Ideas for school refusal/separation anxiety for IEP meeting tomorrow

[Kristin L]

We have an IEP meeting for my son (10-GAD, depression, suicidal ideation) tomorrow and I was hoping for some ideas on how we can make a plan to support him. We have a wonderful school social worker (who is the lead social worker for the whole district), a special ed teacher for my daughter who adopted the whole family, a caring teacher and other great staff who will be at the meeting. He never had any problems with school before Covid. He was a leader, extremely social, well liked and funny. He enjoyed helping other kids and he tested extremely gifted even with some timed test anxiety reducing his scores. When Covid hit and we were distance learning, he struggled to stay engaged with class and with the distraction of YouTube. Our school day would stretch out long because he couldn’t settle down and finished his assigned work. 9 months into the school shutdown, he became extremely depressed and started having intrusive thoughts about suicide. We had hoped school starting up would help. Since then, he has struggled with getting to school and if he made it, staying there. He becomes overwhelmed by all the people or thoughts of sharp objects he knows are around the building. He ends up in the social worker’s office telling her his plans for self harm to either end it completely or hurt himself to get out of school. We’ve had a few more trips to the ER and three short inpatient stays as well as two stints in PHP and intensive outpatient programs which he does so well, they never get to the larger issues. We’ve added massive separation anxiety to the list since his last inpatient stay–he feels like we just left him and he thinks we aren’t coming back. Residential treatment seems out for this reason. Another stay in a PHP or intensive program will just put him more behind in school and not really get to his issues since he is not disruptive. They have a program that could keep him safe but it is targeted to kids with major behavior issues and the school social worker thinks it would not be a good fit for him. I agree. The goal is to get him back to school. One thought was to tell him the only other option is the program for kids with behavior issues and have a tour. This seems like it might just raise his stress level. Another idea was to do some kind of homeschooling/distance learning with some frequent DBT therapy but everyone agrees this might make getting back to school even harder for him. He is also missing sports, which he loves, and he missed his traditional camp program where he knows the counselors, too, because of the anxiety. Would some sort of ERP help? We are also meeting with his doctor tomorrow and looking at increasing the dose of his Abilify which he started last week on Wednesday in addition to guanfacine, sertraline and NAC. Any advice would be very welcome.

[Natasha]

Hi Kristin,
I would defer to the team you have working with you, as they know your son and his issues. Both kids have a complicated mix of struggles that go way beyond anxiety. ERP is highly effective for OCD and even many anxiety thoughts, but his mood instability seems to be the primary issue right now. DBT is a great approach for that type of issue.

[Kristin L]

Thank you, Natasha. The team is stumped. The school social worker has been getting questions about why he isn’t in school but no one wants to trigger the suicidal behavior. We might just have to keep him home for school until we find a better med combo and maybe progress in therapy even if it will just make him more isolated and socially anxious. I wish the programs had come through with the follow up care they promised when we started each one. It’s so hard to keep starting from scratch with therapists.

[Natasha]

Yes, unfortunately that sounds like the most viable option right now. Sorry for all the struggles.

[Kristin L]

I feel so bad this pistes here—I meant to have it in the anxiety section. Sorry! Here’s an update;

We had a great IEP meeting and then a good appointment with his prescribing doctor. We are going to start the district’s distance learning option on Friday and we’re referred for 3 sessions per week if DBT—one individual, one with parent (we are separated) and one group with other kids. After spring break, we have the option of moving him back to his school where his twin sister continues to go. We are so lucky to have such a supportive community around us. I had to pick my daughter up yesterday after she reacted badly to the rest of us leaving the school after the meeting. She flipped chairs, swore, abs threatened self harm (copying her brother). They told her she got a do over today. We had a great night’s sleep and she went right to class and stayed there happily today. Amazing how much better today looks after yesterday.

[Natasha]

(Don’t worry it’s in this section)

I’m glad it was a productive IEP meeting and that you have an amazing group supporting you! It sounds like a good plan. That’s good to hear that your daughter was able to go right to class today ❤️.

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