School Refusal in Children
One of the additional challenges for parents and a teacher is when, for emotional reasons, a child refuses to
go to school. In the past, the term school phobia was used to describe these children. Today, the term
school refusal is used and identifies the fact that children have significant problems attending school for
many reasons that are not necessarily the result of a true phobia, such as separation or social anxiety. Just as
there are many reasons why children refuse school, there is considerable difference in the severity of the
behavior. Severity of school refusal ranges from frequent complaints about school attendance to part or full
day absence from school. For some children absences may last for entire weeks of school or more. School
refusal occurs in approximately 2% of school-age children although some estimates are as high as 5%.

Possible Causes for School Refusal

School refusal may be a child’s reaction to anxiety over separation from a parent, anxiety about performance
circumstances such as taking tests or giving speeches, social anxiety, or other stressful situations at school
or home. These children show extreme distress about attending school, including an increase of physical
complaints (stomachaches, headaches). Usually their parents have knowledge of the absences.
These children are unlike students who are truant, in contrast to school refusal students, they generally hide
their absences from their parents, may be involved in antisocial activities, and typically they don’t show
emotional distress about attending or missing school.

School refusal occurs at all ages but has been found to occur more frequently during major changes in
children’s lives such as entrance to kindergarten or the change from elementary to middle school. School
refusal also tends to occur with greater frequency following vacations and weekends. Stressful events that
may trigger school refusal include a move, changing schools, the death of a loved one, or
parental divorce or even academic difficulties for some children. When left untreated, school refusal causes
significant stress for parents. Potential consequences of excessive school refusal are severe, from lack of
academic progress, failure to develop adequate social relationships, and significant family conflict which
may develop to adult emotional disorders.

Characteristics of School Refusal

•        Aggression
•        Fatigue/sleepiness
•        Clinging to an adult
•        Fear and panic
•        Extreme comfort seeking behavior
•        General and social anxiety
•        Disobedience and uncooperative
•        Refusal to motivate in the morning
•        Changing anxiety, emotional, social problems into physical complaints
•        Running away from school or home
•        Worry
•        Temper tantrums and crying

Common characteristics and features of children who refuse school due to emotional reasons are varied, and
include the following:

Separation anxiety - Children who refuse school because of separation anxiety may be worried about the
safety of a caregiver or other loved one and fear something bad will happen to that individual. It is common
for these children to complain about going to school and engage in morning battles before school that may
involve crying, yelling, kicking, or flight. While many young children experience separation anxiety in
preschool or before going to kindergarten, the behavior is more serious when separation anxiety is so
extreme that it results in refusal to attend school.

Performance anxiety - Some children have extreme anxiety about taking tests, giving speeches, or athletic
competition in physical education class. Those who have anxiety about these types of performance
situations worry about being embarrassed or humiliated in front of their peers.

Social anxiety - Some children may feel social anxiety or worry about social interactions with peers and/or
teachers. They are uncomfortable in social situations and may fear socializing with classmates have a
tendency to see the world as threatening and have general worries about something bad happening. These
children may also have specific fears of disastrous incidents.

Depression - Some children experience depression or both anxiety and depression, and the symptoms
include sadness, lack of interest in activities, sleep difficulties, feeling tired, feeling worthless, feelings of
guilt, and irritability. A very serious symptom of depression is suicidal thoughts. A child who is talking about
harming himself or herself should be referred to a mental health professional to ensure his or her safety.

Bullying - Some children fear being bullied. These children want to avoid school because of very real
situations in which they are physically threatened, teased, or left out by other children.

Health concerns - Some children tend to have frequent physical complaints. Physicians and the school
nurse can assist parents and school staff in deciding whether a child has a real physical problem or if
physical complaints are related to anxiety. School refusal may also develop after a child has been home sick
with an actual illness. In these situations the child refuses to go to school even after recovering physically.
The child’s physician can communicate with school officials regarding when the child who has been ill can
return to school or whether there are any restrictions for the child at school. If there is no medical reason
for staying home, the child should be at school.

Warning Signs of School Refusal

Parents and teachers need to recognize the following warning signs of school refusal:

•Frequent complaints about attending school
•Frequent tardiness or unexcused absences
•Absences on significant days (tests, speeches, physical education class)
•Frequent requests to call or go home
•Excessive worrying about a parent when in school
•Frequent requests to go to the nurse’s office because of physical complaints
•Crying about wanting to go home

Intervention for School Refusal

When a teacher sees any of these signs it may be a good idea to speak to the school psychologist or other
school support staff and contact the child’s caregiver. It is important to develop an intervention plan as
quickly as possible when these warning signs occur, because a quick response has been found to increase
the chances of successful outcomes.

•If academic difficulties are present, teachers may adjust assignments to the child’s level: Provide tutoring
and/or request evaluation to determine if there is a learning problem or disability requiring other services.

•Provide a quiet and safe area in the school for a child to go to when feeling stressed: This may be the
school psychologist’s or guidance counselor’s office
or another place that feels safe and comfortable to the child.

•Ensure that the child feels safe at school: When a child feels threatened about going to school because of
bullying or a disorganized, unsafe school environment, steps need to be taken to make the child feel safe at
school. Many schools have anti- bullying programs that teach children how to handle themselves when they
feel threatened.

Assessing School Refusal

Since school refusal may be the result of many reasons, assessment should involve a variety of methods and
sources it should include information gathered from more than one setting, such as interviews, observation
of the child, and a review of academic records and attendance history. Questionnaires completed by
teachers, parents, and the student can provide additional information about the child’s developmental, social,
and emotional condition.

Academic ability testing may be required, especially if there are academic difficulties contributing to the
school refusal. An assessment of the reason for the school refusal behavior also involves determining the
causes and reaction of the child’s behavior. Frequent reasons or causes include escaping from anxiety-
provoking situations or to gain attention from a parent or other caregiver. Some children may avoid school in
order to engage in a desired activity at home (watching television, playing video games). Understanding the
satisfaction from school refusal can help in determining the root of the problem.

Assistance with School Refusal

School refusal may involve significant levels of anxiety and/or depression that will need to be assessed and
managed by a mental health professional who will then select intervention strategies customized to the
individual child’s difficulties. Some strategies include relaxation training, social skills training, setting up
rewards or opportunities based on school attendance, goal-setting, and teaching children to use helpful
thoughts and actions when they are worried or fearful.

Parent training may be needed to help develop smooth morning and evening routines and to provide attention
to positive behaviors and while ignoring negative behaviors and physical complaints that have no medical
basis. It is important to emphasize to parents that they should not support the school refusal behavior by
providing an environment at home that is more desirable than school, such as letting the child watch
television, play video games, or engage in other fun activities when he or she is at home during school
hours. For a child who has experienced the death of a loved one or whose parents are going through a
divorce, supportive counseling may be necessary.          Developmental Disorders          Autism          Parenting Issues