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Hendrixt
Our 14yrs old D has been AN since January - undergoing FBT in CAHMS in the UK, is weight restored and eating well but has just started refusing to go to school. We’ve done lots of work with the school to mitigate any problems which may cause anxiety. She has good, supportive friends, who she eats with at school. It is not affecting her eating which is going well and she is starting to really enjoy her food.

We are not too worried about the academic aspects and if she needs to stay off school to aid her recovery then we are prepared to accommodate this but we are worried that any long term absence could lead to her becoming socially isolated and lacking in normality which may in fact hinder recovery.  When we try to get her into school in the mornings she becomes extremely anxious and borders on having a panic attack. The anxiety / fear of going to school can bring her mood down for the whole evening before a school day and she cannot sleep at night. She has now been off school for over two weeks and the fear does not seem to be abating. 

Wondering if anyone had been through this? 
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sandie
I understand your worry. We have not experienced school refusal but anxiety and low mood became overt when weight restored at least it became more in focus as focus shifted away from food. Anxiety was preAN and D has benefitted from Sertraline. I have read threads on this forum on this forum about managing school refusal. 
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Hendrixt
sandie wrote:
I understand your worry. We have not experienced school refusal but anxiety and low mood became overt when weight restored at least it became more in focus as focus shifted away from food. Anxiety was preAN and D has benefitted from Sertraline. I have read threads on this forum on this forum about managing school refusal. 


thanks Sandie. We are awaiting an appointment with the psychiatrist to discuss possible medication. 
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teecee

Our D hated school. We persisted in insisting on school but not whole days. We built it up from the odd hour some days and the odd lessons she ‘liked’. She was allowed to spend a lot of time in the library with a member of staff who she trusted who was fabulous. 

yes we did experience meltdowns and lots of phone calls stating she was having panic attacks. Sometimes they necessitated her coming home sometimes not. 

Our D struggled physically and was mentally exhausted after a couple of hours. It may be that yours is too and is embarrassed about having panic attacks in front of peers. We took the stance that she had to confront issues and not avoid and the real friends would be there to support her in the end...which they were. 

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Hendrixt
teecee wrote:

Our D hated school. We persisted in insisting on school but not whole days. We built it up from the odd hour some days and the odd lessons she ‘liked’. She was allowed to spend a lot of time in the library with a member of staff who she trusted who was fabulous. 

yes we did experience meltdowns and lots of phone calls stating she was having panic attacks. Sometimes they necessitated her coming home sometimes not. 

Our D struggled physically and was mentally exhausted after a couple of hours. It may be that yours is too and is embarrassed about having panic attacks in front of peers. We took the stance that she had to confront issues and not avoid and the real friends would be there to support her in the end...which they were. 



Hi Teecee,

Sounds like you did great in dealing with this problem, I hope we can too. I get the feeling that she is just generally exhausted at the end of refeeding and, although she is physically health, she is finding it hard to hold everything together and worries about breaking down, or busting into tears or having some sort of panic attack in front of friends. I think that is part of it. She is also feeling the pressure from GCSEs, as they all are at this stage.
 
We have been going through a few weeks of only being  able to get her in for partial weeks and partial days but it has now completely ground to a halt with her refusing to get ready in the morning and having a very severe reaction to any suggestion to going to school so it’s going to take a lot to just get her there. The approach of getting her to spend any time in school at all, as you did with your day spending time in the library, sounds really good and we are considering things like that at the moment, for example; allowing her to go in for favourite lessons only or even just going in at breaks and lunch to spend time with her friends.  The only thing is is that she won’t do anything which appears to be out of the ordinary as she feels ashamed so she currently is rejecting all these types of suggestions and opting just for staying at home permanently so it’s very difficult with her and she is very resistant to getting into any sort of conversation about it 

Thanks for all your advice and also for your advice on the other post
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Ellesmum
I’m in the same boat Hendrixt,
D has done some full days but is often in the pastoral centre instead of lessons, nevertheless I’m happy she’s joining in, socialising and doing pretty well as far as grades go.  She’s come further than I could have imagined a year ago.

I think that repair to the damage caused by starvation takes a long time, especially the brain and it must be exhausting to still be unwell mentally to an extent, rebuilding physically, catching up on work and friendships and have a bit of misplaced (I cannot think of a good word but guilt? Shame?) about the reason for having been away a while- it’s an awful lot for a person to deal with.

At the moment I’m happy for rest days, certain lessons etc. She also has a card she can show to leave a lesson for a break, no questions asked. 

Really, education can be resumed at any stage in life, so I’ll continue to encourage school but not put pressure on. I’ve made my peace with this as I’d rather have a happy, living daughter who doesn’t quite reach her original potential than an anxious, unhappy high achiever or of course the even more ghastly alternative. 

