School Avoidance in Teenagers

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shahseh22

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I'm seeing an increasing number of teenagers avoiding school due to persistent anxiety and panic attacks. More importantly, I'm seeing them refuse school and resort to independent studying programs. I feel like this is just a temporary fix and I'm advocating for them to go to school, but then I get a lot of pushback from the parents, who want me to sign forms authorizing them to miss school. I was hoping that there is some literature or good articles I can refer to help with this or to educate the parents.

I initially thought it had to do with bullying but a part of me thinks that these kids just want to stay at home and play videogames and sit on social media all day.

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I saw a ton of this on my inpatient child rotation earlier this year (kids literally threatening suicide because they are anxious about school). But the attendings I worked with were pretty hardcore about discouraging online programs and challenging kids to go to school. But I did not get into any literature on it, sorry. It does seem like it is multifactorial: there is a social anxiety component (around being judged by peers), there is some secondary gain (get to stay home and do something more fun), and perhaps some attention seeking. There is also the family dynamics piece in which the kid is enabled/allowed to continue to refuse school.

It's such a strange phenomenon and change from when I was a teen. I mean, high school sucks, but I just don't understand why they can't just be goths and listen to the Cure like normal miserable teenagers.
 
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As a psychologist who works primarily with teens, this is a huge problem that has multiple causes and factors that have maintained/worsened it. In addition to those mentioned by Old&intheway, there are several others I can think of:

1) this generation seems to have a completely different frame on emotions/mental illness than previous ones. There is much more of a tendency to base decisions to do or not do something disproportionately on emotions/feelings instead of making decisions based on other factors or goals. They also seem to view transient psychological states as permanent pathological states- for example if they have ever experienced depression every subsequent feeling of being down or in distress is labeled as depression.

2) there is constant negative (and positive) reinforcement of mental distress from the school system (you have anxiety? You now get a 504 that says you can turn in assignments whenever you want instead of the due date), parents (“My daughter can’t be called on in class, she has social anxiety; I can’t ground her after being non-complaint or aggressive, it will make her depression worse”), and peers. This has fed into the impression teens have that the world should adapt to ease their struggles instead of them adapting to improve coping/resiliency.

3) the general conflation of feelings with mental health/well-being. Also the perpetuation of the idea that you are not being empathetic to people with mental or behavioral health challenges unless you let them avoid all “triggers” or things that upset them.

4) many kids do feel increasing less equipped for dealing with in person interactions with others because they are so used to interacting through screens. Undoubtedly, they feel less confident or feel less skilled at interacting in person. Many prefer to avoid what may then feel like an overwhelming social component to school.

5) celebrity role models who remove themselves from work/life to get treatment and fancy residential treatment centers- strengthening the misconception that one must be removed from life stressors in order to heal or make progress

6) an industry of on-line or “independent study” schools have sprung up to cater to the above phenomenon and provide what seems like a viable solution to parents tired of fighting with their kids about school attendance.

The decades of research in exposure, context-dependent learning and anxiety would indicate that allowing them to remove themselves from school would most likely lead to saddling them with a long-term struggle with anxiety/anxiety disorders and be the opposite of what will help them treat an anxiety disorder or develop effective coping.

End rant :dead:
 
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I saw a ton of this on my inpatient child rotation earlier this year (kids literally threatening suicide because they are anxious about school). But the attendings I worked with were pretty hardcore about discouraging online programs and challenging kids to go to school. But I did not get into any literature on it, sorry. It does seem like it is multifactorial: there is a social anxiety component (around being judged by peers), there is some secondary gain (get to stay home and do something more fun), and perhaps some attention seeking. There is also the family dynamics piece in which the kid is enabled/allowed to continue to refuse school.

It's such a strange phenomenon and change from when I was a teen. I mean, high school sucks, but I just don't understand why they can't just be goths and listen to the Cure like normal miserable teenagers.

Post. Of. The. Day!
 
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Amazing post about the cure, one of my highlights from training was denying a mother my authorization for home school for a COMPLETELY asymptomatic child, she even admitted that it was easier FOR HER to have him stay at home, hah!
 
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As a psychologist who works primarily with teens, this is a huge problem that has multiple causes and factors that have maintained/worsened it. In addition to those mentioned by Old&intheway, there are several others I can think of:

1) this generation seems to have a completely different frame on emotions/mental illness than previous ones. There is much more of a tendency to base decisions to do or not do something disproportionately on emotions/feelings instead of making decisions based on other factors or goals. They also seem to view transient psychological states as permanent pathological states- for example if they have ever experienced depression every subsequent feeling of being down or in distress is labeled as depression.

2) there is constant negative (and positive) reinforcement of mental distress from the school system (you have anxiety? You now get a 504 that says you can turn in assignments whenever you want instead of the due date), parents (“My daughter can’t be called on in class, she has social anxiety; I can’t ground her after being non-complaint or aggressive, it will make her depression worse”), and peers. This has fed into the impression teens have that the world should adapt to ease their struggles instead of them adapting to improve coping/resiliency.

3) the general conflation of feelings with mental health/well-being. Also the perpetuation of the idea that you are not being empathetic to people with mental or behavioral health challenges unless you let them avoid all “triggers” or things that upset them.

4) many kids do feel increasing less equipped for dealing with in person interactions with others because they are so used to interacting through screens. Undoubtedly, they feel less confident or feel less skilled at interacting in person. Many prefer to avoid what may then feel like an overwhelming social component to school.

5) celebrity role models who remove themselves from work/life to get treatment and fancy residential treatment centers- strengthening the misconception that one must be removed from life stressors in order to heal or make progress

6) an industry of on-line or “independent study” schools have sprung up to cater to the above phenomenon and provide what seems like a viable solution to parents tired of fighting with their kids about school attendance.

