He’s sick again. Or so he says. He was fine yesterday, last night even. But today he has a headache and a stomachache. I, with as much patience as I can muster, assure him that his head and stomach will stop hurting after he eats, then after he gets to school… He gives me his 52 best arguments for why he can’t go to school today. Again. When I fail to relent, he becomes anxious, then angry. You would think that this was his very first day of school, that he hadn’t been doing this every weekday morning every fall, winter, and spring since he was four-years-old. It feels like we’ve had the same conversation – argument – every day since he started pre-k. Every morning we replay the same scene over and over again. Every day, win or lose, I am left exhausted and he is anxious and angry.

What is school refusal?

School refusal, or school avoidance, is the refusal to attend school or stay in school due to emotional distress. It’s different from truancy in that kids with school refusal feel anxiety or fear towards school, whereas truant kids generally have no feelings of fear toward school, often feeling angry or bored with it instead. That’s not to say that if your child refuses to go to school because of his emotional distress, that he won’t incur a truancy petition being filed by the school, just as he would if he were refusing out of defiance. Additionally, school refusal can often come out in the form of anger or hostility; it can be hard to distinguish between defiance and emotional distress, especially at first.
There are various signs and symptoms of school refusal, and it can look different in every individual. These kids may outright refuse to attend school or create reasons why they shouldn’t go. Some common signs and symptoms include
  • The child saying they feel sick often or waking up with a headache, stomachache, or sore throat (or offer some other vague, unexplainable symptom).
  • If he stays home from school, these symptoms might go away but come back the next morning before school.
  • The child may have crying spells or throw temper tantrums.
  • They have frequent complaints about attending school.
  • Frequent tardiness or unexcused absences.
  • They are absent on significant days (i.e., tests, speeches, p.e. class).
  • They make frequent requests to call or go home.
  • They may worry excessively about a parent when they are in school.
  • They might make frequent requests to go to the nurse’s office because of the physical complaints.
  • They may cry about wanting to go home.
It’s important to note that school refusal is not a clinical diagnosis, as deemed by the Diagnostic Statistical Manual (DSM-5), though it can be associated with several psychological disorders, including separation anxiety disorder, social phobia, generalized anxiety disorder, major depressive disorder, conduct disorder, autism spectrum disorder, and learning disorders, to name a few. It’s critical that kids who are school refusing receive a comprehensive evaluation by a physician and then by a mental health professional if no physiological causes are found.

What causes kids to resist attending school?

There are numeroues reasons why a child might start refusing to go to school. Some factors that can cause such reluctance are as follows:
  • The child might want to avoid school-related issues and situations that cause them to experience unpleasant feelings, such as anxiety, depression, and psychosomatic symptoms. It is one symptom that can indicate the presence of a larger issues, such as an anxiety disorder, depression, learning disability, sleep disorder, or panic disorder.
  • The child may want to avoid tests, presentations, group work, specific lessors, or interaction with other kids.
  • The child may perceive their teacher(s) as “mean.”
  • The child may be afraid of failure.
  • The child may want attention from significant people outside of school, such as his parents.
  • The child may be reacting to events such as his parents separating or having marital problems.
  • The child may be jealous over a new sibling.
  • The child may want to do something more enjoyable outside of school, like practice hobbies, play videogames, watch movies, play with friends, etc.
  • The child may be anxious about academic achievement and being tested.
  • The child may have anxiety over toileting in a public restroom.
  • School refusal may be a response to bullying or peer rejection.
  • Shyness or social phobia may contribute.
  • The child might be worried about parents or siblings (such as a parent with substance abuse issues).
  • The child may be anxious or fearful of emergency drills (like fire, lockdown, or tornado drills).
  • The child may feel “lost” at school.
The truth is, school refusal is often a symptom of a deeper problem. Anxiety-based school refusal alone affects 2-5% of school-age kids. It’s even more common at certain ages; school refusal commonly occurs between ages 5-7, between 10-14, and at times of transition such as entering middle and high school.

What can parents do?

When a child won’t go to school, it’s tempting to treat it as a behavioral problem or to simply ignore it and hope it goes away (trust me, I know). But for kids who are afraid of school for whatever reason, being forced to go can be extremely distressing, sometimes even becoming like a phobia.
Not going to school is also not an option, so it’s important that parents find ways to support their child while still helping them get the education they need. Since the types of symptoms these children complain about can be caused by physical illness, the first step that I recommend is getting a physical exam for your child, prefereably with their pediatrician or primary care physician who has experience seeing them. When physiological factors are ruled out, the next step should be to arrange a meeting with your child’s school counselor or with a therapist. Family therapy can even be helpful; it can help your family find ways to support your child.

Other Helpful Strategies

  • Try to correct the problem quickly, if possible. The longer a child stays out of school, the harder it can be to return.
  • Don’t shame your child for not wanting to go to school. Be a supportive partner and an empathetic listener.
  • Talk to your child about their reasons for not wanting to go to school. Brainstorm strategies together to help resolve school problems, such as how to handle bullies and mean teachers. (Rehearsing such responses to these problems can especially be helpful.)
  • Talk about the positive aspects of school (e.g., friends, favorite subject) but without ignoring your child’s negative feelings.
  • Meet with your child’s teacher to discuss the problem. You may also need to meet with school staff to create a plan or an IEP that addresses your child’s needs. Some children need to gradually reintegrate back to school, going to school in small doses as they get used to it. Working at home or with a tutor can help bridge the gap.
  • Help your child build a support system. If they have trouble making friends, help them find new activities they enjoy so they can meet like-minded kids.
  • Encourage and praise small steps.
  • The way you respond to your child’s school refusal can make things worse. You’re your child’s biggest ally.
  • Commit to be extra firm on school mornings, when kids tend to complain most about their symptoms.
  • Keep discussions about physical symptoms or anxiety to a minimum before school.
  • Avoid telling your child’s friends/peers about their school anxiety.
  • Avoid shaming and threatening your child for not going to school.
  • Don’t make fun of your child, and don’t allow siblings to make fun of them for not going to school.
  • Don’t do nothing, assuming the issue will work out on its own.
  • If your child does stay home, be sure he’s safe and comfortable, but don’t give him any special treatment (no special snacks, visitors, etc). He should be supervised throughout the entire day.
  • Don’t take it personally.

How Counseling Can Help

Since school refusal is often related to a deeper mental health issue, such as anxiety, counseling can be especially beneficial. A trained therapist can assess and evaluate whether your child is struggling with something or is “just being defiant.” I use various psychological approaches appropriate to the child’s age that provide not only empathy and validation but also cognitive-behavioral strategies such as systematic desensitization, exposure therapy, and operant behavioral techniques. The goal of treatment is to help the child to restructure his thoughts and actions into a more assertive and adaptive framework that allows a more rapid return to school. I also work with the family in helping them support the child, as well as help frazzled parents learn how to better cope. Additionally, in most instances, a counselor will work collaboratively with the child’s school.