The Truth Behind School Refusal

By Kelly-Ann Allen and Christine Grove, Monash University

The term "school refusal" refers to child-motivated behavior—either refusing to attend school, refusing to attend specific classes, or having great difficulty remaining in school for the entire day. As many as 5 percent of students experience school refusal, but this rate is much higher for students with psychological conditions like anxiety.

Isn’t School Refusal the Same as Truancy?

School refusal can often be confused with truancy, but it is important to recognize the difference between the two. Truancy is usually unexplained and without parental consent. Sometimes, students who skip school have no substantial reason as to why they don’t want to attend school. While truancy and school refusal can both be recurring, this is the only similarity between the two. School refusal is actually quite different from truancy and much more complex.

School refusal, on the other hand, typically results from anxiety or distress at the thought of attending school. It is negatively related to academic achievement and relationships with peers and teachers. You can imagine that a student who is not attending school regularly may find it hard to build relationships with peers. Losing friendships, or failure to make friendships in the first place, can compound students’ anxiety and result in even more school refusal.

School refusal can be quite overwhelming and distressing for students and their families. Families can invest a lot of time and energy to help their children successfully attend school, but most often it’s a daily battle. Thus, school refusal can trigger major conflict within the family. Parents often don’t understand what it is that their child is going through; as a result, school refusal can often be met with frustration and a battle of wills. After so many failed attempts at getting their child to attend school, families can be at odds and not know what to do.

In addition to refusing to go to class or school all together, school refusal can take on other forms, such as:

• Refusing to get dressed in their school uniforms
• Refusing to get out of bed in the morning
• Refusing to travel in the car
• Refusing to leave the car when they arrive at school

Source: Jeremy Bishop/Unsplash

Early Identification of School Refusal

While there is a wide range of possible interventions, getting students to attend these interventions—which are often external to the school—can be just as difficult as getting the student to attend school. Further, there is no quick fix or one-off strategy that solves school refusal. One approach that works well in addressing school refusal is consistent collaboration between parents or primary caregivers, the school, and external professionals who are involved.

Interventions

A professional assessment to identify school refusal triggers has been shown to be very effective in working with the family and child to address this issue. An assessment can identify what may be the triggers associated with school refusal—such as stress, bullying, or a trauma response. It is important to get to the heart of the young person’s difficulties, as there could be underlying anxiety, depression, or another mental health challenge.

Assessment often entails interviews with multiple people and a medical assessment to rule out any physical concerns. Functional assessments, self-reports, parent and teacher reports, and a review of school attendance will provide a comprehensive picture of what is happening inside the mind of the young person.

Exploring the source of anxiety or school refusal will identify what the contributing difficulties are. It is often more than one difficulty happening at once. Relationship issues, severe test anxiety, bullying on social media or real life, family problems, or the ill health of a parent or caregiver can all work together to engender school refusal.

Health care professionals, including school psychologists, usually conduct the assessment and work in consultation with the school and parents to ensure a collaborative approach to address the school refusal and identify the refusal triggers.

Recognize the Signs

• History of separation anxiety

• Excessive complaining

• Worry or stress about school

• Talking often about fears at school that may seem small to the parent, but are in fact big and distressing to the child

• Physical signs like stomach pain, discomfort, or headaches

There are some young people who feel as though they are letting down their parents and/or teachers, and may struggle to open up and explore their triggers. However, establishing a trusting relationship with an adult can help.

For a child who has had low attendance, the school psychologist may be in the best position to work with the young person. The school psychologist will use evidence-based interventions to treat the school refusal using play therapy, psychotherapy, family therapy, or cognitive behaviour therapy. Sometimes, medical intervention—such as using pharmacological approaches alongside therapy—may be considered.

Strategies to Explore and Address School Refusal

• Peer Buddy System: The peer buddy system has been shown to be effective during recess and lunch breaks, as well as for unstructured activities, to help reduce anxiety triggers during these periods.

• Re-Entry to School Plan: Re-entry to school plans can be effective if the student has missed a lot of school days. It is crucial to work in partnership with the young person, school, teachers and professionals to help the youth return to the classroom. This is most often done using a process called systematic desensitization, in which the student might return for a small increment of time to class and then gradually add more time in the classroom. The plan should include strategies that outline what will happen if the young person starts to feel stressed at school that help them feel secure and safe, like taking brain breaks or meeting with the well-being team.

• Routine, Structure, and Sleep: Routine, structure, and sleep are integral to positive school refusal interventions. It’s important to not over-schedule your child, as this can increase worries and stress. Establish specific morning and evening routines and make sure they’re getting enough sleep.

Just like any intervention and healing plan, there can be periods of great improvement followed by setbacks, often after holidays or missing school due to illness. When setbacks occur, acknowledge the young person's struggle, communicate openly and honestly about school, and empathise with their situation. Remember, setbacks feel disappointing for the young person, too, so try not to compound these feelings.