The decades of research in exposure, context-dependent learning and anxiety would indicate that allowing them to remove themselves from school would most likely lead to saddling them with a long-term struggle with anxiety/anxiety disorders and be the opposite of what will help them treat an anxiety disorder or develop effective coping.

End rant :dead:

I love and agree with every aspect of this post - the one point I question is whether there is data for point 1. I definitely feel that the dynamic outlined is a problematic and common one in my patients, but is it the case that more adolescents think this way than in the past?
 
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I love and agree with every aspect of this post - the one point I question is whether there is data for point 1. I definitely feel that the dynamic outlined is a problematic and common one in my patients, but is it the case that more adolescents think this way than in the past?

I haven't seen data to suggest this is so, more of a common generational refrain. For examples of this, see the critiques of Twenge's dubious methodology in a similar area.
 
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4) many kids do feel increasing less equipped for dealing with in person interactions with others because they are so used to interacting through screens. Undoubtedly, they feel less confident or feel less skilled at interacting in person. Many prefer to avoid what may then feel like an overwhelming social component to school.

I feel like this is such an important point and one which parents don't seem to have any comprehension of. We have pretty clear data which correlates increased screen time to higher levels of mood dysregulation, yet parents seem to be perfectly content with plopping their kids in front of a screen to make parenting easier. I personally hate the massive surge in use of tech in our daily lives and try and disconnect when I can, but with the current generation growing up where constantly being in front of a screen is the norm I feel like this is an uphill battle which we are destined to lose.

Amazing post about the cure, one of my highlights from training was denying a mother my authorization for home school for a COMPLETELY asymptomatic child, she even admitted that it was easier FOR HER to have him stay at home, hah!

And this highlights what I've found to be another huge problem. I feel like the current generation of parents are "lazy" when it comes to parenting. Purely observational, but a lot of parents today seem to be far more intent on further their own lives and goals and truly focused parenting is becoming less of the top priority. So parents look for short-cuts to try and cram everything their doing into their lives, which includes just bending to the child's will. Maybe I'm off here, but I feel like parents today seem to be much more about letting their children have free will and raise themselves with minimal authoritarianism implemented (and parents will attack teachers/coaches/whoever else who tries to actually hold their children accountable).

Repeat exposure to the thing you want to avoid can in fact cause trauma rather than resilience. I think it's very situation specific.

Fair point, however you can't develop a resilience to something if you're never exposed to it. I completely agree it's situation specific, and it may not have been appropriate for your situation. However, encouraging individuals who have unilateral anxiety or depression to decrease socialization will typically be more harmful than helpful other than extreme cases (in which they should likely seek inpatient or intensive treatment anyway and then re-enter social situations). Sure, there are situations where I think the home school/online options are viable, but I personally think these are the vast minority of cases and our society has shifted too far to accommodating the individual as opposed to helping them develop healthy habits.
 
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Totally fair point. It’s really my conjecture based on anectodatally seeing shifts in the language used by adolescent clients, language used by teachers and administrators in IEP meetings, changes in messaging in mental health awareness initiatives and resources on campus. I also should have been clearer that this is likely a transactional process between teens, parents, culture and not necessarily driven by the teens inherently.

I’ve also only noticed these shifts relatively recently, so I imagine that if it exists as a real attitude shift, it may take some time to show up in the data. Also possible that this attitude is growing in a small subset of adolescents but not in teens on the whole. Possibly an interesting research question for a future grad student to explore.
 
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That's not true .

That's not a very nuanced position.

If you take a person's predetermined sensitivities and apply a situation of varying severity, the outcome is going to be variable, no matter how much exposure.

The US military prepares people to be water-boarded, and yet it remains an effective technique for torture that people cannot be inured toward.

Exposure to abuse, neglect, noxious stimuli, etc., are not known for producing healthy, hardy humans. Developmentally, the opposite is true: The more an infant internalizes a sense of safety given to it by those outside of it, the more safe it finds the world. A child isolated from human contact does not become an Ubermensch but rather a feral child who has severe difficulty with basic activities of living and interaction.

If you are saying that avoidance can worsen eventual outcomes, I would agree. It could be worse or more jolting in a specific instance without frequent exposure. This is why some philosophers like the Stoics believe you should frequently meditate on your death, the death of your children, your house burning down, etc. (Whether that works is debatable.) But just because frequent exposure minimizes a worsening does not mean that each exposure will be better or that the overall effect of repeated exposures is healthful or leads to a good life. If every instance of an exposure is painful, if it never improves, it is irrational to continue it. If there is improvement either with or without therapeutic tools, that's great and avoidance should be avoided to maintain those positive gains. It's not inevitable, though. We don't generally send people with PTSD back into a war zone because we think their reaction to seeing a person dying a brutal death in front of them will improve a second time around. And yet some in the same scenario can cope and continue.
 
That's not a very nuanced position.

If you take a person's predetermined sensitivities and apply a situation of varying severity, the outcome is going to be variable, no matter how much exposure.

The US military prepares people to be water-boarded, and yet it remains an effective technique for torture that people cannot be inured toward.

Exposure to abuse, neglect, noxious stimuli, etc., are not known for producing healthy, hardy humans. Developmentally, the opposite is true: The more an infant internalizes a sense of safety given to it by those outside of it, the more safe it finds the world. A child isolated from human contact does not become an Ubermensch but rather a feral child who has severe difficulty with basic activities of living and interaction.

If you are saying that avoidance can worsen eventual outcomes, I would agree. It could be worse or more jolting in a specific instance without frequent exposure. This is why some philosophers like the Stoics believe you should frequently meditate on your death, the death of your children, your house burning down, etc. (Whether that works is debatable.) But just because frequent exposure minimizes a worsening does not mean that each exposure will be better or that the overall effect of repeated exposures is healthful or leads to a good life. If every instance of an exposure is painful, if it never improves, it is irrational to continue it. If there is improvement either with or without therapeutic tools, that's great and avoidance should be avoided to maintain those positive gains. It's not inevitable, though. We don't generally send people with PTSD back into a war zone because we think their reaction to seeing a person dying a brutal death in front of them will improve a second time around. And yet some in the same scenario can cope and continue.

