In short
Children’s anxiety and school refusal in 2026, focusing on why “accommodating” anxious behavior backfires and how to build skills through gradual, evidence-based return to school.
Guest backgrounds
Kristen McNeely is a California board-certified behavior analyst and licensed marriage and family therapist. She was a school district behavior specialist for 10 years and now runs a private practice specializing in parent support for childhood anxiety and school refusal. She uses SPACE (Supportive Parenting for Anxious Childhood Emotions), an evidence-based Yale Child Study Center approach.
Key claims
Anxiety worsens when families remove triggers in the moment; accommodations can snowball into chronic avoidance. Online/hybrid schooling and “just keep them home” plans after COVID can reduce friction and delay skill-building, leading to longer school refusal. Talk therapy may be developmentally ineffective for some kids; parent-focused treatment is central.
Notable examples
“Snowball” accommodation (e.g., letting a child avoid school until they never return); her own panic-attack recovery via graded exposure (Target, then Target+Starbucks). School refusal functions include avoidance of discomfort, separation anxiety, and access to home rewards (gaming/TV/social media).
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Chapters
Tap a time to open that second in VOThe Current State of Children's Anxiety
1:01 to 2:10
Discussing the rise of anxiety in children and parental challenges.
“So we're talking a lot about anxiety on the podcast.”
Understanding Accommodations and Anxiety
2:10 to 4:02
Exploring the impact of parental accommodations on children's anxiety.
“You know that he doesn't like the sound of anybody chewing, so we're all going to let that kid eat in a separate part of the room and then in a separate room and then at a separate mealtime.”
The Impact of the Pandemic on Kids' Mental Health
4:02 to 6:40
Analyzing how online learning during the pandemic affected kids.
“But it does strike me that kids are safer now than they probably have been generally at any time in our history.”
Long-term Effects of Avoidance on Anxiety
6:40 to 8:13
Discussing the risks of avoiding triggers for anxious children.
“I'm wondering if you have thoughts on why that might be, that this seems to have changed and it is now staying changed.”
Building Skills to Cope with Anxiety
8:13 to 12:16
Sharing strategies to help children and parents cope with anxiety.
“school and not able to go to school at all.”
Early Intervention and Understanding Anxiety
12:16 to 14:00
The importance of teaching young kids about anxiety and coping methods.
“And we need to figure out what are the small steps that we can actually do that thing that makes us feel anxious because that's how we're going to feel better.”
Understanding Anxiety in Young Children
14:00 to 15:56
Learn about the signs of anxiety in preschool-aged children and its implications.
“as much as I do, and this still feels this hard, I can only imagine how hard it must be for those parents who don't know anything about anxiety.”
Understanding Anxiety in Young Children
16:01 to 17:15
Learn about the signs of anxiety in preschool-aged children and its implications.
“Please support Wet Fresh Hell and tell them our podcast sent you.”
Defining School Refusal
18:30 to 22:38
Understand the dynamics of school refusal and its emotional impact on families.
“So we're back and school refusal is a term that now I think most people have heard involving basically a child who is extremely anxious and doesn't want to go to school.”
Factors Contributing to School Refusal
22:38 to 27:45
Identify various factors that lead to school refusal in children.
“Let's double click on that for a minute because we're talking about school refusal as if it's something that everyone's familiar with.”
Show all 16 chapters
Approaching School Refusal
27:45 to 28:00
Explore effective strategies for addressing school refusal in children.
“Does it start with talk therapy to get at the underlying issues both at the same time?”
Challenges of Therapy for Kids
28:00 to 31:22
Learn about the difficulties children face in talk therapy and the importance of developmental readiness.
“And for them, talk therapy can be really challenging.”
Sponsor: Crocs
31:22 to 31:33
Discover how Crocs can elevate your back-to-school style with new footwear options.
“and school refusal, and we'll be right back.”
School Refusal vs. Exposure Therapy
32:23 to 36:45
Understand how school refusal is connected to exposure therapy and learn strategies to support anxious children.
“This product is not intended to diagnose, treat, cure, or prevent any disease.”
Understanding School Refusal Patterns
36:45 to 42:00
Explore the common characteristics and patterns associated with school refusal among children.
“Hey, you weren't expecting to go out first thing.”
Kristen McNeely: Supporting Kids with Anxiety
42:00 to 43:23
Learn about Kristen's work on helping children overcome school-related anxiety and refusal.
“And so sometimes I worry that my Instagram is less popular because I'm so focused on the parent and I'm not doing a lot of the fluffy kid content.”
