids sometimes, but as parents, we feel like we’re doing something wrong or we, we can’t always think as clearly when it’s our own kid involved.

Dr. Sarah (14:30):

Yeah. I mean, I see that all the time, even outside of, you know, this particular thing where or our own judgments of what we are supposed to be able to do as parents gets us really activated. And then we become, we’re kind of in that fight or flight state of, as a parent and that’s contagious gets our kids more dysregulated. It just kind of it’s I always talk about, it’s like pouring gasoline on a fire. It’s not helping.

Dr. Erica (14:59):

We can’t help co-regulate our kid, if we’re not regulated. Right. So that’s where sort of, we come in by saying, we might go to the family’s home. Right. We try to create really strict kind of more to routines that everybody knows what the expectation is gonna be, even parents. So we coach parents even on how to give effective kind of commands on how to give effective praise on how to give effective either rewards or consequences. Right. That are really thoughtful because what we really wanna be doing is increasing a child’s consequence and responding in a place of judgment, of calm of insight, not from a place of fear as parents too, right. Or responding from a place of frustration. And so we do all this kind of on the back end and then we track, we get as much data as we can and we track what’s working and we tweak kind of daily so that we can and have plans that are working and are responsive.

Dr. Sarah (15:55):

And you talk about co-regulation, which I think is so important because I think a lot of times when we were talking about changing a behavior, we can get really distracted by the behavior itself. Instead of looking kind of beneath the behavior, like you were saying, like what’s going on underneath this avoidance of school or this refusal to get out of bed in the morning or this like refusal to come downstairs, instead of it being about, we are just, the goal is to like get them to change their behavior, to really understand there’s something deeper happening here. There’s a dysregulation, there’s a fear, there’s an anxiety. And I can’t really, we actually change the behavior until I address that.

Dr. Erica (16:36):

Until you understand the why, right? Why is this kind of happening for this child? And if it is anxiety right. And they’re avoiding because the subway is scary going to school, the building is scary. They don’t wanna be asked something with a teacher. We also try to understand what’s happening there. And can we work with their teachers to, to address that it doesn’t mean that we’re gonna have their teacher never ask them a question again, it doesn’t mean that they’re gonna be allowed, never to take the bus to school again. Right. But we wanna increase their feeling that I can cope with taking the bus to school. Right. So maybe we do a lot of dry runs. Maybe we do a lot of practice. That’s why we have a coach do it with them. So they slowly can build up their confidence and skill to be able to do it more independently. Obviously that’s with an older kid. But with a younger kid, it may even be practicing putting their backpack on at home first and taking off their backpack. Maybe that feels really hard, right? Maybe they get confused between which is their right and left shoe and get overwhelmed. Right. When it’s like a quick transition somewhere. So we really work with families to figure out what are some of these triggers that as adults might seem so trivial. Right. I know which is my right and left shoe, it takes me five seconds. But for a child that might feel overwhelming to them.

Dr. Sarah (17:49):

Yeah. That makes me think too. The like, Ugh, as a grownup, I’m reading this as trivial, but for the child, it feels so much of a barrier. It makes me think a lot about perfectionism in young kids too. Like how do you conceptualize that? Like when you are, how, like, what are the kinds of interventions you’re helping parents with when they notice their kid is really kind of rigid around certain things being just so, or they, they give themselves a really hard time if they do something wrong.

Dr. Erica (18:21):

Yeah. I think those are really tricky things that can come up all the time and you know, to bring it back to school for a second. I mean, school in some ways is so where the kids get so much feedback about whether you’re right or wrong. Right. Like, think about even putting somebody’s artwork up on the, like up on the wall or kids get grades or come on, everybody come see what like little Emma did look at her work. Right? Like that should be a model. So, I think kids are constantly getting feedback on the way things are supposed to be and whether they things match or don’t match. I really try to focus and help parents focus on the process of what a kid is doing rather than just on the product. And sometimes not even commenting if it’s not perfect right. Or not. Right. Like so great. You put your shoes on yourself and you know, what, if they’re on backwards, but we’re just getting in the stro. Maybe it doesn’t matter if I don’t say anything at all. Right. Because I want my kids to end up feeling good about making the effort and if I’m correcting them, sometimes that doesn’t feel so good. Right. Like it’s like, why put the effort in if I’m just gonna be corrected?