1) Your use of personal information makes it difficult to debate you without providing opinions, which would violate TOS.

2) You clearly do not understand what the term "trauma" means, as there are technical meanings associated with that term.

3) Exposure therapy is highly successful.

4) You are conflating many many many things. You went from "things you want to avoid" to extreme child neglect. Again, this is so disorganized it is impossible to debate you.
 
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1) Your use of personal information makes it difficult to debate you without providing opinions, which would violate TOS.

2) You clearly do not understand what the term "trauma" means, as there are technical meanings associated with that term.

3) Exposure therapy is highly successful.

4) You are conflating many many many things. You went from "things you want to avoid" to extreme child neglect. Again, this is so disorganized it is impossible to debate you.

You can’t just say he’s wrong and doesn’t know what things mean, you need to explain where he’s wrong, what he’s conflating, what he doesn’t understand and other misconceptions he may have...
 
1) Your use of personal information makes it difficult to debate you without providing opinions, which would violate TOS.

2) You clearly do not understand what the term "trauma" means, as there are technical meanings associated with that term.

3) Exposure therapy is highly successful.

4) You are conflating many many many things. You went from "things you want to avoid" to extreme child neglect. Again, this is so disorganized it is impossible to debate you.
I apologize for number 1. I see the quandary there. I guess I was giving an example of how I thought there was an exception to the rule, but then the example opens itself to examination. And in this case you're right that it can't be for ethical reasons. If it helps at all, it's possible I've assumed you think about what I wrote what you actually think about what I wrote. And therein lies the possibility of some intersubjectivity.

From my understanding, trauma as it relates to a stress disorder has a high bar such as seeing someone killed in a brutal way or experiencing sexual assault. But all of the terms used in psychiatry, whether it's anxiety, depression, trauma, predate psychiatry. I think using a lower bar of the word trauma, it's possible to describe someone as having a bad life due to repeated traumatic experiences. You could reword that and say it's possible to have a bad life due to repeated highly unpleasant experiences. I saw a lawyer once who said (maybe it's a common expression), every egg cracks differently. He meant that the liability of one party in a court of law is not dependent on a universal level of harm but on the actual harm experienced, and that like eggs, humans crack differently. I think the nervous system is fascinating and I believe we are learning more all the time about how impacted we are by events we used to not consider significant. For example, we've known for a while about the effect of adverse childhood effects (the big offenders) on the nervous system. But newer research has shown that routine infant procedures in a medical setting also affect the subsequent perception of pain.

I think this is confusing because the original post was not about a clear reason for avoidance (not clear in that the stated diagnosis, to a hunch of bullying, to a hunch of video game seeking). I gave my example and said why I didn't think repeat exposure to a non-improving situation is always ideal. I didn't give a diagnosis.

But if we are clear in talking about anxiety disorders, I agree with you regarding what I have read regarding exposure generally.

But I had not indicated I was talking about anxiety disorders, and when you said that exposure therapy is effective you didn't indicate that either. And so that's why I spoke more generally about areas where repeat exposure is not necessarily helpful, why the military doesn't waterboard its combat troops daily for example.

I think there are limits to the human body, and they vary. But there are certainly hard limits even to those most devoted to attaining tranquility through various eastern dissociative techniques (I mention these in particular due to claims of the possibility to never suffer regardless of circumstance).

And I think there are times when it makes sense to change the world around you rather than changing yourself. I believe that people should share their experiences, the ones that are the most shameful or idiosyncratic, in order to advance the cause of social evolution. We have places in the world where there are no people with intellectual disabilities (I still can't believe I can't say the actual word because of the filter) because they are all aborted: Iceland. We've had times in history when all people with that disorder were euthanized: 1930s Germany.

Personally I think we lose out when we don't have the benefit of everyone having a place in society. We don't have to medicalize them away.

Some of the very techniques Albert Ellis promoted in the earliest incarnations of CBT (then RET) were used by him to change people from homosexual to heterosexual. He wrote an entire book on this in fairly recent history, relatively speaking (relative to Freud at least who at least when it came to homosexuality was a bit more up to speed). These techniques now look silly (hopefully), and instead people have changed the world such that those who are gay can simply exist rather than using RET (or other techniques) to try to adapt to a system not designed for them.

Changing the world around you has led to some fair criticisms of people who police speech to create safe zones. But more generally I think that if there are instances where a person cannot find a way through that they should speak that truth and find a way for the world to adapt.


I think similarly there are certain types of people who will be refractive to exposing themselves to certain situations, and perhaps we don't have a medical explanation as to why that is. But even in the case of anxiety, which itself can't be explained but at least described, not everyone will fall under the bell curve of normal response to treatment, to which I agree exposure therapy is very useful in the vast majority of cases.

I was personally interested in the case in this thread regarding someone with anxiety refractory to even high use of benzodiazepines:

What Defines "Hopeless" Cases?
 
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I apologize for number 1. I see the quandary there. I guess I was giving an example of how I thought there was an exception to the rule, but then the example opens itself to examination. And in this case you're right that it can't be for ethical reasons. If it helps at all, it's possible I've assumed you think about what I wrote what you actually think about what I wrote. And therein lies the possibility of some intersubjectivity.