Transcript
Automatic transcript. May contain errors.0:00Hi, it's Sierra Miller. I can't wait for you to check out my new collection of shoes and accessories at Designer Shoe Warehouse. If you love shoes as much as I do, then trust me, I got you. From cute sneak arenas to the perfect flip-flops to stunning heels, these shoes are all style, no drama. It's a girls' girls summer, and DSW has just the shoes. Shop the Sierra Miller collection right now at your DSW store or dsw.com.
0:32Hello, everyone, and welcome to Fresh Take from What Fresh Hell? Laughing in the face of motherhood. This is Margaret. And this is Amy.
0:39Heidi Raykeil:Today, we're talking to Kristen McNeely. She is a board-certified behavior analyst and licensed marriage and family therapist in California. Kristen was a school district behavior specialist for 10 years, and now she owns a private practice where she specializes in parent support for childhood anxiety and school refusal. So welcome, Kristen. Thank you. Thank you so much for having me. So we're talking a lot about anxiety on the podcast. We're reading a lot about this is the age of anxiety. Kids have never been more anxious. Kids are struggling terribly with mental health and anxiety. So I'll start with a huge question that you can break down however you would like.
1:18What do you feel like is the state of children and anxiety right now in 2026? Yeah, I think kids are really struggling. and I see families with kids all the way from toddlerhood through teens. And I think in many ways, their stories are very much the same. People feel overwhelmed by the amount of information and do this, no do that. And it can get very muddy for parents. And I think that makes it really challenging for kids. So I love being able to give parents really clear evidence-based information and hopefully more concrete things that they can actually do to support their kids' overall mental health and especially anxiety-related issues.
2:00Heidi Raykeil:It's so important to get expert guidance on this because you can very easily, I find, fall into what Lynn Lyons, who's a friend of the podcast, calls doing the disorder, that the whole family does the disorder of the anxious kid. You know that he doesn't like the sound of anybody chewing, so we're all going to let that kid eat in a separate part of the room and then in a separate room and then at a separate mealtime. And right, that trying to accommodate anxiety never seems to quite work like it's supposed to. And why is that? Yeah. When I do trainings for school districts or when I'm working with families one-on-one and I start talking about accommodations, first of all, I think it's important to clarify that there's a difference between accommodations that a child might have on a 504 plan or an IEP at school, right?
2:46Where they're getting support in the classroom to kind of help level the playing field. And then there's anxiety related parental accommodations or family accommodations. And those are the things that we do with the very best of intentions to support our kids, but that in the long run actually really reinforce that anxiety cycle and the messaging that we can't handle what's making us worry. When I talk to parents, I often use a visual of a snowball and I explain what an accommodation is and how it works. And then I ask, why do you think I have this snowball up here. And they always can say, well, I can see how it actually snowballs really quickly out of control into something much bigger than we started with.
3:28First, I was just kind of rubbing their back to go to sleep for 10 minutes. And now they're sleeping in my bed and have been that way for three years. And I don't really know how we got here. It is so challenging and tricky because we all want to support our kids when they're feeling anxious. It's just really important that we go about doing it in a way that's also building their skills for tolerating what's worrying them. We keep, and we referenced this a little bit, this anxiety epidemic, anxiety is worse than it's ever been. And I'm not dismissing things like school shootings and climate change and the very hard things that are going on.
4:02But it does strike me that kids are safer now than they probably have been generally at any time in our history. And so I'm always interested, like, why is the world getting safer? And we're all getting so much more nervous. Yeah, it's like Jonathan Haidt describes in his book, you know, kids are safer in the real world than they are online. I think that being online and how easy it is for kids to access, I mean, the world really, has really contributed to that, when I was in my last couple of years in classrooms, so you mentioned I was a behavior specialist for 10 years, half of that time was pre-COVID and half was after.
4:45And what I noticed was that after those first five years, my caseload took a pretty dramatic shift from kids with autism having behaviors in the classroom to kids with ADHD and anxiety. And that was really actually my first exposure to school refusal. But what I really noticed in the classroom was kids could not pay attention the way that they used to. Teachers were having to do things that were a lot more engaging, a lot more dramatic just to hold their attention. And even with that, they were still coming to me very frustrated with how little time kids could actually spend sitting on the rug and listening to them in first grade, second grade, third grade.
5:27If you think about it, when our attention is impacted, when we can't pay attention for something for any reasonable amount of time, that is a pretty dysregulating feeling. And that is a pathway to anxiety for sure. If I can't sit and just rest, I'm going to be anxious. So obviously there are a lot of factors at play. I think that there are some of the trendy parenting things that have led to a lot of this. Some of the gentle parenting social media content has really led parents to believe that they have to validate every single thing that their child feels. And then that kind of spirals into, well, if you validate, but they're still not happy about it, then don't make them do that.