Dr. Sarah (19:24):

Yeah. And I think there’s a way of, of kind of communicating a lot of confidence in a child when you’re on the process. Rather than the product, this idea that like I’m paying attention, kids are very much attuned to what we’re paying attention to and that’s immediate feedback for them indirectly what’s important and what has value. And so if we’re always commenting on how good a job they did or how right they were, or, you know, what the accomplishment was, that’s communicating to them where our attention lies, even if we don’t want them to be so perfect at attending to that product, but saying how did it feel when you were doing that or, oh, you worked so hard even, even though that was hard, you, you kept going.

Dr. Erica (20:14):

You kept going, you know yeah. Show me again how you put your shoes on. Right. I think like two things happened there you’re even getting them to practice a skill that maybe was hard and showing them that you’re really interested in what it is that they were doing. Yeah. Perfectionism, I think really does play into a lot of kids wanting to stay in school or feel comfortable in school. Like, can I be my true self when I’m there? Absolutely.

Dr. Sarah (20:40):

So going back to the idea of co-regulating, so you’re, you know, in these interventions, you’re coming up with these like modifications to the routine, some supports for the parents to, to be more consistent and more clear about what their expectations are, where does co-regulation fit into that? I’m so curious.

Dr. Erica (20:58):

Yeah. So we do a lot of parent coaching sessions as well. So really trying to give parents a reasonable expectations about what to have as goals for their kids. Right? So if you have a child that’s been unable to go to school for two weeks, three weeks longer, right. Saying, Hey tomorrow they’re gonna go to school for the full day may not be reasonable expectation. I think setting those expectation with parents helps them regulate in a way. Cuz they’re like, okay, I know what to expect. Also we really focus with parents on, you know, having them like practice with us. How are they gonna say something? Are they saying it with warmth? Are they saying it with love? How do they say this command? So that again, they’re not sort of wondering, am I doing it right, right. That’s why we give them these routines ahead of time and have them kind of go over them with us so that they really know this is what the plan is gonna look like. This is what I’m supposed to be doing. And they can feel really confident. Cause the more confident right that our parents are, again, the calmer, I think that they’re gonna be when something happens. And we also let them know, we don’t expect perfection in them. Right. We wanna model for them. We don’t expect perfection. We don’t, we do expect maybe you might make a mistake, right? There’s always a chance to fix that. Hoping again. And sometimes making it really explicit that they can model that to their kids as well. Don’t expect everything to be perfect, right? Like you’re not gonna get an a on every single assignment today. You might only stay at school for the first two periods. And that is huge improvement. Again, process over product. But we also kind of talk with parents about, Hey, okay, what are the ways in which your child may respond that are triggering to you? Is it slamming the door? Is it just yelling at you? Is it using kind of inappropriate language? Is it not responding and practicing with them? What are appropriate responses? So then the more that they’re like, Hey, I have people supporting me. I know I can get through this. I know I’m not alone in this. I think it’s easier for parents to actually become in the moment with their kids. And that in turn that shift, the child is like, wait, normally when I do this, my parent is up in arms. That shift, I think actually like pulls a rug from under the kids and helps to regulate them because they’re recognizing that my parents aren’t actually so scared of my behavior. My parents know how to respond to my behavior in a really different way. Huh. Something’s going on here.

Dr. Sarah (23:20):

Right. And I think that all comes in a big way from helping parents to realize that they have permission to look under the waterline. Like let’s say the behavior tip of the iceberg, the kid slamming the door, you know, the kid saying, you know, screw your breakfast and you know, whatever, like saying something shocking, right? Yeah. That a parent might. Otherwise, if you were gonna look at that as only a behavior, that that’s what matters and that’s what needs to be changed. A parent’s gonna get tripped up all over the place trying to fix or teach or discipline every behavior if in fact…

Dr. Erica (23:54):

And missing, right. They’re missing so much there. And that’s really actually the piece that needs to be addressed because ultimately they’re saying they’re throwing out there. Right. All things that the parents are catching or noticing, but it’s not actually fixing what’s happening for this kid and right. And so they’re missing so many opportunities to actually work with their kids. So we also kind of talk with them about that. You know, don’t take the bait all the time. Right? Like don’t feel that you need to actually correct them all the time because that’s actually not our goal. Like coming back to what is their goal in whatever the situation is. Right. Are we trying to increase confidence? Are we trying to increase competence? Like where are we and then how do we really address that?