From my understanding, trauma as it relates to a stress disorder has a high bar such as seeing someone killed in a brutal way or experiencing sexual assault. But all of the terms used in psychiatry, whether it's anxiety, depression, trauma, predate psychiatry. I think using a lower bar of the word trauma, it's possible to describe someone as having a bad life due to repeated traumatic experiences. You could reword that and say it's possible to have a bad life due to repeated highly unpleasant experiences. I saw a lawyer once who said (maybe it's a common expression), every egg cracks differently. He meant that the liability of one party in a court of law is not dependent on a universal level of harm but on the actual harm experienced, and that like eggs, humans crack differently. I think the nervous system is fascinating and I believe we are learning more all the time about how impacted we are by events we used to not consider significant. For example, we've known for a while about the effect of adverse childhood effects (the big offenders) on the nervous system. But newer research has shown that routine infant procedures in a medical setting also affect the subsequent perception of pain.

I think this is confusing because the original post was not about a clear reason for avoidance. I gave my example and said why I didn't think repeat exposure to a non-improving situation is always ideal. I didn't give a diagnosis.

But if we are clear in talking about anxiety disorders, I agree with you regarding what I have read regarding exposure generally.

But I had not indicated I was talking about anxiety disorders, and when you said that exposure therapy is effective you didn't indicate that either. And so that's why I spoke more generally about areas where repeat exposure is not necessarily helpful, why the military doesn't waterboard its combat troops daily for example.

I think there are limits to the human body, and they vary. But there are certainly hard limits even to those most devoted to attaining tranquility through various eastern dissociative techniques.

And I think there are times when it makes sense to change the world around you rather than changing yourself. I believe that people should share their experiences, the ones that are the most shameful or idiosyncratic, in order to advance the cause of social evolution. We have places in the world where there are no people with intellectual disabilities (I still can't believe I can't say the actual word because of the filter) because they are all aborted: Iceland. We've had times in history when all people with that disorder were euthanized: 1930s Germany.

Personally I think we lose out when we don't have the benefit of everyone having a place in society. We don't have to medicalize them away.

Some of the very techniques Albert Ellis promoted in the earliest incarnations of CBT (then RET) were used by him to change people from homosexual to heterosexual. He wrote an entire book on this in fairly recent history, relatively speaking (relative to Freud at least). These techniques now look silly (hopefully), and instead people have changed the world such that those who are gay can simply exist rather than using RET (or other techniques) to try to adapt to a system not designed for them.

Changing the world around you has led to some fair criticisms of people who police speech to create safe zones. But more generally I think that if there are instances where a person cannot find a way through that they should speak that truth and find a way for the world to adapt.


I think similarly there are certain types of people who will be refractive to exposing themselves to certain situations, and perhaps we don't have a medical explanation as to why that is. But even in the case of anxiety, which itself can't be explained but at least described, not everyone will fall under the bell curve of normal response to treatment, to which I agree exposure therapy is very useful in the vast majority of cases.

I was personally interested in the case in this thread regarding someone with anxiety refractory to even high use of benzodiazepines:

What Defines "Hopeless" Cases?

1) You are creating a new and idiosyncratic definition to the term "trauma". Then you use this idiosyncratic definition to compare the literature about which does not use your definition. This is a formal error of logic.

2) You are using argument from hearsay. My imaginary friend told me your lawyer friend was wrong. See how that works?

3) Legal findings are not the same as scientific findings. This is a false equivalence.

4) Then you are just positing your beliefs with zero justification or support.

5) Then you deflect into new subject matter.

6) consistent benozdiazepine use causes anxiety. See Cohen, 1995.
 
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Well, I was put on benzodiazepines indefinitely in 1998 (and then a second one added in 2001 at college), a bit after Cohen. I don't need 6) explained to me. I've explained 6) to psychiatrists who told me I was wrong about 6). I was pointing to another psychiatrist in this forum who was describing an inpatient with refractory anxiety, in which the point was they had thrown everything and the kitchen sink at the patient including therapy. I was explaining that zebras exist.

But more generally I feel like I'm painting a picture and you're seeing a lot of individual pixels.

Edit: *I was going to say unicorns but they don't actually exist. And then zebras, but I know zebras connotes a different diagnosis altogether. My point was that there are outliers within a diagnosis.

So you address none of my points and return to your own experience trumping data...
 
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So you address none of my points and return to your own experience trumping data...
My experience validates the data that you say you have regarding benzodiazepine use. I'm not sure how you came away with me trumping it?

I picked that one point.

As for 1) You told me I obviously didn't know what trauma meant. You didn't tell me what it meant. I expanded on my thoughts on what you probably thought it meant and how I can see trauma as a spectrum and a word that can be used in many ways (after all some psychoanalysts call birth the first trauma). Your view of language and view in general are somewhat concrete.

As for 2) You said I am using hearsay because I used a folksy saying from a lawyer to explain a pithy idea that people react differently to the same level of injury? Would you not say that is true of your patients?

As for 3) Again this was an example to explain how people responding differently to the same stimulus. You're taking a very concrete view of my way of expressing that.

4) Which views am I positing without support? I suppose the majority of them. But I am exploring ideas. I didn't claim to be making a scientific report, which brings up the point that we are not even talking about a specific diagnosis or treatment modality: My original post that you responded to simply said (paraphrasing): Some situations for some people are bad and should be avoided because no good comes of trying and failing over and over.

5) By "deflecting" into new subject matter, I suppose you are referring to my discussion of changing your world in lieu of repeat exposure? This is not a new subject, but rather a continuation of the discussion. I am writing about how I think there are times a situation is bad and there aren't good solutions and that a situation should be changed rather than the person.

And as I said, I already responded to 6) . . . again not sure where you got that I was trying to trump you. I agreed with you on 6).
 
This forum wasn't built to debate evidence vs charged personal experience. Good on you for sharing your experience, but looking at your post history reveals your knack for starting threads peripherally related to things that have happened to you as part of your care (edit: and lots and lots of things directly related to personal experiences). You've been a member here since 2011 and your tag says that you are a 'Patient/Interested in Psychiatry'. I have no idea what your qualifications are and I can definitely see why people are incredibly uncomfortable engaging in a dialogue with you when are posting incredibly charged personal experiences. There is space for disagreement in these forums, but there is so much transference in what you're posting that it's really hard to see past that and address anything. When providers post on here, the cases are filtered and stripped of so much of the charged nature of things.