6:06And you can see like how this just leads us right down a path to pretty significantly anxious kids.
6:12Heidi Raykeil:I have a question about the pandemic because it made sense in the years right after the pandemic that kids who missed early childhood development with peers were going to not know how to share or not know how to sit on the rug like maybe kids, five and six year olds in the past. There's a lot of differing opinions on when the pandemic ended or if we're still in it, right? But when the intense part ended is five years ago now. And it feels like this blip we saw, this change is kind of plateauing in a new place. It isn't returning to baseline. I'm wondering if you have thoughts on why that might be, that this seems to have changed and it is now staying changed.
6:47Yeah, I think one of the things that really stands out to me is most kids went to online learning during the pandemic, right? And then some stayed in that longer depending on their states and their schools and how they were learning. I think some kids, especially those who are anxious, really liked that online option. And so many parents kept them in that. One of the things that I see constantly now in our local Facebook groups is parents asking about what are some good virtual school options? What are some good hybrid options? What are some good homeschool virtual options? And when we pull kids out of that school environment, we're often removing anything that might be triggering for them.
7:29Now, there are certainly families who can have a child be homeschooled or doing virtual school, but then have them very involved in sports or theater. Locally, we have a lot of kids who are actors because we're not too far outside of LA. So they might be doing that type of schooling because they're also acting. So they're being exposed to regular lifestyle and the things that would make them nervous. But for many kids who are anxious about school, the answer has become, well, just don't send them to school, right? Just keep them home. Just do schooling in a different way. And when we remove those opportunities for kids to have a little bit of friction with those things that they worry about, we are failing to build skills.
8:09And so what I'm seeing kind of five years down the road is, especially for the kids who are maybe in middle or upper elementary at that time, they're now in middle or high school and not able to go to school at all. And what I worry about is there's nothing magical about high school graduation when it comes to school avoidance and school refusal. It's not like, okay, graduation's happened. You don't have to go to school and now you're magically better. This typically translates into the workforce, being able to go to college, being able to move out of the home. And so these are the things that keep me up at night sometimes.
8:43You talk about on your Instagram, you had this and it really stuck out for me, that addressing anxiety in the short term sometimes makes things worse in the long term. And I thought like, I am a very anxious person. I've talked a lot about it on the podcast. I have OCD and I've always had just a high anxiety set point, just a nervous kid. I know, especially with OCD, it's like, okay, I'll touch all these things and it'll make it okay. But there are times where that starts to like take over my whole life. It's like, that is kind of my short-term fix. So talk about this idea because I feel like when I started to understand this, I was able to cope with my own anxiety so much better.
9:25Yeah. Well, it comes back to that idea of accommodation again. So So we could come up with any number of examples, but let's say you have a child who doesn't want to go to school. They wake up in the morning and they say, I have this test. I don't want to go. And you say, okay, we won't go today. We'll try again tomorrow. And then the next day it's, well, I have this other project and I don't want to do that either. Okay, we won't go. And it can just spiral out of control. And so those things that that morning, yeah, they felt a lot better. The pressure to do the thing that was making them anxious felt a lot better.
9:56It was gone. but then it just makes it harder the next time for them to get back in the swing of things. You could say the same thing for a kiddo who needs to do swimming lessons and they freak out in the pool. And so you say, okay, nevermind, let's take a break today. Now they feel much better, right? That trigger is removed, but then tomorrow it's going to be harder for them to get back in. So no matter what we do, if we remove that trigger in the moment, the next time that same feeling is probably going to come back. Now, I'm not saying that we should flood kids with the things that they're completely terrified about.
10:30Don't like leave them in a room with a tiger. That's how, no. No, that's not how it works. But it is about building skills and really small steps. Actually, I'm happy to share a personal example if you think that would be helpful. So when my daughter was born, fairly soon after that, I had to have my gallbladder removed. I ended up having some medical complications from it and it resulted in panic attacks. and I was having panic attacks for about six months before the doctors realized what was going on and could get me on the medication that I needed to be on. For anyone who's had panic attacks, you know that six months of them will like basically stall your life like right there.
11:09It had gotten to a point where I didn't want to leave my house. Like it just turned my life upside down. Like I remember thinking, how am I ever going to work again? Like what is my quality of life going to be. And I really leaned on my own training at that time and thought, okay, what is the small step here? Like, okay, I can't go to work right now. I took a leave of absence, but what is the small step? Well, at the time running into Target felt like a medium amount of anxiety. And so my goal was I'm going to go into Target. I'm going to buy one thing. I'm coming right home. And I did that a couple of times.