Its very difficult but you’re not alone in this x 
Ellesmum
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ValentinaGermania
We did not have that here but a friend of my d had that (without having AN) and I can only tell you that it does not get better with leaving her at home. The anxiety is not real in most cases as the anxiety about fear food and as with fear food you need to work on that by exposition. Talk to the school and make a plan with a very reduced schedule. Bring her in in the morning and tell her you will fetch her up after the first lesson. Maybe it is possible that you stay there as well?
Then increase it slowly to 2 lessons, 3 and so on. We had that problem in Kindergarten, our d did not want to go there and we did it that way. So maybe that helps (they are a bit like toddlers again in that state).

All that under the premission that there is no real reason for that she refuses to go. Are you sure there is no bullying happening?
Keep feeding. There is light at the end of the tunnel.
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Hendrixt


tina72 wrote:
We did not have that here but a friend of my d had that (without having AN) and I can only tell you that it does not get better with leaving her at home. The anxiety is not real in most cases as the anxiety about fear food and as with fear food you need to work on that by exposition. Talk to the school and make a plan with a very reduced schedule. Bring her in in the morning and tell her you will fetch her up after the first lesson. Maybe it is possible that you stay there as well?
Then increase it slowly to 2 lessons, 3 and so on. We had that problem in Kindergarten, our d did not want to go there and we did it that way. So maybe that helps (they are a bit like toddlers again in that state).

All that under the premission that there is no real reason for that she refuses to go. Are you sure there is no bullying happening?


Hi Tina. Yes we are sure there is no bullying as she has a very supportive and really nice group of friends and that’s one of the reasons we’re trying to avoid a prolonged absence. 

Also I think you’re right that a lot of the fear is unfounded and some exposure type therapy is needed to get her back in. Just this morning we are planning for Monday when she returns to school after a weeks half term holiday (adding to 3 weeks for her as we couldn’t get her in before the holidays). We are going to propose that she only goes in for one lesson, Art which she finds the least stressful, in the morning, with the option of coming home straight after the lesson. If that is successful maybe we can build it up over time.

Wish us luck xx
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Foodsupport_AUS
We had a lot of issues with school refusal around the time of weight restoration. For us there was multiple issues going on at the same time, anxiety, suicidal thoughts, self-harm and the eating still was very hard work with full supervision needed. Initially we did go with a prolonged absence - she had been out of school for more than a year at that stage, and ultimately it got extended by another 5 months. 

The social isolation worried me a lot too at that point, but she really didn't want to see her friends or other young people - feeling great shame at her changed body. 

So we worked at things slowly - I arranged outings for her with non peers- beading classes for example. I took her out to movies. We tried bringing close friends over, but she declined to talk to them/ see them. When things were still not really changing we started looking at some alternative schools for her - that finally brought her to realise that she didn't want to change schools or do distance education for ever. We then started a one month transition back to school program. 

The academic aspects made little difference to her. Socially she was some years behind her peers for a number of years afterwards, but has now caught up and doing those normal social things you expect young adults to do. In some ways she is more mature than many 23 year olds. 

Overall I would suggest just going with what makes you feel the most comfortable and if it is not working try something different. I have known of a number of children who needed to change schools, not because of bullying but rather because they just needed a different environment.
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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ValentinaGermania
I would also arrange some outings with school friends or some school friends coming over to your house so she sees that she is missed there and hears what she has missed when she was not there ("did you hear about what happend in maths").
Keep feeding. There is light at the end of the tunnel.
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sk8r31
We had success with the second half of the school year when my d was 13 by just sending her for two classes, Spanish & Art.  This allowed her to maintain some social connection with peers at school.  She was ready to go back to the school environment full time for the next school year.  Meds may be helpful for extreme anxiety, and it may be useful to discuss with your healthcare provider.  As Foodsupport and others have said, any academic gap is likely to be made up, it's the social connections that may need your attention.  If you can provide social interaction away from school, with community classes or inviting friends over that may be a good way forward.  I liken it to socializing with a toddler, when you may be arranging 'play dates'.  I am also an advocate of volunteerism with our kids...takes them 'out of themselves' by being able to help others.  So if your d has a particular interest...animals, helping with younger kids, visiting the elderly etc, it may encourage both social engagement and self-confidence. 
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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teecee

I think approaching it from the view of preventing her isolating herself (which the illness loves to do) and balancing that with requiring her to attend without over exhausting her is a fine balancing act. Our D slept a lot...and I mean a lot - even after WR. The sofa was like a bedroom much of last year. 

The education has to come second. I stated that she had to continue attending school however there was no requirement to sit GCSEs and as far as I was concerned they were not a priority. What I found was that D was so desperate to leave school and go to college she couldn’t bear the thought of an extra year at the school. 

Be aware that having said all this about school and that she hated it and never wanted to set foot in it again...recently she said to me that it actually wasn’t that bad and wanted to go back in to see old teachers and friends! She did take herself off in on an open day to say hi!! I was flabbergasted considering where we were last year! 

Keep reminding her school is a requirement and you won’t condone her being at home and isolating herself. You can only keep trying. 

