Joanna Fortune: My son only attends school in the afternoon, doesn't have friends and avoids lunch breaks 

Joanna Fortune: "Loneliness and peer isolation are contributing factors to mental health issues. This is another reason I would strongly advise that you bring him to your GP, who can do an initial mental health assessment and refer him to local services if necessary."

My son is in first year. He started well, but after the October midterm break, he began coming home early and missing days. Now he goes to school in the afternoons. 

He hasn’t any friends in school and avoids lunch breaks. His school has been great about encouraging him. However, I am worried that he won’t be able to get up in the mornings to take his summer exams. 

He has been getting good grades up to now. He says he doesn’t sleep at night and finds it hard to get up early. I have spent hours getting him up for school. 

Any advice to get through the last term would be helpful.

Your son seems comfortable going to school each day, albeit for the second half of the day. Is there something beyond tiredness that is interfering with his engagement in school up to lunchtime?

You mention that he doesn’t have any friends and link this to his avoidance of lunch breaks. This leads me to wonder if he can only feel comfortable in school when a dreaded, lonely lunchtime has passed.

Then there is the point that he is not sleeping at night and is too tired to get up and go to school in the morning.

Why is he not sleeping at night? Is this insomnia, or is he staying up late on a gaming or digital device?

When someone experiences a prolonged pattern of sleep disruption, I would strongly advise that a GP review them to ensure there is no underlying medical reason for their inability to sleep.

If it’s because he is staying up late gaming or using a digital device, you might want to consider setting boundaries, such as not having such devices in bedrooms or disabling Wi-Fi after a certain time at night. 

I don’t say this to suggest you respond to your son’s struggle with punishment, but rather to explore ways you can help him establish a better sleep pattern that will enable him to wake with enough energy to get through his school day.

The combination of lack of sleep, difficulty with peer interaction, poor and inconsistent engagement in school and his general lack of responsiveness to your efforts to get him there on time makes me wonder about his mental health status. 

Does he have friends outside of school? I am wondering if something has happened between him and his friends or if peer connection is something he has always struggled with.

Loneliness and peer isolation are contributing factors to mental health issues. This is another reason I would strongly advise that you bring him to your GP, who can do an initial mental health assessment and refer him to local services if necessary.

I am glad to read that his school is being helpful and supportive in its efforts to strengthen and enhance your son’s engagement. Understanding what is underpinning school avoidance is critical, and a higher priority than summer exams.

Talk to him when you are both comfortable and calm— a side-by-side chat on a car journey often works best. 

Try to stay calm and curious about what is happening from his perspective, so you can meet him where he is at and work with him rather than pushing to get him through this difficult time.

You might find my podcast episode on school refusal helpful: exa.mn/15-minute-school-refusal

• If you have a question for child psychotherapist Dr Joanna Fortune, please send it to [e-mail]