11:44Then I started kind of extending the time that I was at Target. Then I started doing Target and Starbucks on my way home. So it was these preferred things that I liked doing, but building the amount of time that I was away from my home. Fast forward four months after that, and I was really in a much better place. There were still things that caused some anxiety, but I was able to cope with it. It was really all about that exposure and reteaching my brain, this feels scary, that doesn't make it dangerous, and we can do this. So I think the most important thing for parents to understand when it comes to that avoidance is that the avoidance is what's going to make the anxiety grow.
12:24And we need to figure out what are the small steps that we can actually do that thing that makes us feel anxious because that's how we're going to feel better.
12:31Heidi Raykeil:It's amazing to hear that about panic attacks, because I think the difference with a kid is when you're an adult or even a teenager can take on for themselves. OK, I have panic attacks. I have OCD. I know I need to do this work. I know I don't want to. But I write with a younger kid. It often, I think, turns into mom or dad is making me do this. I don't want to go to school. Mom is making me go to school. And mom's the jerk. and it gets completely externalized and they're not yet owning that this is something that they can fix and should fix and that's on them. It isn't on convincing mom that she's wrong.
13:08Heidi Raykeil:It seems like that must be the first step with younger kids in this work. Yeah, I think, you know, I have a five-year-old and so some of the work that I've done with him is just in very plain language explaining how we do the things that make our worries less. So he knows that he worries about things and he can tell you the way to not worry about something so much is to do it. And then I'll say, but how do we do it? And he says, a little at a time. So yes, we can absolutely adjust our language and start teaching those skills at a really young age. That's actually something I've gotten really passionate about as I had my own experience with him going to, in California, we have something called transitional kindergarten.
13:47So it's basically like the four-year-old preschool, but they're now in a comprehensive campus. And it's hard. These are little kids on a comprehensive public school campus. And so that can cause a lot of anxiety. And I remember seeing him struggle how hard it was for me and thinking, wow, if I know as much as I do, and this still feels this hard, I can only imagine how hard it must be for those parents who don't know anything about anxiety. And I can so easily see how they would go from that to never mind. This is too hard. It's too soon. It's too much. I'm pulling them out of school. And so one of the things that I'm trying to do now in my work is really start building skills at that age and give parents a good understanding of what does anxiety look like in a three, four, five-year-old and start there.
14:36Because when we can build habits that young, we can have such a different trajectory for their whole life. We are talking to Kristen McNeely, and we are going to come back and talk about one of her areas of expertise that I'm super interested in, school refusal.
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18:54I think she was a little more on the forward side of this, the progressive end. But I have a sibling who had profound school refusal. We didn't know what the heck was going on. This was mid-1980s, and the term school refusal was nowhere in the lexicon. And it was a very upsetting and frightening experience for the whole family. I mean, very much for my parents, very much for the kid involved. And just overall, it felt like, what is this? I mean, it felt like I could see why people in the olden days were like, they're possessed by the devil. Like it really felt like this kid was normal all day.
19:37And then at seven o 'clock in the morning before school would become a completely different person. And my parents were not ones to be like, tweet, tweet, you stay home, dearie, because this is hard for you. But I mean, they would be vomiting in the car. I mean, it was very profound what was going on. And so I've always been super interested in this idea. And then it just passed. And we never thought about it again. As an adult, I was sort of like, wait, we had this crazy period. So tell me everything about school refusal. How did you get interested in it? Where are you seeing it? Is there more of it?
20:10I'm fascinated by school refusal. Yeah. Well, like they had mentioned earlier, my caseload in the school district had kind of shifted post-COVID. And actually, I think I had a case or two before the pandemic, but definitely afterwards, we started seeing more resistance in coming to school, especially with kids with ADHD. They were having a lot of anxiety. I think what I liked about it the most was that it was so clear to me that it was a family system issue and actually more than the family system, because I'm a firm believer that it's actually the child, the parents and the school. So it's a family plus school.
20:42I really appreciated how much collaboration was required in these types of cases. We can't just try and treat the kid. We can't just try and support the parents. We can't just blame the school. We will get nowhere without all three of those pieces in place. So I think I just really enjoyed the level of collaboration and also creativity. I had spent the first part of my career working in homes with families with kids on the autism spectrum. So I was very familiar with the idea of parent support and school refusal seemed like this really nice kind of blend of parent support, plus also putting in a lot of support at school.
21:21So what I found was that when we could kind of think outside the box and set up a really supportive plan for the student, we had a lot of success. I was really fortunate at the time. I had a director who was really well-versed in kind of the legal things around school, special education. She also was very open to creatively thinking about how we would help a child. She was very child-centered. And so I was able to kind of practice doing these cases in a couple of different ways and just really loved seeing the level of success. At this time, my kids were kind of growing. They were starting to get into elementary school.
