School Refusal and Orthostatic Dysregulation – A Doctor’s Perspective for Parents
If your child cannot wake up in the morning and is struggling to attend school, Orthostatic Dysregulation (OD) may be part of the underlying cause.
OD is a condition related to autonomic nervous system dysfunction and is common in adolescents. It is frequently associated with school refusal and absenteeism.
This is not laziness or lack of discipline, but a medical condition that often requires proper evaluation and support.
In this article, we explain the relationship between school refusal and Orthostatic Dysregulation, how to recognize the symptoms, what parents can do, and how medical care can help.
Contents
- Why some children cannot wake up in the morning
- The connection between school refusal and Orthostatic Dysregulation
- Common symptoms of Orthostatic Dysregulation
- “Active at night but unable to function in the morning” – why it happens
- Why forcing school attendance can backfire
- How medical support can help
- What parents can do at home
- Care at Azabu Juban Clinic
- When to seek medical consultation & how to book
1. Why some children cannot wake up in the morning
Many parents come to us saying:
- “My child looks fine at night but cannot get out of bed in the morning.”
- “They complain of headaches or stomachaches before school.”
- “They want to go to school but physically can’t.”
During adolescence, the autonomic nervous system is still developing and can be easily disrupted by stress, growth, and sleep rhythm changes.
One of the most common medical conditions behind these symptoms is Orthostatic Dysregulation.
2. School refusal and Orthostatic Dysregulation
Orthostatic Dysregulation can lead to:
- Severe difficulty waking up in the morning
- Dizziness or faintness when standing
- Fatigue during school hours
- Increased absences and tardiness
- Anxiety, guilt, or low mood related to school
Over time, these physical symptoms may develop into school refusal, not because the child does not want to attend, but because their body is unable to cope.
3. Common symptoms of Orthostatic Dysregulation
Your child may have Orthostatic Dysregulation if several of the following are present:
- Difficulty waking up in the morning
- Lightheadedness or dizziness
- Headaches or abdominal pain
- Palpitations
- Chronic fatigue
- Symptoms worse in the morning, better in the afternoon
- Symptoms worsen on school days
These symptoms are real and physically distressing, even if medical tests appear normal.
4. Why children seem “fine at night but not in the morning”
With Orthostatic Dysregulation, the autonomic nervous system struggles to regulate blood pressure and heart rate when changing positions.
As a result:
- Evening: symptoms improve
- Morning: standing and waking cause significant discomfort
This often leads to misunderstandings such as:
“If they can play games at night, they should be able to go to school.”
In reality, this pattern is typical of OD, not a sign of defiance.
5. Why forcing school attendance can make things worse
When Orthostatic Dysregulation is present, forcing attendance may lead to:
- Worsening physical symptoms
- Increased anxiety or depressive symptoms
- Complete school withdrawal
In some cases, rest and medical support are part of the treatment, not a failure.
6. How medical care can help
Medical evaluation can help by:
- Assessing autonomic nervous system function
- Screening for anxiety or depressive symptoms
- Providing lifestyle and sleep guidance
- Considering medication when appropriate
- Supporting both child and parents
The goal is not simply to return the child to school, but to restore physical and emotional stability.
7. What parents can do
Helpful approaches include:
- Avoid blaming or labeling the child as lazy
- Do not compare them to siblings or classmates
- Focus on comfort and safety rather than attendance
- Ask open questions like “What feels hardest right now?”
A calm and supportive home environment is one of the strongest predictors of recovery.
8. Care at Azabu Juban Clinic
At Azabu Juban Clinic, we provide comprehensive care for children and adolescents experiencing:
- Orthostatic Dysregulation
- School refusal
- Anxiety and depressive symptoms
- Psychosomatic complaints
We evaluate both physical and psychological factors and work closely with families.
Parental consultations alone are also welcome.
9. When to seek help & how to book
Consider medical consultation if:
- Morning difficulties persist for several weeks
- School absence continues or increases
- Physical symptoms interfere with daily life
- Parents feel overwhelmed or unsure how to proceed
▶ Book an appointment with Azabu Juban Clinic
(Online and in-person consultations available)
03-6809-4515
4th floor OTM, 2-3-8 Azabujuban, Minato-ku, Tokyo 106-0045