Dr. Sarah (24:39):

Yeah. It reminds me, it’s funny. I just had a session this morning with a family and the mom was telling me about how she, her, you know, she had set some limit. Her daughter got really upset and called her stupid and told her to get away. And normally that would be a triggering thing for the mom. Understandably. Right. Then I think the mom would feel very compelled in that moment to sort of teach or discipline that kind of behavior, which is understandable. But the work we’ve been doing is trying to allow this mother daughter relationship to have a little bit more tolerance in space. And the mom heard her daughter. She sort of saw that it was coming from a place of pain and gave space. She was like, you know what, I’m gonna give you’re upset and I’m gonna give you some space. And in, and about 20 minutes later, the daughter came to her voluntarily and started sharing with her. Some of the things that had been bothering her earlier that day, that had nothing to do with the mom, but she was just irritated it and upset and sad about something. And we talked about how mom totally could have picked up that rope in that moment. Like you said, taken that bait in that moment and felt compelled. And almost like she was shirking her duty as a mom to not discipline in that moment, but she didn’t and she sat back and she created space. And in that space, that was what I think her daughter needed in that moment to connect with her.

Dr. Erica (26:11):

Right. Her daughter, it sounds to me like her daughter was saying, I’m so upset. It’s not really about you, but I feel safe enough to actually take it out on you. Right. And I think that’s also hard for parents to recognize, right. That oftentimes those behaviors that they’re doing, especially in the morning before school aren’t about just anger towards the parents. It’s about all these other things. And that’s why, right, we have to look below the surface to actually be able to address and understand those things. Are you finding more in your practice, you know, families coming in with kids having a hard time kind of returning to school or going to school, has that been like an more of an issue lately or kind of status quo?

Dr. Sarah (26:52):

I think it’s, you know, I have to think about that. Cuz I have had a couple younger kids who were like kind of out of the blue having a lot more trouble with school, but they were kind of like, like we were saying like a subclinical anxiety at baseline and then never had issues with school. But then since COVID, it was like the separation for mom and dad made it like unwieldy for them. And then I have a few more like teens who have been struggling with it.

Dr. Erica (27:23):

That makes sense I think.

Dr. Sarah (27:25):

Yeah.

Dr. Erica (27:25):

It’s interesting to see. I actually see what you’re seeing a lot about the older students having trouble and then the younger students also having struggles who’ve never really gone through that before.

Dr. Sarah (27:37):

Yeah. Cause it’s like, it’s interesting because usually by first second, grade, this is old hat for most of these kids and this population of kiddos, this is brand new.

Dr. Erica (27:50):

Well I think that separation anxiety, right. That a lot of kids kind of play out when they’re younger and separate and get comfortable with that. They didn’t get the chance to practice that in so much of the same way. Right.

Dr. Sarah (28:03):

And I think, you know, when our, when our four-year-old is expressing separation anxiety, we’re like, that makes so much sense. And I have a lot more empathy for that and a lot more patience for that. But when our seven or eight year old is expressing it, we’re like, oh my God, what’s wrong with you? Something’s not right. And I think it is important in these moments to, you know, it’s worth paying it to. But it’s also worth zooming out and locating it in the context of the fact that these kids have had now three years of somewhat of a disrupted academic life.

Dr. Erica (28:35):

But, and how our response is so important, right? Like just like what you were saying, we’re kind and compassionate to our four year olds. And yet we’re not to our seven, eight year olds. And I think the message that that sends them, right, to the seven, eight year old is, oh my God, something’s wrong with me? I’m not maybe good enough the way I am or people aren’t seeing me. And if I’m not being seen, maybe I have to dig in even more to be seen.

Dr. Sarah (28:58):

Yeah. Do you see that a lot where there’s like, if the parents are kinda having a little bit of trouble understanding why a child might be doing this behavior, why it might make sense, like going beneath the water and that the child then gets louder.

Dr. Erica (29:13):

Exactly. I think we see that a lot actually, but I think kids are all really looking to be seen to an extent they’re all wanting to pay attention to what’s happening below the water. And for so many of us that’s so to do, because I think we often think about, okay, we’re responding to behavior, right. So we need to really pause, but who has the time always to pause. Right. And to think about what’s happening below. And I think with all the other stuff happening in our minds, like our, you know, especially when it’s first thing in the morning or last thing in the day when it’s a bedtime or dinner time, like we’re almost too preoccupied to think about what’s happening in those times. Like what, oh, I’m sure it’s just about, you know, the doll, you’re just upset that like your sister has the doll, but it, it really might be about something very, very different..

Dr. Erica (30:01):

And that’s really the time I think at the end of the day, almost for us to like think through and about the examples that maybe have come up that day so that we can sort of start to make some hypotheses because if we didn’t address them today, that’s okay. Like we’re not gonna catch everything that happens. And so I don’t want, I mean, I have two young kids and I certainly miss things. Right. And so, but I always think like, okay, but now that I’ve had the time to think about it, tomorrow is a new day that these themes are not just coming up for my kid once and then leaving. They’re themes of their life. And so I have tomorrow can actually either reflect on it or narrate that or do some play around it. Right. There’s so many opportunities to address this.