Look, it looks like you had some really ****ty experiences growing up and they've clearly affected you. Maybe I'm really wrong or speaking totally out of turn, but I don't think that going through this process that you're going through here is going to give you the closure that you're seemingly looking for and I hope that you do find it somewhere. It's hard to challenge personal experience with reason and evidence and hard to follow your philosophical musings and see how they relate to this discussion at hand.

Your entire personal anecdote could have been summed up in this sentence of yours:
I think there are times a situation is bad and there aren't good solutions and that a situation should be changed rather than the person.
Maybe that would have led to a fruitful discussion.

Again, maybe I'm speaking totally out of turn (wouldn't be the first time), but this is almost cringe worthy. In your posts you constantly describe yourself as a patient and using these deeply personal experiences as an almost strawman for discussion just makes me really really uncomfortable. If nothing else, it has certainly derailed this thread which is unfortunate because I'm interested in child psych and was hoping to learn more about this and I'm sure others were as well.

I really do wish you the best.
 
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If nothing else, it has certainly derailed this thread which is unfortunate because I'm interested in child psych and was hoping to learn more about this and I'm sure others were as well.

Nothing ground-breaking or evidence-based, but my mentor's (excellent CAP doc) favorite pearl was that if you wanted to understand the pathology of the child you're treating you should look at the parents. The parent's pathology will often give you invaluable information into what is going on with the kids, both socially and biologically. This is assuming you can actually have a decent conversation with the parents of course, but if you can then the insight is invaluable.
 
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Nothing ground-breaking or evidence-based, but my mentor's (excellent CAP doc) favorite pearl was that if you wanted to understand the pathology of the child you're treating you should look at the parents. The parent's pathology will often give you invaluable information into what is going on with the kids, both socially and biologically. This is assuming you can actually have a decent conversation with the parents of course, but if you can then the insight is invaluable.

That's something I've definitely talked about at interviews as well. It's not that I prefer child psych to adult psych, it's that I like both. You can't get away from adult psych if you work with kids... atleast not if you want to meaningful treatment. Need buy in from the parents and that's not going to happen if you don't understand them and their motivations somewhat.
 
(Not a professional)

Depending on where you are, if the teenager can wait till he's 16 years old and register to an highschool for adult, it might be an option to explore.If he's a good student, he can easily do the usual 5 years curriculum in 2-3 years there, so he won't lose much time.

Usually those schools are much more laid back and enjoyable (due to the presence of so many adult students).I doubt there's much bullying going on there, and students can work at their own pace.Usually the school also provide some sort of "family-like support", since they have a social reinsertion mission on top of the curriculum.
 
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4) Which views am I positing without support? I suppose the majority of them. .


Part of participating in a professional discourse is the expectation that all will discuss matters using professional standards. This includes understanding the relevant terms. And the relevant evidence. And the relevant logical fallacies. And the relevant literature. And agreeing to stay on one subject. Etc.
 
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Part of participating in a professional discourse is the expectation that all will discuss matters using professional standards. This includes understanding the relevant terms. And the relevant evidence. And the relevant logical fallacies. And the relevant literature. And agreeing to stay on one subject. Etc.
I have now received your course syllabus.

In every thread you throw the phrase "logical fallacies" out like it's a weapon. It's like a parody, except I'm not quite sure of what. If you're workshopping a character, I'd say you've got something. This was particularly entertaining:

Undergrad Psych Discussion

"
NOW i am bowing out. this decision is no indication of losing the argument.
"
You seem to find a lot of people guilty of a laundry list of logistical fallacies, except you never quite make the attachment between the spurious statement and the specific fallacy. The charges just come rolling out, apropos of a mental connection you have made you seem to think others are aware of through telekinesis.

It's like the equivalent of one of those TV sitcom characters who has no understanding of court throwing out legal jargon in defense of themselves. Objection! Hearsay! Overruled!

I'm guessing maybe you don't interact this way in daily life, and this is a place to try something on or vent? If this is how you talk to people in earnest, I really don't know how to relate to you and maybe that's a way you want people to feel. Or you might just be a concrete thinker with very particular perseverations.
 
This forum wasn't built to debate evidence vs charged personal experience. Good on you for sharing your experience, but looking at your post history reveals your knack for starting threads peripherally related to things that have happened to you as part of your care (edit: and lots and lots of things directly related to personal experiences). You've been a member here since 2011 and your tag says that you are a 'Patient/Interested in Psychiatry'. I have no idea what your qualifications are and I can definitely see why people are incredibly uncomfortable engaging in a dialogue with you when are posting incredibly charged personal experiences. There is space for disagreement in these forums, but there is so much transference in what you're posting that it's really hard to see past that and address anything. When providers post on here, the cases are filtered and stripped of so much of the charged nature of things.

Look, it looks like you had some really ****ty experiences growing up and they've clearly affected you. Maybe I'm really wrong or speaking totally out of turn, but I don't think that going through this process that you're going through here is going to give you the closure that you're seemingly looking for and I hope that you do find it somewhere. It's hard to challenge personal experience with reason and evidence and hard to follow your philosophical musings and see how they relate to this discussion at hand.

Your entire personal anecdote could have been summed up in this sentence of yours:
Maybe that would have led to a fruitful discussion.

Again, maybe I'm speaking totally out of turn (wouldn't be the first time), but this is almost cringe worthy. In your posts you constantly describe yourself as a patient and using these deeply personal experiences as an almost strawman for discussion just makes me really really uncomfortable. If nothing else, it has certainly derailed this thread which is unfortunate because I'm interested in child psych and was hoping to learn more about this and I'm sure others were as well.

