Going back to school is a time filled with emotions for children – excitement and curiosity, but also nerves and anxiety. For students, feeling anxious when returning to school is normal. But for some children that anxiety becomes overwhelming, and some may refuse to go to school to avoid those feelings. 

When it comes to school refusal, it’s important to note that your child is not alone. As many as five percent of students in the United States engage in school refusal. The truth is parents can feel powerless to help their kids. Understanding why children refuse to attend school and knowing ways to address it can help parents overcome this hurdle. 

What is school refusal?

School refusal is when children or adolescents have difficulty consistently attending school for the full day or even partial days. Most kids have some reluctance to go to school at one time or another, but kids with school refusal have difficulty attending on a regular basis and it is usually associated with significant distress.

While school refusal is not a specific disorder on its own, it is commonly associated with several anxiety and fear-based disorders including:

Why do kids avoid school?

There are many different reasons children will avoid school and every child is different. Anxiety is often a major reason for school refusal, but other conditions may also be a factor, such as:

  • depression
  • oppositional behavior
  • bullying/targeting in the school environment 

In addition, times of transition can also serve as a trigger for children to avoid school. Examples include:

  • returning to school after summer vacation or winter break
  • after remote learning
  • when starting at a new school
  • moving from elementary to middle school or middle to high school
  • after being home for illness 

How does anxiety impact school refusal?

As humans, when we feel anxious, our natural tendency is to avoid or escape that situation. If children face anxiety triggers in the school environment, they naturally experience the urge to avoid school or leave school early to escape whatever is causing the anxiety. 

Experiences in school may also trigger anxiety and the desire to escape, such as: 

  • having a panic attack at school 
  • perfectionism or performance worries and the feeling of pressure to get good grades
  • social anxiety triggered by getting called out in class or navigating the unstructured times such as the lunchroom 

By leaving or avoiding school, children experience relief - that feeling of anxiety goes away. This relief is a powerful reinforcer. In other words, avoidance works in the short term to lessen distress, but in the long term it maintains anxiety and makes it more difficult to get back to school. Kids need the opportunity to learn that they can handle being at school, they can tolerate those feelings of distress and they can get through the day. 

How to treat school refusal

The first step in treating school refusal is to understand what is causing the avoidance. We want to tailor treatment to each individual, so we address their core fears. 

We encourage parents to be curious. Ask your child why they are avoiding school rather than assuming you know the reason. Open the door for dialogue. For instance, if a child is being bullied, we need to know about that, and we want to be sure there is appropriate intervention, and the student is returning to a safe environment.

When a child and parent seek treatment for school refusal, we will start out with a thorough assessment to understand the child and the family, and what the reason may be for the school refusal. While individual therapy will be different for each child, the guiding principles of treatment are the same.

Cognitive behavioral therapy, specifically exposure therapy, is an effective treatment to help children return to school. Exposure therapy involves the child slowly taking manageable steps to be reintroduced to the school environment, or to face the parts of school that are anxiety-provoking. The key is reintroducing the child to what causes their anxiety in small steps, so the child is not overwhelmed.

For example, if a child has not attended school for a while, we will work with the parents to help the child gradually return to school. That might involve driving by the school one day, sitting in the school parking lot another day, and walking through the school escorted on another. These small steps give a child the opportunity to learn that they can go to school and cope with this situation and their anxiety.

If there are anxiety-provoking situations in addition to school, we may also do exposure work in the community or a therapist’s office so we can build up a child’s confidence to deal with these situations. The more kids practice, the easier it gets. However, there are some exceptions, and some children may benefit from a higher level of care (for instance, a partial hospitalization program) that can provide the additional support they need.

The role of parents when a child refuses to attend school

Frequently there are physical symptoms associated with school refusal, such as headaches and stomach aches. It’s important to take these symptoms seriously, so have your child evaluated by a pediatrician to first rule out physical illness.

Everyone needs to be confident that we are not missing something serious that needs medical treatment. Once that has been accomplished, we have behavioral therapy that can be remarkably effective in getting kids back to school.

Parents play a critical role in developing the plan for treatment and for making that plan happen. Parents often assist in exposure therapy and may need to set firm limits to get the child to school.

This can be exhausting and may cause conflict within families, affect parents’ ability to get to work on time, and more. We like to partner with parents in helping them set these limits while validating their child’s emotions and experiences. 

We can also develop a “what ifs” guide for parents, so they have a plan to address different situations as they arise. For example, it is important for parents to recognize that being at home gives the child access to preferred activities such as television or video games, which can also reinforce school avoidance. Therefore, we may talk to parents about how to make home more school-like and less fun.

Get the school involved in your child’s treatment

We recommend that parents talk with the school as early as possible when a child is avoiding school. The more school that is missed, the harder it is to get a child back. The school staff can be extremely helpful for families. They have a lot of experience dealing with this issue and can offer resources to help. 

For instance, you could have someone help your child with transitions (such as leaving the car), or have a designated guidance counselor, social worker, or someone the child can go to if they need a break or are experiencing a trigger. 

School refusal also means missing academics. If a child is behind in lessons or assignments, it can cause more stress for the child. Collaborating with the school can help to address this, perhaps by assigning less classwork, offering longer deadlines for assignments, or providing additional tutoring to help the child catch up. 

It’s important for parents to remember that schools have a lot of experience working with kids who feel anxious. Sometimes simple interventions are available that can make a big difference for children. 

We’ve treated many children and families for school-related anxiety. If your child is struggling, let us help you. Learn more about our program here or learn more about school refusal in this Mindcast podcast from the experts at Bradley Hospital.  

Jennifer A. Herren, PhD

Jennifer Herren, PhD is a staff psychologist at the Pediatric Anxiety Research Center (PARC) and a clinical assistant professor in the department of psychiatry and human behavior at Brown University. She specializes in the use of cognitive behavioral therapy (CBT) and exposure therapy in treatment of pediatric anxiety and obsessive-compulsive disorder (OCD).