Dr. Sarah (30:47):

Yes. And that makes me think of something that I bring up a lot, which is the debrief, what I call the debrief, which is, you know, you don’t have to, first of all, I highly dissuade parents to sort of teach in the moment or try to help kids connect dots in the moment. But I think after the fact, either a little bit after the fact, or even like you’re saying it could even be a day or two kids, remember what happened. So if they had a big meltdown before school, on Tuesday and on Wednesday night, when you guys are getting ready for bed, you say, Hey, remember yesterday morning when you were having a really hard time, I wanna understand what going on for you a little better, so I can help you more and like processing it with a child even a day later. Like there’s no window that closes for us as parents.

Dr. Erica (31:33):

Never. And I think, you know, even if you think to yourself, cuz I also hear a lot of parents say this, well, I don’t wanna talk about the bad thing that happened yesterday. Cuz today was a, a good day. Right? That like, you know, today was a good day maybe. Right. But that doesn’t always have a lot of bearing on what tomorrow is, is a new day. Right. And so I think it’s really important to think like even though today was a good day, you don’t have to be scared that you’re gonna negatively impact tomorrow, breaking up something bad that happened yesterday or two days ago. In fact, maybe you’re helping to ensure that tomorrow is also gonna be a good day. Because you’re picking up on whenever that hanging leaf was right. There’s still an untied knot somewhere that our kids are questioning. And so for some reason today they skills or the confidence or the strength to have a different day, but who knows what’s gonna be there tomorrow. And so I think we’re still sending the message. We see you, we’re here with you. We’re supporting you. I dunno how you feel about that.

Dr. Sarah (32:37):

I a hundred percent agree. And I, I think in some ways, even like not bringing it up, leaving it unsaid, communicates a little bit of fear, right? Like I don’t think that you can handle me bringing this up and if, and this good day is so fragile and your good behavior is so fragile that if I mention something bad happened yesterday, it will destroy the good from today. And like I think that’s something as parents, we might be projecting onto the situation. That’s not at all fair because the reality is is if we can say we had such a great day today and now that we’re feeling so connected and good and snuggly here in this chair, we read our story and reflecting how good today felt. We can talk about what didn’t feel good the day before and that doesn’t undermine any of this goodness.

Dr. Erica (33:25):

Exactly. And I think that’s really where I wanna try to, you know, increase parents’ confidence, right. That they can always do this and not be so worried. I think so many parents, you know, are anxious about, if I say this, if I say the wrong thing, is that going to increase negative behaviors.

Dr. Sarah (33:42):

Yeah. And I, it’s funny because you know, this makes me think of how you and I actually met, which was a training for this kind of awesome new therapy called SPACE. Which is a sort of a confusing name, but it stands for supportive parenting for anxious childhood emotions. And so we, we met at this training and the cool thing about SPACE is that it’s completely, it was created by Eli Lebowitz from the Yale Child Study Center. And it’s all about treating anxiety and OCD and young children through solely working with the parents.

Dr. Erica (34:15):

The parents. Yep.

Dr. Sarah (34:16):

And helping parents learn how to not teach the, how to do the therapy. Like we’re not training parents in like CBT for anxiety. We’re actually helping parents, when our child is anxious, helping parents understand the ways that, that child’s natural anxiety management response. Like they have this anxious feeling in their body. It doesn’t feel good. They are compelled biologically to try to do whatever they turn that feeling off. And because children are so intertwined with parents at this stage of life, their mechanism for turning off the anxiety is eliciting the parents to get involved in turning off the anxiety. And so what this treatment does is it helps the parents learn to notice, when am I being pulled in to manage my child’s anxiety and where can I not engage in that loop? Because that loop is what’s maintaining my kids’ anxiety in a way.