 

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deenl
Hi Hendrixt,

Our son was very ill and reversing malnutrition took a very long time in our situation. In the end our son was out of school totally for almost two full school years. For the last few months of the second school year he went in for about 2 hours a couple of days a week, building up to a half day every day. The psychiatrist did worry about normal development etc but our son could not eat out and about and I was adamant that he could not miss nutrition. The first year or so he was in a terrible state, not even interacting with his brothers, then gradually rebuilding the relationship with them and eventually with one friend who would come and visit. The second year he was still very uptight and pretty isolated. But in spite of everything, going back to school went really well. His mentor said that the social side was going better on his return than the year before he got sick. He has always been pretty introverted and so does not have a huge circle of friends but he is relaxed and happy at school, not afraid to be himself and let his quirky sense of humour show. Academically, he is doing fantastically and is expected to graduate secondary school on time. What's really interesting for me is that much of his perfectionism has disappeared. He is still a very dilligent and motivated student who works hard but doesn't sweat the small stuff and takes a lower than expected mark in his stride. I have to say that we have no regrets about letting him take time out of life to recover in his safe bubble before stepping back into the world but it is certainly something where each family has to do what is best for themselves.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Hendrixt
Ellesmum wrote:
I’m in the same boat Hendrixt,
D has done some full days but is often in the pastoral centre instead of lessons, nevertheless I’m happy she’s joining in, socialising and doing pretty well as far as grades go.  She’s come further than I could have imagined a year ago.

I think that repair to the damage caused by starvation takes a long time, especially the brain and it must be exhausting to still be unwell mentally to an extent, rebuilding physically, catching up on work and friendships and have a bit of misplaced (I cannot think of a good word but guilt? Shame?) about the reason for having been away a while- it’s an awful lot for a person to deal with.

At the moment I’m happy for rest days, certain lessons etc. She also has a card she can show to leave a lesson for a break, no questions asked. 

Really, education can be resumed at any stage in life, so I’ll continue to encourage school but not put pressure on. I’ve made my peace with this as I’d rather have a happy, living daughter who doesn’t quite reach her original potential than an anxious, unhappy high achiever or of course the even more ghastly alternative. 

Its very difficult but you’re not alone in this x 


Thanks Ellesmum. Yes long ago I accepted that education needs to wait for recovery. The benefits of school for me are more about the social aspects and retaining as much of a feeling of normality. I worry that long term isolation from her peers may bring on a depression. It's helpful reading about what you did though. There are many options that I never thought of so maybe it doesn't have to be an all-out in school or totally out of school. The card is a really good idea
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Hendrixt
tina72 wrote:
We did not have that here but a friend of my d had that (without having AN) and I can only tell you that it does not get better with leaving her at home. The anxiety is not real in most cases as the anxiety about fear food and as with fear food you need to work on that by exposition. Talk to the school and make a plan with a very reduced schedule. Bring her in in the morning and tell her you will fetch her up after the first lesson. Maybe it is possible that you stay there as well?
Then increase it slowly to 2 lessons, 3 and so on. We had that problem in Kindergarten, our d did not want to go there and we did it that way. So maybe that helps (they are a bit like toddlers again in that state).

All that under the premission that there is no real reason for that she refuses to go. Are you sure there is no bullying happening?


Hi Tina,

I also worry that a prolonged absence may not make things better and I worry about her getting depressed as at prior to the last few weeks she did seem to have a lot of interaction with school. The reduced schedule and building it up idea sounds good and I've been having some preliminary discussions with the school as to how we could make this work. I think she's a bit old for us to stay in school with her but we can certainly drive her to school for lessons and bring her home. I've recently re-negotiated my working arrangements so I'm constantly working from home and available to manage all this. Thanks very much for your advice
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Hendrixt
We had a lot of issues with school refusal around the time of weight restoration. For us there was multiple issues going on at the same time, anxiety, suicidal thoughts, self-harm and the eating still was very hard work with full supervision needed. Initially we did go with a prolonged absence - she had been out of school for more than a year at that stage, and ultimately it got extended by another 5 months. 

The social isolation worried me a lot too at that point, but she really didn't want to see her friends or other young people - feeling great shame at her changed body. 

So we worked at things slowly - I arranged outings for her with non peers- beading classes for example. I took her out to movies. We tried bringing close friends over, but she declined to talk to them/ see them. When things were still not really changing we started looking at some alternative schools for her - that finally brought her to realise that she didn't want to change schools or do distance education for ever. We then started a one month transition back to school program. 

The academic aspects made little difference to her. Socially she was some years behind her peers for a number of years afterwards, but has now caught up and doing those normal social things you expect young adults to do. In some ways she is more mature than many 23 year olds. 

Overall I would suggest just going with what makes you feel the most comfortable and if it is not working try something different. I have known of a number of children who needed to change schools, not because of bullying but rather because they just needed a different environment.


Hi Foodsupport - amazing how clear and sensible your advice always is. Thank god for the people on this site. Last week I was lost with this and rang our therapist - would you believe the advice was to cut out the school snack to reduce anxiety around meals at school !!

It sounds to me that with all the problems you had, a prolonged absence was definately inevitable. What a terrible time you must have had. Our D does some minor self harm but no suicidal thoughts and her eating is going well at the moment. It's good what you did in terms of keeping her active during the absence and we will look at following that advice if we can't get her into school. 
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