21:59And so I would be, you know, pulled aside by someone, you know, I'm having trouble with this. What should I do? And so my husband was just encouraging me to start a private practice. And he said, you know, you should really be getting paid for these conversations. Fair. So I decided to go ahead and take the leap. And as I kind of got more into school refusal, I realized that there's just a lot of gaps in people's knowledge. A lot of times schools don't know what to do. Parents have no idea. I think one of the unique things about school refusal is, as you kind of described, Margaret, there can be a lot of shame around it.
22:33It's not something that's super commonly talked about. Like I'll still say, oh, I specialize in school refusal and moms will look at me like, what's that? You know what? Let's double click on that for a minute because we're talking about school refusal as if it's something that everyone's familiar with. Will you describe it? And also, like, I can speak to it from personal experience in terms of like, my parents were tough Irish people. They were not like, oh, sweetie, you don't have to go to school if you don't want to. But I mean, I have a kid on the spectrum, Amy, and I have both talked about the idea of like, well, they eat when they're hungry.
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23:06It's like, you haven't met my kid. Like a kid with ARFID won't eat when they're hungry. So just for people who might be hearing the term school refusal for the first time, give it like a good definition and a little bit of why it's not just like tell your kids to get their butt on the bus. Absolutely. Yeah. And I think what you were talking about with your brother would probably have been considered like truancy back in the day or like they're becoming a dropout. Right. That's how we refer to it. So school refusal is kind of the last step on this spectrum that usually starts out as what we would call school avoidance.
23:40These are the kids who might go to the nurse's office in the middle of the day and say, you know, my tummy hurts. I don't want to go to class. I want to go home. Maybe they're arriving tardy. They're late to school a lot because they had that difficult morning. Or maybe they're calling it lunchtime and saying, you know, I want to come home. Those are typical school avoiders. And that can very easily and quickly transition into full school refusal where they won't go at all. And also, to be clear, like all kids do that some days. Yes. And then certain kids more than others. But then it's like it's the snowball you were talking about.
24:12Exactly. When we talk about something called chronic absenteeism, this is when students are absent for 10 percent or more of the school year. And so as we're approaching that kind of 10 percent of days, no matter where we are in the school year, that's really where we want to be sensitive to. okay, they've missed kind of a significant amount of school and it seems to be anxiety or emotion related. And so that's when we really want to be paying attention to this can be kind of a blossoming school refusal case. And then, you know, you could transition to school refusal. You have kids who may be out completely.
24:44You may have kids who are missing days at a time. And then on the far end, I guess you would have kids who have really been out for weeks or months.
24:52Heidi Raykeil:What are the different reasons? Like, it seems to me that sometimes it would be something bad happen at school and I'm refusing. Sometimes it's kids with chronic pain can miss school. And then the whole family, I think, can develop thinking like you need to wait until you feel better to go back. That's one kind. Sometimes it is, I suppose, just generalized anxiety that starts running downhill to that spot. But what are the different ways this can sort of develop? Yeah, we look at, you know, there might be something at school that they're trying to avoid. So there's a school refusal assessment that we can do to look at kind of what are the things that are contributing to the school refusal.
25:25And so for some kids, it's this avoidance of discomfort. So it's maybe tests or quizzes or loud sounds or certain classes. Maybe there are some social issues. Maybe there's some bullying. Maybe they're just having difficulty navigating some friendship situations. For some kids, especially I would say the younger ones, separation anxiety can certainly be a cause. And then the fourth function that we look at is what we call access to tangible rewards. And this function definitely increased over the pandemic. So this would be when kids are wanting to do something at home that they enjoy. Online gaming, computer, TV, all of those types of things, social media.
26:06That function is not typically the primary. That usually is the result of one of the other reasons that's led to the school appeasal. And then now they're at home and now they're also doing all these enjoyable activities. And that makes it very hard to go back to school. And is there, I know for my own kids and for my family, this was a middle school issue very clearly. And so is that right? Is that anecdotal? Or is this something that comes up often with middle school age kids? Because that's what happened in my family of origin. And I'm definitely seeing it now in the, you know, are you sick or are you sick of going to school?
26:43Right. Conversations. Middle school is so hard. I have a kiddo who's about to start middle school and I'm embracing myself. But any of those transition years are really the peak time. So kindergarten, sixth grade, if your middle school starts in sixth grade, seventh grade, if it starts in seventh grade, and then even the transition to high school, it can be a peak time as well. I think middle school is unique just in the amount of, you know, there's puberty, there's maybe needing to establish new friendship groups, there's possibly changing classes for the first time. It's a much bigger campus.