Dr. Erica (35:07):

Exactly. And I think that’s really where with the school refusal and with the coaching, we try to actually come in because so many parents wanna accommodate their kids’ anxiety. Right. That’s a big thing in SPACE is that parents see that their kid is anxious and you know what, you’re young, maybe you are only four or five and they’re sort of saying, you know what? You don’t have to go to school today, my love. You can stay home or we’re gonna do this thing and that’s gonna be a lot of fun, right. Or even when the kid is older, kind of the same thing sometimes can happen. And on the one hand, I can appreciate that. Like if you wanna take away your kid’s anxiety, I think that’s, you know, a lot of like normal like parental behavior, right. And we don’t want our kids to feel scared at the same time. We’re sort of perpetuating that. There’s actually something scary, right? We’re accommodating, we’re changing our life for our kid to feel less scared of a situation though. Here’s the sticking point, right. That isn’t actually scary or isn’t actually unsafe. Exactly. And so what we really wanna do is we really try to coach and help parents to then help their kids understand that, Hey, school doesn’t have to be scary. That doesn’t mean that there isn’t something hard for a kid about school and that’s where we wanna help them develop whatever that lagging skill may be. So I really believe that it’s actually both parts are true in this kind of situation, right. Building up their confidence in their ability to cope with scary situations. And then at the same time helping them, if there is something challenging. So for instance, you know, if the kid really does have a social skill kind of difficulty or has been made fun of, or maybe, you know, like a younger kid is having a hard time learning to read, I can understand that going to school might be tricky. We wanna make sure we’re getting the kid the support for that. And also making them feel like, Hey, they can cope and do hard things.

Dr. Sarah (36:56):

Yes. And I think that’s like the core, one of the core things about SPACE is what, what Eli refers to as like a supportive statement, which is he calls it like the mac and cheese. Like acknowledgement and confidence.

Dr. Erica (37:11):

Yes.

Dr. Sarah (37:11):

So like you can’t have a supportive statement has to have both, you can’t have mac without, you can’t have mac and cheese without both mac and cheese. So like you, you have to acknowledge that this is really hard. Ugh. School feels really, really challenging right now feels really tricky. It feels really scary. Yeah. And the confidence. Right. And I know that you can handle feeling scared sometimes.

Dr. Erica (37:37):

Exactly. And that’s so much the piece, right. The, I know that you could handle the uncomfortable feeling. Right. That’s what we’re, I mean, I think adults do this too. Right. We feel discomfort and we try to really push away from that. Right. And how do we help our kids to actually approach the discomfort? I, I know for me when my kid is anxious or upset and almost, I want to like withdraw from that feeling too. I right. I wanna do what I can cuz I don’t wanna feel the anxiety or the discomfort for my own kid. Right. Let alone have them feel it themselves.

Dr. Sarah (38:08):

Yeah. No, it’s, it’s a big snowball. Right.

Dr. Erica (38:11):

Right.

Dr. Sarah (38:12):

It is. And it’s so normal and so understandable to wanna shut that off. Right. We, yeah. As generally as people are not that great at feeling discomfort, like it really is a practice that requires a lot of work, a lot of work for everybody. And like for little kids, it’s like good luck. It’s really hard. They need us to be strong enough for that.

Dr. Erica (38:39):

Cause one of the things that I’ve really been thinking about is, you know, I’m actually helping them by helping them tolerate this discomfort. And by even showing them that I feel discomfort and I can push through it that I’m still safe, that I’m okay to feel tough things and to do tough things, I think actually helps to breed resilience in them and models actually really appropriate behavior. That discomfort isn’t something actually that we have to really shy away from all the time or really be fearful of. I’m not saying they have to go run into it all the time either, but that it is a feeling and experience that is okay, just many others.

Dr. Sarah (39:16):

Right. And it’s not something they have to be alone in either. Like I think that sometimes parents get tripped up between sort of this all or nothing. Like either, either we have to take all the anxiety and all the distress away for them or they need to be tough and they need to kind of just figure it out. And I think there’s space in between where you can kind of, again, this is that acknowledgement and that confidence, like I can acknowledge that this is really hard and I can show you that I really trust you can do this. I’m not gonna leave you all alone to figure it out by yourself, but I’m not gonna solve the problem for you either. Like I’m just gonna sit here next to you.

Dr. Erica (39:56):

Yeah. And have you found that ever to be the tricky part is how much to help for parents to know how much they need to help the kid figure it out

Dr. Sarah (40:04):

All the time. That is, I mean, that is the, that’s usually why people come to me is to figure out where is that happy little balance beam. Right. Cause it is really hard.

Dr. Erica (40:19):

I also don’t think it’s like a one, you know, response. Like I don’t think every situation with every parent and child you’re gonna give the same answer. Right. And it’s about like knowing yourself, knowing your kid, knowing the situation. There’s so many variables. I think that kind of play a role into deciding how much hands on support do they need and how much emotional support, you know, do they need.

