School Refusal

School refusal, or school avoidance, occurs when a student will not go to school or frequently experiences severe distress related to school attendance. Children may have problems attending school for many reasons, including anxiety, depression, difficulties with peer relationships, family difficulties, or health concerns.

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, illness or death of a loved one, parental divorce, or academic difficulties.

When left untreated, school refusal causes significant stress for parents. Potential consequences of prolonged school refusal are severe, and may include lack of academic progress, failure to develop satisfactory peer relationships and significant family conflict.

Symptoms and Types

While every child is different, the following are some of the behaviors that may be present in children who refuse to attend school:

• The child may complain of physical symptoms (such as stomachache, headache) that get better when the child is allowed to stay home.
• The child may tell you that he or she is anxious or afraid of a certain situation that happens at school.
• The child may visit the nurse's office while at school, often requesting to be picked up early.

Diagnosis and Tests

School refusal is usually diagnosed with a team approach, including your doctor, you, the child, and school teachers and counselors. Your child's doctor will be involved to rule out any medical problems that may be occurring. A complete history and physical exam will be done. School officials may be contacted for more information.

If it is determined that a child’s school refusal is related to an emotional problems, such as anxiety or depression, or to a behavioral problem such as oppositional or defiant behavior, a child psychologist or other qualified behavioral or mental health professional should be consulted to assist a family with developing and implementing a treatment plan. 

Management

Since every child is unique, each situation will be handled on an individual basis. The following are some of the interventions that may be used to help your child:

• Return the child to school.
• Make sure the school teachers, counselors, and principals understand the situation and do not send the child home for the wrong reasons.
• Consider assessment and or psychological counseling if anxiety, depression, or behavioral problems exist.