27:13Harder academics are coming in while your body is changing. It's a really hard time. It's just all the things. And then the social dynamics tend to get very Lord of the Flies too. Yes. There seems to be this idea that middle school is a rite of passage to having a smartphone. And so now we're also having kids on smartphones, accessing social media, accessing group chats. I have a large number of families that I support where that really is a significant part of the problem.
27:40Heidi Raykeil:And so the approach, I'm wondering, does it start with scaffolded return to school? Does it start with talk therapy to get at the underlying issues both at the same time? How does it play out? Yeah, I think the talk therapy piece kind of depends on the individual child. So for the most part, the families that I support, the kids are either diagnosed with ADHD or autism sometimes. And for them, talk therapy can be really challenging. I thought this was a really interesting point that you made, actually. Like therapy for kids for whom talking is not a central skill. Yeah. And even for younger kids who maybe don't have any other type of diagnosis, it's just hard for kids to talk about their feelings from the past and then be able to apply what they learn in therapy in the future.
28:29That is just a major skill. And so I always worry about kids going to therapy too young or when they're not developmentally ready. Because what I want is that when they're an adult and struggling, I want them to go to therapy when it's actually going to be effective for them. And if we start them young, that can build some like just negative experiences with therapy. And so then they won't go when they're older. I think the other thing that I worry about is, you know, there's been so much emphasis on social emotional learning in schools in particular and teaching kids a lot of skills related to their emotions.
29:06And some of that is great, don't get me wrong, but we can overdo it. And so I always laugh because I usually work only with parents, but I do occasionally have kids join sessions when they want to. And I always start by telling, I raise my right hand and I say to them, I solemnly swear I will not teach you five ways to take a deep breath. and like the relief on their faces because that is what they've learned and it doesn't help them. So yeah, it's definitely really about supporting the parents and first understanding what are the anxiety patterns happening at home that probably follows actually getting at the core of the school refusal.
29:44So what is the reason behind the school refusal or what are the multiple reasons and then kind of going from there.
29:49Heidi Raykeil:Do you deal with parents if it's a two-parent home? Do you deal often with one parent saying it's cruel to make him go to school when he can't and other parents saying this is ridiculous and this has gone on long enough and you get in that car right now, young man, is it split sometimes? Yes, oftentimes actually. And so I'm trained in SPACE, which is an acronym. It stands for Supportive Parenting for Anxious Childhood Emotions. It's an evidence-based treatment out of the Yale Child Study Center. And what we know about SPACE is that it has been shown to be as effective as cognitive behavior therapy, but without the child present.
30:23And so that is the treatment protocol that I typically lean on. So one of my favorite sessions in space is what we call the spectrum of parent support. And that is where we look at what are each parent's approach to anxiety. Some parents come at it from a very protective space where they feel like, I think this is just too much for them. I don't feel like they can handle this yet. And some parents approach it from like, this is no big deal. Like get it together. You're fine. And it's probably to no surprise of anyone. Often the moms lean a little more protective and the dads lean a little more demanding.
30:56And what I actually really love about this session is oftentimes parents will come in kind of finger pointing at each other and leave the session understanding, okay, actually there's problems with both approaches and we need to kind of come in the middle. And so in that session, I teach them new language to use to kind of get at both of those things where we want to validate how the child is feeling. and we also want to express confidence that despite that feeling, we know they can do it. We believe in them.
31:21Heidi Raykeil:We're talking to Kristen McNeely about anxiety in children and school refusal, and we'll be right back. Hey, Chicago. Class it up with Crocs. You know back to school is coming in fast. So why wait to find your new fave footwear? Step into a local Crocs store and step into your new look. Try it. Style it. Make it yours. because the right pair doesn't just show up, it shows off. First day fits, handled. Walk out ready for whatever's next. Visit your nearest Croc store today. Hey friends, Olivia from OLLI. Between new routines and the ultimate group project known as parenting, you need science-backed solutions that work with your life.
32:06That's where OLLI comes in. Start your mornings off right with Maltese made to support nutrition and immune health. Choose from our lineup of gut-supporting probiotics And we've got occasional sleep support to help the whole fan chase their big dreams. Head back to class with the number one gummy supplement brand. Stock up on Oli.com today. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. So in part three on our podcast, we always dig in for solutions. So one of the things that you said on Instagram that I wanted to ask you about is that school refusal is the evil twin of exposure therapy.
32:43So tell me about that statement. I mean, I think we hear a lot about exposure therapy, meaning like if you're afraid to fly, get on a plane. If you're afraid of water, jump in, like expose yourself to the thing you're most afraid of. Yeah, some of the advice around school refusal is definitely like the evil twin. So some of the common things that I hear from other people or that I see on social media is just enroll them in online school. Like they can't handle it, just put them in online school. or maybe you should homeschool them or don't worry about an assessment. There's nothing that the school can do anyways.
