I have an adolescent headache center. Adolescents, severe headache, and home schooling: a complex issue. In the 80’s and 90’s, I took a tough love approach, “my job is to work here, yours is to go to school… no excuses, you have to go, if you are vomiting too bad, if you can’t see, too bad, go to school.” That approach is right for some, but not for many others.
Over the past 13 years, I have gradually taken a more nuanced approach; every kid and parent situation is different. They range from mild factitious disorder (Munchausens) by proxy (I wrote an article last year on this, if anybody is interested… in teenagers) to fairly normal psychiatric status.
Psychotherapists who are good with adolescents are invaluable and must see the child. We do psych testing, but much more important is the therapist-kid relationship; not uncommonly, the therapist will say something like, after 2 months, “…she has tremendous fears about starting H.S., and fears growing up, is highly anxious, she is just not ready to go to H.S…” The hope with many of these kids is establishing a good therapeutic relationship.
The healthier the parent (mom) is, of course the better. The worst situation is when the mom and child both have personality disorders (although we do not diagnose PD in a child until later on). I have followed a number of these kids into their 20’s and it is not good. For those sicker moms, where it is a mild factitious disorder, I have had much more success with a subtle dialectical “go with the flow” approach; confrontation leads nowhere. I call this a “dialectical by proxy” approach, but it has a reasonable chance of success; success is separating mom and kid for college, giving the child a chance to function independently, not focusing on health issues.
Many kids do need tough love, and to be kicked in the rear to go to school; but others do much better with home schooling, or a modification of full-time school. A recent study of home schooled kids with headaches revealed decent results, although they did wish they had more interaction with their peers; in my experience the severe headache kids often have anxiety, including social anxiety, and avoid many social situations. Therapy can work on that. Some kids need easing back into the school, and if they will go I will write letters accomodating them for late starts, early release, no gym, etc… in other words, I will go to bat for them, to make school easier, if they will at least go part of the day. That works for some.

The idea with these kids is to get from A (9th grade) to B (graduating HS), even with a GED. If it takes part home schooling, part-time HS, whatever, so be it. If we can get them through HS, and SEPARATE them from mom, they usually do well into their 20’s. An old study of these children followed them into their early 20’s, and the majority do very well. My experience mirrors that, with some exceptions (it all depends on the level of psychopathology in the kid; those with PD’s do not fare as well).

Many of these kids, of course are very somatic, and have other doctors… I always try to minimize meds and almost never hospitalize them; I discourage the ER. I try and get them away from the medical establishment, toward viewing themselves as healthier, not chronically ill. We push “active coping”, which is almost everything other than taking pills. Studies of disability in kids have indicated that pain level itself is the 3rd or 4th predictor of disability; catastrophizing, passive coping (vs. active), fear of pain, etc. are all higher predictors. This is similar to disability studies in adults.

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