2. Can become a disorder when – Intensity increases Multiple symptoms persist Length of time increases Impairment occurs

3.  Worry /apprehension  Excessive shyness  Avoidance  Distress/tantrums  Heart races, Shortness of breath, other physical symptoms  Expect bad things to happen/ cannot cope

4.  Severe difficulty attending school resulting in prolonged absence  Parents are aware & attempt to intervene unsuccessfully  Demonstrate significant emotional upset about attending school

5.  Bullying  Transition to High School  Family stress  Academic Problems  Illness in others  Traumatic Life Event  Fear/Difficulty with teacher  Change of school  Divorce

6. Learn skills to manage anxiety Social Skills training Cognitive Therapy Exposure

7. School Intervention : Developing an attendance plan Provide warmth & support Facilitate Attendance Plans- notice and act, maintain contact Identify concerns the student has about school Provide strategies Provide a mentor Consistent Approach

8. o Understand anxiety & school refusal o United, consistent approach o Smooth morning routine o Clear message: “We cannot allow you to stay home.” “We will do whatever we have to in order to get you to school.” o Escort to school o Communicate with school consistently o Provide rewards/incentives o Model confidence

9. Kenneth Oclatis, Ph.D. Director, Outpatient Clinics and PT/OT Services Saint Francis Hospital