I really do wish you the best.

It's extremely difficult to play hindsight 20/20 with experiences in the high school age. People look back on some stuff saying there was no good to any of x,y,z, that all the suffering was pointless, etc etc, but it's completely impossible to know imho.

Who knows, maybe "fruitlessly" suffering/being exposed to something traumatic over and over and getting worse and worse in some way..... wasn't as fruitless or as avoidable as you think it was. For some reason some things we look back and romanticise how it could have been different, and frankly I don't find compelling arguments in any of it. I guess I just think everything makes you who you are today, and it's hard to even quantify if who you are now is even good or bad, or what has taken you to that point. Call it the zen of nothing is good or bad... OK, not to an extreme but maybe yall follow.

Going to school or some equivalent is quite literally the norm of our species' growth and development. At some point you have to leave home and interact in situations that are NOT entirely of your own making. And there will be SOOOOOOOOOOOOOO many elements of that, that is "traumatic" "seemingly avoidable" YET ARE NOT AVOIDABLE. If it was, you'd be avoiding it. It's only avoidable theoretically or in some imaginary world. It's attachment to potential, not accepting and facing what is.

If high school feels the most like any Roman Gladiatorial era media you've ever watched, compared to any other situation you've lived in your life, maybe it's good to be reminded that is basically what it is - an exposure to a more base side of human nature, one that we all need to not only grow out of that behaviour, but to learn to deal with it. Humans are insanely lucky these days, in this society, that this microcosm of humanity tends to represent the worst of what we go through socially for most people (until you start medical training....). People can be nasty, sadistic, mob mentality, might makes right, cult of beauty and youth, money, power, glamour, and yeah, you gotta learn to deal with it. It's not just nurture, it's nature. Just be glad there's no actual lions to feed you to, or you best believe it would happen in the school-aged crowd.

Seriously, school is where we learn to be empathetic and to spot and avoid sociopaths/psychopaths/total dickheads, and other basic life social skills. That sounds easy to do by watching tv or reading online, but it actually takes interacting with one's own peer group early on.

Peer pressure, self esteem, setting boundaries, dealing with bullying, embarrassment, all of it.

I was miserable in school, and I don't think avoidance would have ultimately served me. Same for a lot of "traumatic" experiences I've had, including the truly traumatic ones.
 
The phenomenon of school where you have a lot of people of the exact same age together is a relatively recent experiment. I'm not sure it's of the natural order of things.

People in the past would have learned as apprentices and journeymen, learning from those older than them. There would have been more heterogeneity. Going back further, hunter-gatherers would not have stratified by age so distinctly.

School now is also rather unique in how it is so long of duration, both of the day and the years. There are a lot of groundhog years between kindergarten and 12th grade where you're treading over similar material and the medium of school itself becomes fodder for an entire industry of teen movies and television shows based on school culture (90210 etc) rather than a practical tool to a particular end. Look at that 13 Reasons Why discussion where we discussed that. Look at the Kavanaugh hearings. Regardless of anything else, it was clear those kids spent their years in high school like some high-brow version of the Jersey Shore. I think it's a rather inefficient use of time (as well as undergrad repeats so much of it for those who worked hard in high school). I think the inefficiency is baked into the point of the system in that our society has nowhere else to house children and no better ideas. But I don't think it is an ideal system. It seems to 1) lack a clear purpose for many people who enter into it (and virtually everyone enters it) and 2) not go about achieving results in any reasonable amount of time.
 
.

Going to school or some equivalent is quite literally the norm of our species' growth and development. At some point you have to leave home and interact in situations that are NOT entirely of your own making. And there will be SOOOOOOOOOOOOOO many elements of that, that is "traumatic" "seemingly avoidable" YET ARE NOT AVOIDABLE. If it was, you'd be avoiding it. It's only avoidable theoretically or in some imaginary world. It's attachment to potential, not accepting and facing what is.
.


Relevant to the idea of the ever-expanding universe of experiences deemed traumatic: https://www.tandfonline.com/doi/abs/10.1080/1047840X.2016.1082418
 
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I'm seeing an increasing number of teenagers avoiding school due to persistent anxiety and panic attacks. More importantly, I'm seeing them refuse school and resort to independent studying programs. I feel like this is just a temporary fix and I'm advocating for them to go to school, but then I get a lot of pushback from the parents, who want me to sign forms authorizing them to miss school. I was hoping that there is some literature or good articles I can refer to help with this or to educate the parents.

I initially thought it had to do with bullying but a part of me thinks that these kids just want to stay at home and play videogames and sit on social media all day.

As others have said, I would explain to them the cycle of avoidance and how it is effective short term but ineffective long term. Not only is this reinforcing their anxiety, it is giving them the message that their anxiety cannot and should not be tolerated. If they are given this message about high school, I don't know why they wouldn't apply it to other things that would ultimately impede their ability to be functional adults (like college, work, etc). The more you avoid, the more you get into the habit of avoidance and the harder it gets to break it.

Also, birchswing, you wouldn't send a veteran back into a combat zone. But you would have them confront things that remind them of a combat zone but aren't dangerous (like fireworks, smell of barbecue or diesel fuel, etc). The ultimate goal of trauma therapy is to learn that things you associate with the trauma, including the memory of it, are not in themselves traumatic.
 
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Also, birchswing, you wouldn't send a veteran back into a combat zone. But you would have them confront things that remind them of a combat zone but aren't dangerous (like fireworks, smell of barbecue or diesel fuel, etc). The ultimate goal of trauma therapy is to learn that things you associate with the trauma, including the memory of it, are not in themselves traumatic.
Yes, that makes sense.

But to understand the long crooked path that led to me making that comparison, one has to remember I was being told very generally "That's not true" in response to me saying "repeat exposure to the thing you want to avoid can in fact cause trauma rather than resilience. I think it's very situation specific."

