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Behavioral Health

More on School Refusal

Causes Of School Refusal

There are a number of factors that cause or contribute to school refusal:1,3

  • Breaks from school when children become closer to a caregiver (e.g., after a summer break or a holiday vacation)
  • New challenges at school
  • Anxiety symptoms or an anxiety disorder, including Separation Anxiety Disorder, which is more common in young children, or school phobia or Panic Disorder, which is more common in older children and adolescents. More »
  • Major changes (e.g., deployment, moving or changing schools)
  • Significant stressors (e.g., death of pet or loved one, divorce)
  • Bullying
  • Tests or oral presentations
  • Athletic performance
  • Undressing for showers in gym class
  • Not getting along with teachers or peers

For most parents the easiest and most instinctual solution is to allow their children to stay home. However, this actually is the most problematic solution, as it allows the child or adolescent to avoid the anxiety-invoking situation and actually strengthens the avoidant (problem) behavior. Thus, if your child is screaming or throwing a temper tantrum to avoid school, this behavior will become progressively worse each time you allow them to avoid school. Further, the absence from peers and extra attention received by children who engage in avoidant behavior could lead to teasing and increased risk for depression1 If your child or adolescent′s behavior is disruptive and/or defiant, you may will want to work with their school in order to avoid having your child possibly suspended or expelled, which would also reinforce the avoidant behavior and exacerbate the problem.

Facts About School Refusal

Although many children and adolescents may refuse to attend school from time to time, it is estimated that between one and five percent of school-aged children suffer from significant problems associated with school refusal. Boys and girls seems to be equally affected.1,2

It is important to accurately describe the symptoms your child is displaying. This need for accuracy of symptoms is due to the large number of causes that can bring about school refusal (from an anxiety or phobia to conduct disorder). While the Diagnostic and Statistical Manual of Mental DisordersFourth Edition (DSM-IV), does not currently classify school refusal as a mental disorder, research has suggested between 50 to 80% of children refusing to attend school also have a mental disorder such as an Anxiety or Depressive Disorder.1,4 Typically there is an anxiety component underlying school refusal, however young people who are refusing to attend school do not necessarily meet criteria for an Anxiety Disorder.

Once school refusal has developed into a regular pattern it has become a significant problem. Children or teens are not likely to “outgrow” the problem, particularly if they are continually allowed to avoid school-related problems and/or fears by staying home. Like many anxiety-related issues, the more the feared situation is avoided, the worse the problem becomes. In fact, as the child or adolescent ages and the problem continues, the more limited the treatment options and effectiveness. Symptoms are likely to improve over time for families and young people, who receive treatment or learn coping strategies that they regularly practice while attending school.

  • 1Heyne, D. (2006). School refusal. In J. E. Fisher & W. O'Donohue (Eds.). Practitioner′s guidelines for evidence based psychotherapy. New York: Kluwer.
  • 2Burke, A. E., & Silverman, W. K. (1987). The prescriptive treatment of school refusal. Clinical Psychology Review, 7, 353-62.
  • 3American Academy of Child and Adolescent Psychiatry (2004). Children who won′t go to school. Fact Sheets For Families, 7. Accessed 4/18/06.
  • 4Egger, H. L., Costello, E. J. & Angold, A. (2003). Refusal and Psychiatric Disorders: A Community Study. PSYCH.Journal of the American Academy of Child & Adolescent Psychiatry: 42, 797-807.

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