Since January 2008, our only child, a bright and sporty daughter of 15, has been refusing to go to school after a normal first term at a local private school. Her behaviour was a mixture of determination, belligerence, sadness, anger, anxiety, rudeness and being out of control with her emotions with everyone, but especially us and her house mistress. We put it down to adolescence, peer pressure at a new school and (after discussion with the school counsellor) being an only child. The school was helpful and our GP referred us to the local child and adolescent mental health service via the NHS. The wait for help was to be six weeks. In the meantime, we were told to make life at home as uncomfortable as possible - to confiscate iPods, computers, TVs, mobile phones etc - and to try and coax our daughter back to school as and when. It is very hard to get a 14-year-old who is as strong as an adult out of bed when she just lies there; we went from being very upset to extremely worried. Eventually, we felt physically sick each morning as the alarm went off. As parents we decided we would have to move her to another school closer to home, with shorter hours and excellent pastoral care. She was immediately offered a place and started three days later, but after the first day she arrived home in emotional turmoil and school-refusing again. The problem is obviously not with the school but with our daughter. What should we do?

- Maura and Adrian

What a difficult situation. It is clear that you feel powerless to help your daughter, whose behaviour seems to have suddenly and inexplicably changed.

You are right to describe her behaviour as school refusal (SR) - this is a known disorder. One in four children occasionally refuses to attend school, and it becomes a routine problem in about 2 per cent of children. It is seen equally in boys and girls and generally occurs between the ages of 5 and 11 (due to school transitions), and 14 and 15 (due to puberty and associated pressures). Most children with SR will have shown related difficulties at some earlier time - separation anxiety when first going to school, social anxiety, or low mood.

I suspect that many will have read your letter and thought, “just make her go to school”. There is an element of control and manipulation in the behaviour of a school refuser, and clearly when they are older it is not as simple as hauling that child into the car and depositing him or her at school. However what now needs to happen is that you both feel really clear about what is going on and find ways to become assertively supportive of your daughter.

It is first important to recognise that your daughter's SR behaviour is not the problem in itself, but the symptom of an underlying set of difficulties. There can be many explanations for SR behaviour. Often the child is too anxious to leave his or her parent. It is common to see this in children whose parents are separating or having marital problems; after a parental illness; or due to significant life events such as a house/school move, bereavement, birth of a new sibling etc.

Equally, SR children can be “kept” home by anxious, depressed or lonely parents. Or the child may be experiencing school-related difficulties (no friends, being bullied, problems with teachers, etc). A careful assessment needs to be carried out in order to clarify what is underlying the SR behaviour.

It is very frustrating to read of your six-week wait for NHS treatment. Mental health services for children and young people are desperately underfunded. The tragedy is that when you are eventually seen, your problem will be six weeks more entrenched; early intervention in SR cases is essential. My first recommendation is therefore that you find a private clinical psychologist who specialises in treating SR via the British Psychological Society - www.bps.org.uk, telephone 0116-254 9568.

I hate to be negative, but it is not ideal that you have changed her school. Obviously you are now clear that the problem is located in your daughter and not the school, but the challenge to get her in is greater as her anxiety will be increased by the unfamiliarity and lack of a friendship network. I strongly advise a return to the old school if possible.

Treatment will be a combination of therapies to help your daughter to challenge her anxiety-driven thoughts and beliefs. She will be systematically desentised to return to school by starting with short daily attendance and building over time. There will be rewards for desired behaviour and no reinforcement if her progress slows or stops.

As parents, you need to not be anxious with your daughter. You are her role models, and unless there really is something bad going on at school, you can show her how to face fear in life. The best outcomes are seen when families become assertive and organised in the face of their child's chaotic behaviour.

For more help, contact the Advisory Centre for Education (ACE), 0808-800 5793, Young Minds parent information line, 0800-018 2138, and The Royal College of Psychiatrists, Factsheet 9: Children And Truancy.

If you have a family or psychological problem, e-mail Tanya at drtanyabyron@thetimes.co.uk

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