Treating Anxiety-Based School Refusal

More and more kids are refusing to go to school, leading to a worsening of their depression and anxiety..

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The Rise of Chronic Absenteeism

Chronic absenteeism—defined as students missing more than 10 percent of the school year—has become a serious issue in the aftermath of the COVID-19 pandemic (U.S. Department of Education, 2025).

During the 2022–23 school year, 28 percent of students in the U.S. were chronically absent. A significant portion of these absences is increasingly linked to mental health issues such as anxiety, depression, or both.

According to a student survey, 16 percent of those who missed school cited anxiety as the reason, while 12 percent reported feeling too sad or depressed to attend (EdWeek Research Center, 2023).

Understanding School Refusal

In more severe cases, this pattern of absenteeism develops into what clinicians refer to as school refusal. This typically begins with increased complaints about school, especially in the morning before school starts. Over time, these complaints escalate, and the child begins to miss many days of school, much to the frustration and worry of their parents or caregivers.

The child or teen often tells their parents that they are too anxious or too depressed to go to school. In an effort to avoid further distressing their child, many parents allow them to stay home. At first, this seems like a compassionate response: “How can I force my child to go if they say they’re too anxious?” But eventually, in many cases, the child stops going altogether.

The Escalation of Avoidance and Family Breakdown

When parents try to insist that the child go to school, conflict arises. Some children may become highly dysregulated or even make alarming statements like, “If you try to make me go to school, I’ll kill myself.” In such moments, parents don’t know what to do and are understandably terrified, so they give in. As a result, the expectation of going to school fades away.

This, of course, is the function of the dysregulation, i.e., to incentivize their parents to let go of their expectations. If the child or teen becomes upset every time the topic gets raised, eventually the topic stops getting raised, thereby reinforcing dysregulation. By this point, family routines collapse, and the child often spends most days isolated in their bedroom, passing the entire day (or night) on a screen.

When Good Intentions Make Things Worse

At first glance, reducing demands and avoiding distress seems reasonable. After all, the child is no longer in crisis. But this well-meaning strategy ultimately worsens the underlying problem.

Here’s why.

I’m convinced that if there were a “recipe” for making a child or teen depressed and anxious, it would be to keep them in a darkened bedroom, estranged from family, and give them unlimited, unmonitored screen time. Kids recognize that this life is in sharp contrast to their peers’, and it’s a life devoid of any positive momentum, purpose, or meaningful effort.

The Path to Recovery

Research consistently points to what works in treating anxiety and depression—and it’s not retreating into isolation. Instead, the path to healing involves re-engaging with life:

• Staying busy
• Setting and achieving goals
• Building a sense of purpose
• Participating in meaningful relationships

None of this is easy for someone struggling with mental illness. But these are precisely the things that lift people out of depression.

When it comes to anxiety, avoidance is the enemy. Whether the feared situation is school, social events, flying, snakes, or what have you, the gold-standard treatment is exposure: repeatedly facing those fears until the anxiety diminishes (for example, see Davis, May, and Whiting, 2012). Avoiding challenges in life only strengthens anxiety over time and increases long-term suffering.

Reframing the Role of Parents

It is entirely possible to help most anxious and depressed kids get back to school. The goal isn’t just school because many of these kids also avoid other aspects of life: interacting with family, cultivating friendships (other than with kids who are also avoiding life, common in some online communities), and participating in age-typical responsibilities, such as helping out around the house, getting a driver’s license, having a part-time job, and so on.

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The start of treatment involves helping parents look at all this in an entirely new way. In order to best support the child to move forward and overcome their avoidance, it’s essential that parents raise their expectations and flip the script: “I know this will be hard, but I’m confident you can do it.”

The child will still cite their anxiety or depression, but it’s important that parents counter that narrative: “Yes, true, but people with anxiety or depression can still create a full life, one that’s worth living, and I know you can, too. We’re a family, so we’ll get through this together, but it’s time for a change.”

As the psychologist James Lehman put it, when you excuse a child from the normal responsibilities of life, you’re sending them the message that you agree they are damaged goods.

The Need for Supportive, Structured Intervention

Parents will need tremendous, ongoing clinical support because most children will resist these new expectations with a vengeance. It’s not easy to give up a lifestyle of doing almost nothing, especially when it has become their only, and very unhealthy, coping strategy.

In our clinic, delivering Intensive Family-Focused Therapy, a team of three therapists works with every family. Treating avoidance is highly complex and challenging. This is even more the case when the child or teen is suicidal, so the work must be slow, methodical, strategic, and above all, safe.

Initial goals are intentionally kept modest:

• Completing schoolwork (often first via distance learning)
• Contributing to the family by helping around the house
• Practicing self-care (like showering regularly)

Gradually, these efforts build toward more challenging goals, such as social engagement, recreational activities besides screens, and returning to school. For some kids, online school is a better fit, or alternatively, a hybrid program that allows for both distance learning and some in-person instruction.

Managing Screen Time as Part of Treatment

Getting a handle on and reducing screen time is almost always required. Screens contribute to avoidance in a myriad of ways, but leveraging screen time (using it as a privilege to be earned each day for non-avoidant activities) is also a powerful way to incentivize a child to begin making difficult but important changes.

Growth Through Challenge

We grow in hard spaces, not easy ones. People become confident and resilient by engaging in challenging things—by striving, failing, learning, and persevering—not by avoiding them.

Avoidance may feel like a solution in the moment, but in the long run, it’s the problem. With effective treatment and the right support, even the most avoidant kids can transform their lives and step into the future their parents dream of for them.