The original post did not specify anxiety disorders (panic disorder was a guess among others). And in my example, I never stated that my issue in high school was an anxiety disorder. I went out of my way to not give my own or anyone else's diagnosis. In hindsight I wish I hadn't brought it up because it was unnecessarily detailed and people read something into it, whereas I meant for it to stand in as a general example that there can be situations that should be avoided—where it is rational to do so. It was a bad example because 1) others can't comment on what they think I overlooked or didn't have insight into and 2) there was therefore not common agreement that it was an example of a situation that should be avoided.

In my example of war, I was trying to point out the over-reaching nature of saying "that's not true" to saying repeat exposure to something you want to avoid can increase trauma rather than resilience. If we had been having a narrow discussion about anxiety disorders in every day, fairly healthy situations, I would not have responded that way. But per the original post, there was no known etymology. There are areas of the world and times in history where environments are not terribly healthy.

What if there were a hypothetical school where sexual assault is tolerated? It would be rational to avoid that. There have been instances of church-run boarding schools in particular where the most rational thing to do would be to run away, or certain for-profit boot camps for troubled youth that are abusive. If I were a child at the Judge Rotenberg Center with an electrode shock battery backpack attached to me, I'd think I was pretty rational for wanting to leave. If you can stomach it, there's a video online of a student tied down and electrically shocked over thirty times for several hours (I am not talking about ECT--this is purposefully extremely painful shocks delivered to the skin).

So I will still contend "repeat exposure to the thing you want to avoid can in fact cause trauma rather than resilience. I think it's very situation specific" is in fact a true statement, which I was challenged on. And that was the core of the debate, and it did not start involving avoidance to every day activities with regard to anxiety disorders. My personal story muddied the waters on that count.
 
Edit:
No use wasting any more time. The ignore function apparently works and works well. Problem solved!
 
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You would have done well to heed your own advice earlier, yet it seems that you can't help but keep dig...dig...digging... Thread is about school avoidance, likely for public school, yet you're bringing up a theoretical school where sexual assault was tolerated. What are you talking about?

There is no core of the debate. There are just these myriad revisionist whimsical philosophical rants you keep going on. This is legit your entire posting history. JFC...

This is maddening.

Oh wait. We can block users right?

Edit: Omg it worked. This thread and forum are so much better all of a sudden!
That isn't what I wrote. I was quoting PSYDR.
 
As someone who has had this person on ignore for at least a year, I literally can't remember what that person's username is.

It also made this thread initially very confusing.

To be totally honest... I'm not sure why they even still have an account on this forum. Their post history is... troubling to say the least. And that's the last of that.
 
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To be totally honest... I'm not sure why they even still have an account on this forum. Their post history is... troubling to say the least. And that's the last of that.
I've thought on this.

Lately I think SDN has been too liberal with the banhammer in trying to create... whatever it is that they're trying to create.

In any case, is it appropriate for the psychiatry subforum to have a resident "psych patient/person interested in psychiatry"? Like, do we want this forum only limited to psychiatrists, or to also include students interested in pursuing psychiatry, psychologists, patients, family members of professionals/patients, etc? And of course, anyone can choose to ignore any such individual.

Beyond the question of legal liability where it regards medical advice (and yeah, that is a line providers and patients alike on here have to tread for safety and SDN's ability to function), in that I'm saying, yes, that's a no-no, but I will say that I actually appreciate where SDN might be conservative in banning people who are mostly just disruptive by offering their own opinion, especially where that opinion in controversial or may represent a minority opinion.

I don't want to... be insulting to say that, it may help those who are interested in pursuing psychiatry, to see the opinions of those on the other side of the fence... that is to say, "laypeople" or people who... may represent a certain population that is frequently encountered in psych.

It's a bit frustrating at times, because specialty subforums offer professionals a chance to sort of decompress with like minds, away from some of the very frustrations that can be encountered on the job. And it can mess up the flow.

TLDR
What would a psych forum be if there weren't any popcorn? :corny: or nuts? Not to be metaphorical....:whistle:
Besides, aren't we all a little crazy?
 
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I will also point out the irony of discussing ignoring a user in a psych thread about avoidance as a potentially troublesome coping mechanism, especially as it derails said thread :laugh:
 
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I'll be honest. The unctuous "I wish you the best" and conspicuously virtuous attempts at understanding from a PGY1 annoyed me more (though not much) than the quick flip to formal and similarly unnecessary pronouncements of ignoring me and the glee of doing so. The latter made more bald my perception at the insincerity of the former.

Not looking for pity or analysis.

I'm somewhat mindful of maintaining a dispassionate nature in what I post in not appealing to anybody's favor as I think it would dilute the value of what I have to say. If it's helpful, it's helpful. If it's not, it's not. I can stand the heat. The authenticity is unchanging (except for that character I had . . . that was fun). I admired futuredo in posting what for her were her realities in the face of pressure to try to change what was true for her in order to better assimilate. That's a tricky wicket.
 
I have zero issues with diverging opinions. It's one of the things that makes medicine fun.
But when someone with a dubious background has been posting for years about things that pretty much border on asking for medical advice by inserting their own personal experience into every discussion and dragging it to a conversation about that, I think it crosses a line. My issue wasn't with the fact that they may not be a medical professional, instead it's with the content of their posts. Look back at their post history. This doesn't seem to be a one off thing.

I think this forum is better for having psychologists, psych RN's/NP's, and social workers. Students are already here (hello!) and all the interview related threads are on this sub forum even though we're not doctors yet. I don't think I'm trying to be exclusionary in the way you portray it. I've actually never felt this way about anyone on this site before. I do think that certain ground rules should apply to try to foster some sort of worthwhile discourse.

I will also point out the irony of discussing ignoring a user in a psych thread about avoidance as a potentially troublesome coping mechanism, especially as it derails said thread :laugh:

Hey now! That poster said it was a good idea so I figured I'd indulge them!

