Well, I'll be the other side of the coin. We did go the small private school route for our dd1 who had severe sep anxiety, too, and some ADD behaviors (inattentive). We have not done meds and don't intend to do so at this point.
Her sep anxiety was definitely the worst the teachers had ever seen and remains the worst I have ever seen in any child. She didn't throw up, but she has anxiety about being sick and I can probably count on one hand the times she's thrown up in her whole life by age 11 now, so not sure it would ever manifest that way for her.
We knew she would be very anxious about K, though, since she had been anxious since birth and had a rough time in preschool, too. So we did seek out the private school. She loved her teacher and liked a lot of school, but really would have loved it if I could stay and go to school with her. Of course, that wasn't really an option, but since this was not public school we did have a lot more flexibility and I could stay for quite awhile in the morning. We worked out a little routine where I would hang out (with dd2 in tow), but just try to fade into the background, so I was a security blanket, but she was interacting with the other kids and the teachers rather than me. Then I would sit with her at circle time (about 45 min after school started) and then leave after circle time was over when they moved into the next part of the day. It was a struggle almost all year long. She refused to participate and do a lot of the activities, cried a the drop of a hat, etc. But she did get used to it and overall I think she really liked her K year. She loved her school and loved her teacher.
Sep anxiety remained a struggle in 1st grade (same small private school) where her refusals took on the form of pretending to be a cat and only meowing and hiding in the corner under the tables, etc. I did the same thing and stayed through the morning circle and then left. Second grade was somewhat better (same teachers 1/2 mixed grade class), but she still had some anxieties especially if her routine was shaken up by a special event or substitute. Again, she really liked her teachers and they were very supportive of her. DH thinks they let her get away with being a cat too much, but I think it was really all they could do or else she would be crying in a puddle on the floor. She loved to observe and absorbed a lot by just listening even if it seemed like she wasn't participating.
In 3rd grade she really started to be more outgoing about participating in class and had a teacher she absolutely adored and still does. She still needed me to walk with her into the classroom in 3rd grade, however, although I didn't stay as long. It wasn't until mid-year in 4th grade that she didn't want me to come in the class any more. I had started asking by this time if she wanted me to come or not because I didn't want to embarrass her by coming if she didn't want Mom around. She really wanted me there, though, until about mid-year.
This year (5th grade) she's been in public school for the first time and is okay with the sep anxiety, but she does still have some school refusals. We just power through them if we can.
You know that anxiety is exacerbated by avoidance, too, right? Avoiding the source of the anxiety is as bad as throwing them in the deep end to see if they can swim so to speak. It's a tightrope walk. They need a gentle nudge, but don't push too hard or they'll dig in their heels. If you allow them to avoid an anxiety provoking situation that's like saying, "Yes, you need to stay far away from the water—it's very scary! Don't go near it! Good thing you stayed away. You be sure to stay away from now on because it's so scary!" Alternately, you can't just throw the water-phobic child in the deep end and expect them to swim. That's a good way to scar 'em for life. You've got to coax 'em to sit on the edge of the pool and put one big toe in and slowly ease them in until they're sitting on the first step. It's slow and tedious and fraught with tears, but eventually you have little victories you can celebrate ("yay, both your feet are in the water! You can do it!") and eventually you can get that kid swimming.
If you can get your child in that Montessori school or some other school environment that is willing to allow a lot of flexibility and will let you come and walk your ds to class and stay for the first part of the morning, etc, I think that's ideal. Unfortunately so many schools are not that flexible. I did not want to homeschool dd1 because I felt like that would be an avoidance behavior for her and would make her sep anxiety worse, but I thought she would implode in public school. Luckily we were able to find and afford this small private school until last year. I have a lot of friends in the homeschool community and could have easily gone that route, but I just didn't think it was the best thing for her.
She has grown so much these past 6 years. She will always have some anxious tendencies. I really think that's just the way she's wired (much like my MIL), but I think her successes working through her anxieties give her strength to tackle the new anxieties that come her way.
We did not do CBT. We did get her eval'd in 3rd grade at the private school's request (they were concerned about accommodations that might be needed for EOGs). I had thought about getting her eval'd many times before, but I really thought she wouldn't participate and it would cause her more anxiety so I didn't do it until the school requested it. We had a private therapist (psychologist who specialized in educational testing) work with her. She did refuse a few tests, but did most of them. She denied having any anxieties, though, so that didn't even register. Crazy.
The reason, though, that the school was concerned about the EOGs was because in 3rd grade her reading was very much below grade level and they needed some official documentation to be able to read the questions to her. They wanted her to do as well as she could on the science questions, for example, and not have her difficulties with reading cause her science scores to be low. The reason she had trouble with reading then, though, was anxiety! Reading was scary and she felt anxious about it and felt like she couldn't do it. She reads well above grade level now 2 yrs later (500+ page books) and it was just time and familiarity and maturity. There was no magic pill or technique that helped with the reading. We pushed a little bit and one day she discovered if she got out of her own way that she could read and have some flow to it (not halting, skipping words, etc) and she could do it fine! She just had to let go of the anxiety.
As I said, she's been this way since birth. She was the same way about walking. My younger dd2 followed a typical pattern of pulling up around 9-10 months and holding on to furniture and fingers and cruising and falling down on her bum a lot, etc. She was walking shortly before her first b-day. Dd1, on the other hand, did the pulling up and holding on to your finger at about the same time, but she wasn't letting go of that finger at all. She held onto our fingers for a good solid 6-8 months and would not let go and try to walk on her own until she was 17 mo old and was confident she could do it w/o falling down. Same with reading. She wouldn't do it until she could do it w/o stumbling over words or having trouble. Lord knows we wanted her to do both. It really hurts your back to bend over like that for 6 months!
Anyway, I just wanted to say I've been there, done that, and come through on the other side somewhat. Try to find some way to let your ds dip his toes in the water w/o dunking his whole head under if you can. That might be a private school. It might be that an IEP can make that happen.
Best of luck!
ETA: Wanted to add, that you know your child best! Listen to what the therapists and school personnel (and crazy people on the internet) have to say, but they don't necessarily always know what's will work the best. If what they suggest sounds right, then by all means give it a try, but if your intuition is telling you something else you should probably listen. I had a routine when dd2 was in the little private school, too, in K, and dd1 was in 3rd. We would walk dd1 to her class first and leave her there and then take dd2 to her class and then dd1 wanted me to come back and say goodbye a second time. So many people told me not to do this, but it was what worked for us. It provided a little mental security blanket for dd1 to know that I hadn't really gone yet and she could get a little bit into the groove and chat with her friends and settle in a little bit, but she was reassured that I would come back and check on her. The professionals felt like it was hard for her to say good bye twice, but they couldn't see it like dd1 and I could. I have no doubt for another child it would be worse and harder to say good bye twice, but because I know dd1 better I knew that was not the case here. Just remember, you know your child better than anyone else does.
Edited by beanma - 5/12/12 at 11:00am