Dr. Sarah (40:42):

And I think, you know, I’m, I think you and I are both in the business of helping parents figure out how to do this on their own. But I also really understand that sometimes it’s too unwieldy to do by oneself. And so it’s like, you know, you can listen to these podcast and you can get some of this information, you could try it on your own. And like, hopefully that’s all you need. And also don’t feel like you’re failing as a parent, if that’s not enough. And that you need a little bit of a, of an objective eye to come in and say, you know what? I think I could see a pattern here that maybe you missed. Right. Cuz I’m outside. I’m just out outside of the mix.

Dr. Erica (41:19):

I think about that all the time. How somebody else having those eyes on top of it is just so much easier than whenever you’re in something yourself. Like you just can’t see things. So clearly again, this is where I think the co-regulation or that you’re doing it with your child together. Right. And how much that snowballing can happen because you are holding some of the emotion possibly for your child. And so when you start feeling the same way that they feel and you can’t separate and calm together or for them. Right. And hold that security, I think that’s also often can be a really good time to think, you know what, I need, I need a little bit of help here.

Dr. Sarah (41:54):

Yeah. I’m also curious, this is making me think about when, you know, a parent is accurately noticing that their kid is having anxiety. Right. My kid feels more anxious than other peers, his age he’s it’s with his ability to do some of the things that I know he likes to do and it’s just becoming interruptive. But when you, the parent also know that you have anxiety, like if you are a parent who is an anxious human being in the world. That’s a really tricky thing to navigate because I think parents go straight to, I caused this or I’m never gonna be able to help them cuz I still struggle with this. Like what do you do? I’m sure you work with parents who are also anxious.

Dr. Erica (42:43):

Yeah, no, I definitely work with a lot of kind of anxious parents. And I think one, you know, some of that is their own individual work, right. To understand their own anxiety where that comes from to work through that. Again, so much modeling can happen for your kids in that way, just by you kind of getting stronger and feeling more secure in situations that your child does really notice and feel. I mean, we don’t realize, but our kids are really watching us all the time sometimes in ways that I wish they weren’t. But they’re definitely really watching us. So that’s kind of one step that I think, I don’t know if that’s, you know, a step that you’ve ever suggested to parents. Yes. is to work through some of their own anxieties and understand that.

Dr. Sarah (43:24):

Yes. That’s totally, I mean a lot of times, cuz I do tend to work with parents on parenting and working on parents with parents to support their children. Though I do work with individual adults. Like, you know, especially in like the maternal mental health, postpartum depression and anxiety work that I do. Like a lot of times when I’m working with parents, specific like in a SPACE therapy or anytime I’m working with parents to treat a child, if one of the parents is really highly anxious in a way that makes it so that it’s too triggering for them or too activating for them to tolerate their kids distress, which is definitely a part of this work, then I think it’s always helpful for them to be also working on that piece outside of the work that we’re doing.

Dr. Erica (44:14):

Totally agree with you. And I never feel like, you know, but it’s so true that you said that so many parents do feel like this is my fault. I cause this in, in my child and this is again, I mean I keep saying this, but parents can really talk to their kids about their own anxiety in a way that’s productive, right. In a way that’s like I’m joining with you and I’m trying something new. So really picking maybe some topics you know, what makes me a little bit anxious, you know what I haven’t done. I’ve never gone water skiing before, right. Or I’ve never gone rock climbing before. I’ve always been a little bit, you know, nervous about Heights and showing their child ways in which they actually are working on a fear that they have. And this doesn’t, you know, parents have, can have, you know, much more adult fears. So that might be a lot bigger. But I think for a parent to model to their child ways in which they’ve are kind of taking charge, making steps, doing things that are challenging, evoke such confidence like in a child like, oh my parent can do this hard thing and you understand me? You’ve joined with me. You’ve connected with me. That’s so huge.

Dr. Sarah (45:17):

Yeah. No, I think that there’s, it’s kinda like what you were saying before about like being afraid to like bring up the bad stuff because it’s gonna ruin the good stuff. And I think there’s a lot of parallels to this, this idea of like, I can’t tell my child my fears because it’ll make them their fears. And I think there are ways to talk about our own fears and our own worries and our own challenges with our kids in ways that have good boundaries that are healthy, appropriate ways to talk about this stuff. But we’re using them as actually like a teachable moment, a connected moment.