33:17And really none of those things are true. Again, kind of going back to the things that we talked about previously, it is really important for kids to learn skills related to anxiety management, whether that means they're going to continue in school or not. Pulling a child from school is very rarely a good long-term solution. It can be part of a short-term solution. So when I was working in the schools and when I'm consulting currently, I sometimes do recommend let's take a break from in person. We can look at some what we call home hospital teaching where they are still getting to connect with a teacher for some time during the week.
33:55and then we are working on exposure in other ways. So that might be they go to school and they deliver something to the front office manager and then they go home. Maybe it's just sitting in the car in the parking lot for a few minutes and kind of letting that anxiety come up and waiting for it to go down because it will. For some kids, we don't have to go that far back. We can start right away with being in school and usually I'll recommend kids start with their most preferred time of day. So maybe they really enjoy lunch recess. And so we'll say, okay, for this week, they're going to go to lunch recess.
34:29They're going to get dropped off right before and picked up right after. The key is we want to find a bar where they are not going to need to escape because it's too much. So the most important thing is that we take that step and we learn that it's actually okay. And to do that, we need to be able to tolerate it. So sometimes I find that usually schools want to move very quickly. Like, okay, they did lunch recess today. So tomorrow it's the whole second half of the day. And really like our brain needs a little more time than that to adjust. So I help parents create gradual return to school plans where we look at what are the supports the student is going to be receiving at school?
35:10How are the parents going to be responding at home? How are they also going to be altering the home environment when the child is home? because we do want to make sure that the home environment isn't this comfy place where they have access to all their favorite foods and activities. It doesn't have to be miserable, but we don't want it to be super fun. And then what supports are they going to be receiving at school? And how can we make a plan to kind of increase that expectation a week at a time? For some kids, I would say kids on the autism spectrum, they often need a little bit more time. So instead of working in week-long chunks, I often recommend working two weeks at a time.
35:46They just oftentimes tend to need a little bit more time to adjust.
35:50Heidi Raykeil:You were talking about preferred activities at home, that it's kind of nice to stay home and play video games. There are also preferred activities at school or out in the world, right? And the same kid who is refusing school might be perfectly fine on going to flag football practice or band practice. Do you use that as a carrot and stick or do you say, no, no, no, that's the kid existing healthily in the world and that's not to be messed with? How do you address those things? That's a great question. I do not use those as carrots. I am all for those things. And the reason why is that anxiety can quickly spiral into depression.
36:24If you think about a child who is not going to school, not seeing their friends at school, their world can shrink really quickly. And once that depression kind of kicks in, it can be even harder to get them back into school. So what I will do is I will use those things that they are willing to do. And I will start pointing out or have parents point out, what are the skills that you're using when you're in that moment? Hey, you weren't expecting to go out first thing. Like you're usually a sub, but you actually weren't called to go out on the court right away. And you handled that. How did you do that?
36:58And so really helping them to learn that there are some skills that they're using there that can also be applied at school. What kind of kids end up with school refusal? Because I think that sometimes people think, oh, it's the kid who's the kind of dropout, burnout kid. I know in our case, it was my extremely high achieving sibling who had school refusal. So I think it can be surprising. Like school refusal is about a kid who would rather be under the bleacher smoking a cigarette. Like that's not always the profile of school refusers. No, it's actually not usually the profile of school abusers, I would say.
37:35I would say the kids who are more likely to kind of head down that path are the kids who have been anxious from a young age. That's why, like I had mentioned earlier, I am getting very passionate about working with parents of four and five-year-olds because there's so much pattern changing that we can do at that age. So kids with separation anxiety are at higher risk. Kids who have moved cities or houses during those transition years are at higher risk. Kids who are neurodivergent, definitely higher risk. Kids who don't have a solid friend group, higher risk. One of the most important things about school refusal that I work with schools on is that one of the best interventions is helping to make sure that kids feel like they're part of a school community.
38:17This is actually an area that I think schools are starting to grow in is really, especially from the pandemic where we lost all sense of community. Schools want to be engaging the community in after school activities, community wide events. When kids feel like they're part of that community, they are much less likely to end up school refusing. And when they feel like I have that one teacher that's waiting for me or that one staff member or that group of friends, it's just much easier to get them back if they're struggling and to prevent a lot of the refusal in the first place.
