北京兒童醫院是我國最早一批開設兒童心理門診的三甲醫院，去年6月，醫院從原來兒童心身醫學科的基礎上，單獨分出了一個“拒絕上學門診”。門診開設10個月，接診近一萬人次。心理方面的問題分抑鬱、焦慮、雙相情感障礙等，拒絕上學屬於什麼問題？為什麼這麼多孩子出現這種狀況，以至於一號難求？

開診10個月、接診近萬人次

"Refusal to go to school clinic" No. 1 is hard to find

On the first day after the Qingming holiday, the source of the one-week number that refused to go to school in the registration system of Beijing Children's Hospital was full. Li Ying is the person in charge of this clinic, and the first patient he sees today is 14-year-old Qianqian, who refused to go to school because she experienced school violence.

Unlike Qianqian, the reason why 16-year-old Jiajia refused to go to school started from the fact that she couldn't find a roll of scribbles. Jiajia and her mother both know that what caused her to not be able to go to school was definitely not the used up scribble tape, but the anxiety and confusion that had been accumulated in her heart for a long time. The huge academic pressure made Jiajia breathless, she didn't know how to tell, only the deep and shallow scars on her wrists knew that she couldn't bear it anymore.

At Beijing Children's Hospital, Li Ying treats teenagers who refuse to go to school for various reasons. Refusal to go to school is not a disease, and for children and adolescents, regardless of the type of psychological problem that causes impaired functioning, the direct manifestation of the behavior is likely to be the refusal to go to school.

北京兒童醫院拒絕上學門診副主任醫師 李瑛：初一群體和高三群體是比較常見的，然後是初三和高一群體，它是有這樣年齡的特點。有的孩子比如有焦慮、抑鬱是比較常見的，軀體化也是比較常見的，有的會共病強迫，不能說百分之百，但是如果這個孩子已經維持不住上學的時候，其實就提示他的問題到了至少中度以上的水準了。

Children who can't get into school

Can't get out of the anxious parent

Any psychological and emotional disorder in children and adolescents can lead to school refusal, and according to the relevant literature, about 30.0% of children and adolescents worldwide have school refusal and related problems. About 0% to 0% of children in the general outpatient clinics of pediatric psychosomatic medicine in China have the problem of refusing to go to school.

According to the doctor, four factors: biological, psychological, family, and social together cause the child's refusal to go to school. Parents who encounter this situation suddenly are often at a loss. In the outpatient clinic that refused to go to school, the reporter saw that many parents put down their work and asked for leave to come in order to take their children to see a doctor. During the consultation, parents' expectations for their children's future and anxiety about not being able to keep up with their peers became the first things to overcome in the treatment process, and Li Ying and other doctors had to help parents adjust their expectations back to a reasonable range.

Li Ying: Because parents are often unable to accept such problems when facing such problems, in fact, it is also a big trauma for the family, and the parents are at a loss at this time, and he doesn't know how to deal with this matter.

During the consultation, Li Ying found that some parents were often in a hurry when they came to ask for help, thinking that their children would be able to return to school after seeing the doctor, and some parents even violently forced their children to return to school, which would increase the pressure on their children and backfire.

Li Ying: In this process, parents often take some extreme methods in the early stage, such as dragging him to send him to school, or scolding or beating him, which has happened in outpatient clinics, and children will become worse under the parents' response. In fact, when children encounter this problem, they are also very confused, and the most important thing parents should do is to accept and face it first, and at the same time try to understand him from the child's point of view, so that he knows that his parents are with him.

During the consultation, Dr. Li Ying noticed that if the whole family focused on treating the child's refusal to go to school, the child's heart knot may become more and more difficult to untie. Therefore, she suggested that parents can choose to stop paying attention to and talking about whether their children go to school or not.

Li Ying: When you really accept your child, he will naturally move closer to you, because the link between mom and dad and child is actually always there. We still have to believe in children, their growth power is very strong, just help them sort it out, and then help them open the stuck points.

Forcing a return to school backfired

The focus is on stimulating children's inner motivation

家長克服焦慮，換位思考，百分之百地接納孩子之後，拒絕上學門診的治療就可以轉向孩子了，如何激發孩子內在動力成為治療的關鍵。

During the treatment, Li Ying will give parents two forms, namely the "Psychosomatic Therapy Family Plan" and the "Behavior Observation Record Form". The Planner is used to schedule your child's activities seven days a week. Parents can agree with their children to engage in non-academic learning based on recreational activities, such as reading books for one hour, going downstairs for one hour of exercise, etc. The "Observation Sheet" is to record the child's work and rest, taking medication, etc. The whole treatment is a process of building up strength and taking small steps, also known as behavioral initiation.

Li Ying: Many parents always focus on big progress and ignore small improvements, but in fact, we need to keep small improvements. As for when to return to school, in fact, in the outpatient clinic, it is more for parents and friends to let go, because once there is an expectation, it will affect the current progress.

In the interview, the reporter learned that the children who receive treatment usually get the motivation to try to return to school after a period of time, but more than half of the children will withdraw again.

Li Ying: From the perspective of intervention, about 3/0 of the children can return to school, or enter a state of transition to school, and 0/0 needs further intervention.

Earlier this year, Beijing Children's Hospital launched a Sunflower Growth Tribal Psychology Workshop to help children and adolescents who have been treated in outpatient clinics for refusal to go to school for a period of time to further recover socialization, integrate into the community, and find a balance between home and school.

Li Ying: We can provide him with a transitional environment in which he meets new friends, and then he gets new support from his new friends and feels that he can be accepted.

When school is seen as "absolutely right", children who leave school are under even greater pressure. In fact, the end point of school refusal is to find a way to extend oneself again, and the important thing is to help the child find the stuck knot, break through it, and start again. Even if you can't go back to school, life will go on. Regardless of the outcome, children who have struggled through difficult situations will receive their own unique gifts.

(CCTV News)