Dr. Erica (45:51):

Connected moments, right. And even talking to your kid about something maybe you did earlier that day, that was a little bit tough. Right? Maybe you had to ask your boss for an extension on an assignment, right? Maybe you had to, you know, tell a waiter at a restaurant, you know that like the food wasn’t cooked appropriately, right? Like telling kids, right, certain examples when you felt anxious can be really helpful, right. That they can actually connect with you or even getting their advice is also something that kids love. Right. If you were to go to your child about something that you might be a little bit anxious about, you know what, like later today I have to call grandma and tell her that, you know, actually we’re not gonna be able to come these days. We’re gonna go these days. Right. Or something else.

Dr. Sarah (46:39):

Yeah, and I’m worried I’m gonna disappoint her.

Dr. Erica (46:40):

Yeah. I’m worried I’m going to disappoint her. What should I tell her? Right. Really trying to bring in your child. I think makes them feel really confident. Like, oh my goodness, my mom was scared of the situation, but I was able to help them. That feels huge to kids. Right. To think like they really bring value to a situation.

Dr. Sarah (47:00):

Yeah. And I love the distinction too, of like asking them to help with problem solving or versus asking them to soothe your anxiety. Right. And that’s a big, important distinction. Right? So when we are bringing our anxiety to our children, as a modeling of how to cope with anxiety, we’re eliciting their help in the problem solving, not make me feel better. I need a hug. Can you comfort me? Because I think that is communicating something totally different, which is I can’t handle my anxiety. I need you to soothe it for me, which is kind of the thing they’re doing to us that we’re trying to help them realize they don’t, we don’t need them. They don’t need us to do that.

Dr. Erica (47:36):

And really there we’re helping them to practice their own problem solving skills. Right. And it can be an example that you’re actually maybe not even super anxious about anyways. Right. Or, you know, it’s really just to get them to elicit problem solving skills in a time when they’re calm. Cause just like anything, if you are actually anxious about something it’s really hard to elicit good problem solving skills. Really, really hard, right.

Dr. Sarah (47:59):

Yeah, your frontal lobes are offline.

Dr. Erica (48:00):

Yeah. but for a kid, if it’s something that they’re not actually anxious about, right. Like what should I tell your brother today? We don’t have his favorite kind of pasta. You know, do you have any ideas on how I could tell ’em or what could I do? It can be so helpful for a kid to be like, wow, I helped you with something and you’re teaching them how to problem solve. So ideally when they have a problem that comes up or something that they’re anxious, they are better able to access that circuitry that already exists in them because it’s already been activated before in a way that made them feel confident and you could remind them, right. I don’t know how to do this. You can say to them, remember that time you helped me with that problem. Right. When I was so worried about this, you were able to solve that with me. You came up with such a great idea and you could help them.

Dr. Sarah (48:45):

That you can do this. Yes. yeah. That is so that is such a help, like really doable thing for parents to do. Like, I feel like that’s a really nice takeaway from a lot of this is like, okay, yes. Something as big as school refusal can feel really unwieldy for a parent. If we’ve gotten that far into this, that we’re, you know, that can feel very hopeless or like learned helplessness on the end of the parent. And I think being able to say like something as simple as problem solving a scenario with your kid when they’re clear, when they’re calm, but you are feeling a little anxious or you’re explaining a situation that might make one feel anxious, and helping elicit their problem solving skills in a neutral setting for them. And then calling upon that or reminding them that they have that capacity when they’re really in the throws of anxiety, like that’s a very doable skill, tool for parents.

Dr. Erica (49:47):

And it’s short and it’s someone that you can continually kind of practice with them, you know, over time. Um so that, again, that muscle for these kids really gets strengthened. Right. And it becomes just more second nature to them. And so when they’re feeling anxious, that skill could still be strong. Right. That skill can still be accessed.

Dr. Sarah (50:10):

Yes. I love that. And I think that true for like even kids who aren’t, you know, clinically anxious. Like we all have anxiety. Anxiety is like such a human feeling.

Dr. Erica (50:20):

I think ot’s true for all of us. It’s true for me too. Right. Like I know when I’m less clear or I’m nervous about something it’s so much harder to think more clearly.

Dr. Sarah (50:27):

Yes. Ugh. This has been such an interesting conversation. I love having psychologists on the podcast. Cause I love getting like nerding out on the, you know.

Dr. Erica (50:39):

Me too. So it’s so nice to like talk to people about these things that I can’t do with my spouse. You’re like, they’re tired of hearing about it.

Dr. Sarah (50:47):

Yeah. so if people are listening to this and are like interested in learning a little bit more about the work that you do and how they could work with you, like how can people get in touch with you?

Dr. Erica (50:57):

You can find us on our website at www.successfulschooltransitions.com. Everything spelled exactly as you think, no capitals or spaces or anything like that. And so we have all of our information there.