And back to your regularly scheduled programming!
 
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The phenomenon of school where you have a lot of people of the exact same age together is a relatively recent experiment. I'm not sure it's of the natural order of things.

People in the past would have learned as apprentices and journeymen, learning from those older than them. There would have been more heterogeneity. Going back further, hunter-gatherers would not have stratified by age so distinctly.

School now is also rather unique in how it is so long of duration, both of the day and the years. There are a lot of groundhog years between kindergarten and 12th grade where you're treading over similar material and the medium of school itself becomes fodder for an entire industry of teen movies and television shows based on school culture (90210 etc) rather than a practical tool to a particular end. Look at that 13 Reasons Why discussion where we discussed that. Look at the Kavanaugh hearings. Regardless of anything else, it was clear those kids spent their years in high school like some high-brow version of the Jersey Shore. I think it's a rather inefficient use of time (as well as undergrad repeats so much of it for those who worked hard in high school). I think the inefficiency is baked into the point of the system in that our society has nowhere else to house children and no better ideas. But I don't think it is an ideal system. It seems to 1) lack a clear purpose for many people who enter into it (and virtually everyone enters it) and 2) not go about achieving results in any reasonable amount of time.
Eh, I don't disagree with all of this, but as I said, some version of throwing kids together for quite some time and them just having to deal with each other, actually does happen in most cultures, and has essentially been the rule ever since societies have grown beyond the band stage of development and further into tribes or chiefdoms, and beyond. So I don't claim that it's been a big factor in our actual evolution as a species on a genetic level, most of our time as a species being spent in small hunter-gatherer bands, I will say that it absolutely has been a feature of our societies as they have grown beyond that point, and particularly with the advent of agriculture.

It absolutely is noted in most cultures that children do indeed choose to stratify themselves based on both gender and age - it does not appear to be purely a cultural construct or something that is imposed upon them by adults. Indeed, it would appear where this does not happen that it is more owing to constraints in the way that people in a culture have adapted to specific demands of the environment (such as the Inuit, or other cultures that must operate in very small family bands where there may not be a large group of similarly aged young peer groups)

OK, so I will take this back to say that there are not biological determinants in the observation of how members of our species aggregate by age.

Indeed, where this is most seen is in the development of male "gangs," which you observe even in lions and chimpanzees, and very much in humans as well. Given the combative nature of such groups, and the believed adaptive value of male aggression, these groups not only form but form amongst equals in physical development, ie often similarly aged peer groups.

The emergence of young "male gangs" in some species does actually appear to be part of the natural order of things, and it makes perfect sense.

Young women are also often grouped according to physical development, and indeed, menarche and where women are in their reproductive life cycle is often marks one's membership into different groups stratified if not by age, then by reproductive status, which tends to be a function of age. Young girls are also similarly grouped together, and rituals related to "coming of age" are common, and not only mark a particular day or events, but one's transition between groups.

Such groupings of males, females, and by species' development in the life history, is seen in many, many species, and in birds and primates, two species that for various reasons are relevant to studies on the life history of humans.

While it is true that our society is noted by an extreme stratification amongst members by age compared to other cultures, in that you are correct there is more mixing in other societies, even in your example where you have younger members mentored by older members, this also frequently happens in groups, ie a group of younger members together. The examples you describe occur more frequently in groups with a lower population density, such as the Inuit described above. A perfect example is in medieval Western Europe where you had the classic journeyman/apprentice structure, however this also gave way in the post Black Plague population decimation, as the population density rebounded and there was an emergence of the classic guild structure for education, which was also stratified by age. Also the ancient Greeks had an older mentor/protege dynamic. However, in the history of both regions you also see the emergence of "schools" and other groups stratified by age.

No, my friend, I am sorry, but you are wrong, it is the most common cultural observation for members of a society to quite early on be sent from the basic family group structure (away from home, essentially) to interact outside the home, in groups that are typically stratified by age, ie within one's own peer group. This has in fact been the norm ever since a given group has been large enough to have a peer group to speak of.

You could argue this wasn't a factor in our evolution and has been just a modern adaptation, but I think that ignores observations that are cross cultural, appear to happen without adult input, and also if you look at evolutionary psychology, and the parallels with animal development group dynamics.

I am in no way arguing for any given type of age stratification structure and its adaptive or maladaptive utility, just that the existence of such, and in the form of "schools" or "gangs" and in adolescent groups, is fundamental to many species, ours included.
 
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I've been ignoring this person over the past year as well
 
I have been ignoring several members for years. It makes this forum a much more pleasant and educational experience.

One thing I have noticed is that for some ignored members I do not see their posts at all. For other ignored members I see that they have posted something but not the content of what they've posted and I see a prompt that allows me to see it if I want.
 
I have been ignoring several members for years. It makes this forum a much more pleasant and educational experience.

One thing I have noticed is that for some ignored members I do not see their posts at all. For other ignored members I see that they have posted something but not the content of what they've posted and I see a prompt that allows me to see it if I want.
My guess is that it gives you a chance to change your mind. I used to get those notices at first but now I don't see that notice. (I have no clue if this is true, I'd imagine a mod/admin might know the real answer.)
 
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Thanks guys, this was a good thread. I really want to be empathetic but at the same time I want to help my patient's so that they don't feel need a crutch for the rest of their lives. Anxiety is a normal human emotion.
 
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Thanks guys, this was a good thread. I really want to be empathetic but at the same time I want to help my patient's so that they don't feel need a crutch for the rest of their lives. Anxiety is a normal human emotion.

And that's the crux of it.

and also normal is aggregating in peer groups not of your own choosing

thank goodness we try to get kids doing this too early before they can choose not to, or maybe they never would!

oh wait.... unless they can convince their parents not to "force" them to deal.
 
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