School refusal can wreak havoc on families. More often than not, it comes in the form of tantrums: loud, overwhelming meltdowns that can include refusing to leave the house, running down the street to avoid getting in the car or on the school bus or lashing out with physical blows.
School refusal isn’t just a child whining about yet another long day at school. School refusal can be downright distressing for kids and their parents.
Each school year, approximately 2 to 5 percent of children refuse to attend school due to anxiety or depression. Once referred to as “school phobia,” school refusal includes students with mild cases of separation anxiety who miss a few days here and there to students who miss weeks or even months of school because of severe anxiety or depression.
School refusal is a serious emotional problem that is stressful for both children and parents. It can result in significant short- and long-term effects on the social, emotional, and academic development of the child.
Unlike truancy, students who engage in school refusal aren’t simply ditching classes in favor of more exciting activities or hiding their absences from their parents. Although refusing to walk into school or get into the car might feel manipulative to the exhausted parent attempting to get the child to school, it isn’t. School refusal is triggered by underlying mental health issues that require treatment and support.
Development of school refusal
Although it might feel like school refusal crops up overnight, many children who refuse to attend school have been quietly attempting to stamp out feelings of anxiety and/or depression for quite some time before they refuse to attend school. It develops over a period of time and is sometimes related to the following:
- Separation anxiety: This anxiety disorder is common among younger children and includes excessive anxiety concerning separation from parents and an overwhelming fear of harm (including death) befalling parents or loved ones when separated. It can resurface during the transition to middle school and high school.
- Social anxiety: This includes performance anxiety. Students with social anxiety tend to be preoccupied with being scrutinized by peers and adults, worry about how they are being judged, and experience significant anticipatory anxiety about public speaking.
- Generalized anxiety: Children with this disorder experience excessive anxiety and worry about a number of events or activities, and this anxiety causes distress in social, occupational (school), or other areas of functioning.
- Depression: Childhood and adolescent depression includes a wide range of symptoms and can include depressed mood, irritability, refusal to participate in normal activities, sleep disturbance, changes in eating habits, social isolation, and suicidal thoughts or plans.
Signs of school refusal
Tantrums, running or hiding from school, and lashing out with physical force are clear-cut signs of school refusal, but many students engage in more subtle behaviors. Watch for these signs of school refusal that are sometimes overlooked:
- Frequent physical complaints such as headaches, stomachaches, chest pains, muscle pains, feeling dizzy or feeling exhausted
- Regular trips to the school nurse for no real medical reason
- Illnesses on test days or days when students need to present oral reports
- Frequent requests to call home
- Difficulty getting out of bed in the morning
- Refusal to engage with peers or participate in social activities
- Willingness to complete work at home
How to get help for your child
The best treatment to help children struggling with school refusal includes a team approach. While children tend to focus on what they don’t like or worry about at school, the truth is that the underlying issues can include stress at home, social stress, and medical issues (a child who struggles with asthma, for example, might experience excessive worry about having an asthma attack at school). It helps to have a strong team that includes the classroom teacher, family, a school psychologist (if available), and any specialist working with the child outside of school.
1. Assess: The first step is a comprehensive medical and psychological evaluation. Given that school refusal is generally related to an underlying anxiety or depressive disorder, it’s important to get to the root of the problem and begin there. This will likely include both family and teacher questionnaires or interviews.
2. Cognitive Behavioral Therapy: This highly structured form of therapy helps children identify their maladaptive thought patterns and learn adaptive replacement behaviors. Children learn to confront and work through their fears.
3. Systemic desensitization: Some children struggling with school refusal need a graded approach to returning to school. They might return for a small increment of time and gradually build upon it.
4. Relaxation training: This is essential for children struggling with anxiety. Deep breathing, guided imagery, and mindfulness are all relaxation strategies that kids can practice at home and utilize in school.
5. Re-entry plan: The treatment team creates a plan to help the student re-enter the classroom. Younger children might benefit from arriving early and helping the teacher in the classroom or helping at the front desk. The plan also includes contingencies to help the student during anxious moments throughout the day (using fidget toys, taking a brain break to color, a walk outside with a teacher’s aide, etc.)
6. Routine and structure: Anxious children benefit from predictable home routines. Avoid over-scheduling, as this can increase stress for anxious kids, and put specific morning and evening routines in place.
7. Sleep: Sleep deprivation exacerbates symptoms of anxiety and depression. It also makes it difficult to get up and leave for school in the morning. Establish healthy sleep habits and keep a regular sleep cycle, even during holidays and on the weekends.
8. Peer buddy: Consider requesting a peer buddy for recess, lunch, and other less structured periods as anxiety can spike during these times.
9. Social skills training: Many students who struggle with making and keeping friends feel overwhelmed in the school environment. Social skills groups can help kids learn to relate to their peers and feel comfortable in larger groups.
There isn’t a quick fix for school refusal. You might see periods of growth only to experience significant setbacks following school vacations or multiple absences due to physical illness. Acknowledge your child’s difficulty, engage in open and honest communication about it, empathize with your child, and pile on the unconditional love and support.
Freemont, Wanda P. (2003). "School Refusal in Children and Adolescents," American Family Physician, Oct 15;68(8):1555-1561.
Wimmer, Mary. (2010) "School Refusal: Information for Educators," Helping Children at Home and School, National Association of School Psychologists, Bethesda, MD.