Dr. Sarah (51:10):

Okay. I’ll put it in the show notes too. So people can just click the link, but I’m like so excited that you’re doing this.

Dr. Erica (51:16):

Awesome. Me too.

Dr. Sarah (51:18):

I’m sure it’s gonna help so many people because it is a very specific like thing that like needs a very specific type of wraparound care, I think at a certain level.

Dr. Erica (51:30):

Exactly. And, you know, we’re here to support families, both kind of, we do in person work, we can also do virtual work and a lot of kind of consultation. So if you’re sort of thinking, Hey, I just want a consultation or just some ideas about how to best support my child. You know, we’re able to provide just kind of really short term services as well. And really wanna work with families who also have another therapist on board. So we really don’t, you know, need to be like your full-time therapist. We’re really like an injunctive kind of service.

Dr. Sarah (52:01):

Yes. It’s like the intervention around specifically helping this piece of the puzzle.

Dr. Erica (52:06):

Exactly.

Dr. Sarah (52:07):

Cause it requires such a nuanced intervention because like you were saying like, the timing of it is so tricky. Like most therapists are not available to come to your house at seven, between seven, 8:00 AM every single morning and help work a kid through this.

Dr. Erica (52:23):

Right. And like you were saying, we really are focusing just on the school refusal piece, not necessarily on everything below the surface. But we do look at it to make the plan. Right. We still wanna make sure those things are being addressed. And during the school refusal coaching part, that’s not necessarily the time that some of those things are gonna be addressed. So for us, it’s why it’s so important that there is already another therapist on board. So that, that person really is working, you know, towards addressing those underlying deep seeded areas that might be contributing to the behaviors.

Dr. Sarah (52:55):

Yes. Well, this has all been like so illuminating for me and helpful to think about it in this specific context of school fusel, but in anxiety in general. And I, Ugh, I love talking to you about this. I could talk to you for hours about this.

Dr. Erica (53:08):

Me too. I I’m just so passionate, honestly, about school refuse and avoidance. I know that’s such a, you know, niche kind of area, but it really is something that I’m passionate about and talking to families with. And I just love kind of talking to you and your audience about this.

Dr. Sarah (53:23):

But I imagine there are some people listening right now who might have their ears perked up a bit like, Ooh, I’m kind of resonating with what they’re talking about. Maybe I didn’t quite realize that what we’ve been kind of struggling with every morning might actually be a thing that I could get help with.

Dr. Erica (53:35):

Yeah. I would totally agree with that. That there are gonna be people out there. It doesn’t have to be so difficult, you know, and it shouldn’t be so difficult. And if it’s painful for you or your child, that to me is really a time to get some support around this. You know, school is something, unfortunately that your kid is going to have to do for many years, which means you are gonna have to be helping them with it for many years. We want it to be, you know, as Pain free as possible.

Dr. Sarah (54:02):

Yeah. And I would imagine that at the kids that you work with, I’d be curious if some of them afterwards can, can finally like look forward to school and like find joy in it. Cuz it could be such a wonderful place.

Dr. Erica (54:16):

Yeah. I mean, I would say there’s definitely a range. Listen, some kids are never the kind of kids that are like, I love every minute of every day of school, but at least they’re finding it, they are finding some joy. They are benefiting from learning. Right. They like something about school and oftentimes kids won’t acknowledge right. That they actually like it, but their behavior can still tell a story there. That like, they’re going, it’s painless. They’re happy. Right. They’re coming back with smiles. And so clearly we see like a huge shift in them.

Dr. Sarah (54:49):

Yeah. Which is a gift for the kid. I imagine.

Dr. Erica (54:52):

And the family, right. One kid not going to school that stress on that family system is huge. So I really see it as like a gift for the whole family.

Dr. Sarah (55:04):

I love that. All right. Well thank you so much. And we’ll be in touch. We’ll talk more about lots of these things.

Dr. Erica (55:11):

Great. Thanks for having me.

Dr. Sarah (55:13):

Bye.

Dr. Sarah (55:19):We have all been through a lot over the last couple years, so I hope this podcast has been a place you can turn to for guidance, support and reassures in your parenting journey. If you found Securely Attached to be helpful for you, maybe you’ve tried a suggestion from the show or maybe you just wanna help us get the word out to more parents, I really wanna hear from you. Leave a review and let me know what’s been working for you, what you’re liking and what you wanna hear more of. Thank you so much for your support. And until next week, don’t be a stranger.

 


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43. School refusal and anxiety: What parents can do to support their children with Dr. Erica Miller

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