School Refusal

Written by: Angela Lacalamita, MA, LCPC


School anxiety, refusal and avoidance are increasingly becoming a problem with children/adolescents. Researchers estimate that 2-5% of school age children suffer from anxiety related school refusal. School refusal encompasses a broad spectrum of behaviors to include:

• prolonged absence from school

• sporadic attendance

• skipping classes

• emotional or behavioral difficulty in an attempt to refuse school

• physical complaints of illness without medical explanation (somatic) when faced with having to attend school

There are numerous factors that may influence school refusal. Generally, youth refuse school to avoid academic situations that cause distress (i.e. homework or other school related situations), escape social or evaluative situations (i.e. peer groups or tests), to gain attention from a person in which the child has an emotional attachment toward, to obtain rewards outside of the school setting (i.e. sleeping in, or video games). Many children that display school refusal also display other emotional or behavioral difficulty to avoid school settings i.e., running away, substance use, noncompliance, temper tantrums and aggression. If left untreated, school refusal can lead to significant difficulty with a child’s social, emotional and educational development.

The long-term outcome for children who refuse school is not well established, primarily due to an inconsistent definition.  Regardless of the terminology used, school refusal may be a precursor to disturbances later in life if left untreated. If your child is experiencing difficulty in attending school, a comprehensive evaluation from a mental health professional will reveal the reasons behind the school refusal.

The following are tips that can help your child manage school related anxiety or other stressful situations.

• Relaxation Training: a combination of progressive muscle relaxation and breathing exercises can be helpful. Diaphragm breathing is achieved by inhaling through the nose and exhaling through the mouth for a set number of times. Progressive muscle relaxation is a technique in which a muscle group is isolated and contracted for five seconds and then released. This technique can begin by starting with the feet and gradually work up to the head or vice versa.

• Gradually introduce school to your child in small degrees. Eventually this will help them realize there is nothing to fear and that nothing bad will happen (generally for younger children just beginning school).

• Have your child identify the positive aspects of going to school: being with friends or learning a favorite subject.

• Have your child identify any negative thoughts they may be having. Encourage your child to replace the anxious (negative thoughts) with supportive and calming statements, i.e., “I can handle this.”, “I have done this before.”

• Arrange a meeting with your child’s counselor for support and direction.

• Establish routines: Having a routine offers predictability, improves transitions to school and reduces anxiety. The morning routine prior to school should be the primary focus. It can be a benefit to have regular routines for all parts of the day to limit any behavioral difficulty.

• Learn about your child’s anxiety disorder and research the treatment options.