38:50Heidi Raykeil:You describe your work by saying you help parents bring more clarity to their parenting. You say you help kids get through anxious moments with more clarity. So talk about that notion of clarity and how you think that helps. Yeah. I think with just all the different advice that's thrown at us in social media, it can feel so muddy, especially when some of the advice tends to feel conflicting. You know, one of the things that I try and do that I think Lynn Lyons is amazing at is making things extremely concrete. I use so many visuals, some that I've learned from her because she's amazing. but using visuals to really explain to people how the anxiety cycle actually works how no matter what we're anxious about there's this very predictable cycle of how anxiety will play out once we can kind of box each of those steps in i think it helps parents to really see like oh this is actually something that's manageable it doesn't have to be this overwhelming mysterious thing.
39:51I think for kids, it kind of helps to demystify it when we can explain it in this very concrete way and also helps them to know that this isn't something that has to control them. That doesn't mean it's easy. And I'm not saying like, oh, you just explain that and they're fine. But when we can kind of give them those tools, I think that it helps it feel less like this thing that has so much control over them. I think we tend to see a school refusing child as a child with a problem. And you talk a lot about really the patterns around how the parent response is key to how this anxiety starts to play out.
40:33And so talk a little bit about how that's different. I mean, what is it you say, Amy? Your kid is like communicating the problem, right? Like, they're not giving you a hard time. They're having a hard time. There we go. It took us a minute to get there. But yeah. Well, if you think about it, when you have a child who is anxious about something, the way that I kind of reflect it back to parents is they'll say, okay, well, they didn't want to sleep in their bed last night. And so I'll say, and so you, and then there's a parent response. They didn't want to get on the bus this morning. And so you, right?
41:06You cannot have an anxious child without a parent response. And when we change that response, that is when we can support our kids' anxiety. And what I find, especially with space, I often, when it's not a school refusal case, when it's just kind of your run-of-the-mill anxiety case, I will exit parents in six sessions. That is not uncommon at all. And if you think a month and a half of therapy with a parent versus kids end up in therapy for six months, a year, two years, and the parents are often not learning any skills in that time. And so the parent role really is so, so important. And I also want it to be super clear that all of the things that we do as parents are incredibly well-intentioned.
41:49We're just doing what we're here to do or what we've learned ourselves to do. It's not that we're doing something wrong trying to make our kids more anxious. And I think the other thing is that parents don't know how much power they have. And so sometimes I worry that my Instagram is less popular because I'm so focused on the parent and I'm not doing a lot of the fluffy kid content. but I always felt back on the fact that I know this is actually what works and this is what's actually going to help parents. It's going to save them time and money and it's actually going to build their kids' skills for the long haul.
42:23Heidi Raykeil:We've been talking to Kristen McNeely. Kristen's Instagram is childhood.empowered. I'll put the link to that in the show notes. It is full of really useful content. And Kristen, tell our listeners how else they can find you and your work if they'd like to work with you. Yeah, so for California residents, I can provide consultation and therapy services. My website is kristinmcneely.com. And then by the time this episode airs, my new business should be launched and it is called School Capable. It is working with school districts, school administrators, school-based therapists, and other just general therapists supporting kids who are struggling with school-related anxiety and school refusal.
43:04So it's all consultation-based. I will also be able to help families out of state, not therapeutically, it will be all about gradual return plans for school. And so supporting them in developing those plans. And that can be found at schoolcapable.kristinmcneely.com. And we will link to that as well. Kristen, thank you. This was a great conversation, important topic.
43:26Heidi Raykeil:Thank you for having me. Thanks, Kristen.
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From the publisher
Childhood anxiety is on the rise. Parents are often unsure how to respond, and in their well-intentioned efforts to reassure their kids, can sometimes reinforce the anxious patterns. In this interview Kristen McNeely,
LMFT, explains how parents can start to help their kids build resilience by taking small, manageable steps toward the things that might scare them.
We also discuss school refusal—why it's more complicated than simply not wanting to go to school; the warning signs parents should watch for; and why collaboration between parents, schools, and mental health professionals is essential.
Kristen explains why school refusal often begins with school avoidance, how transition years like kindergarten and middle school increase risk, and why pulling kids out of school is rarely an effective long-term solution.
Amy, Margaret, and Kristen also discuss:
Why parental accommodations can unintentionally fuel anxiety
The difference between validating feelings and reinforcing fear
Why gradual exposure works better than avoidance
The four common drivers of school refusal
How ADHD, autism, and separation anxiety can increase risk
Why helping kids feel connected to their school community matters
How parent-focused treatments like SPACE can improve childhood anxiety—even without the child in therapy sessions
Here's where you can find Kristen:
https://kristenmcneely.com/
@childhood.empowered on IG
https://schoolcapable.kristenmcneely.com/
What Fresh Hell is co-hosted by Amy Wilson and Margaret Ables.
We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website:
https://www.whatfreshhellpodcast.com/p/promo-codes/
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