School Refusal

What is School Refusal?

School refusal is a condition in which a child or adolescent persistently avoids attending school due to emotional distress, anxiety, or other underlying psychological factors. It is different from truancy, as children with school refusal often express a strong desire to stay home and may experience physical symptoms like headaches, nausea, or panic attacks when faced with going to school.


Causes of School Refusal

School refusal is often linked to underlying emotional or psychological conditions. Some of the most common causes include:

  • Separation Anxiety – Younger children may experience distress about being away from their parents, particularly if they have difficulty with transitions or past experiences of separation.
  • Generalised Anxiety Disorder – Excessive worry about school-related situations, such as academic performance, social interactions, or safety concerns.
  • Social Anxiety – Fear of being judged or humiliated by peers or teachers, leading to avoidance of social situations.
  • Depression – Feelings of sadness, hopelessness, or low energy that make it difficult to engage in school activities.
  • Bullying – Fear of being bullied or past experiences of bullying can make school an unsafe place in a child’s mind.
  • Academic Stress – Pressure to perform well, fear of failure, or undiagnosed learning difficulties can make school overwhelming.
  • Major Life Changes – Family disruptions such as divorce, illness, or moving to a new school can increase anxiety and reluctance to attend.
  • Traumatic Experiences – Children who have experienced trauma may associate school with distress or danger.


Symptoms of School Refusal

Children or adolescents with school refusal may display a variety of symptoms, including:

  • Emotional symptoms: Excessive worry, panic attacks, mood swings, sadness, or anger related to school.
  • Physical symptoms: Frequent complaints of headaches, stomachaches, nausea, dizziness, or fatigue, often disappearing when the child stays home.
  • Behavioural symptoms: Crying, tantrums, clinging to parents, avoiding schoolwork, or refusing to get ready in the morning.
  • Academic impact: Declining grades, difficulty keeping up with assignments, or social withdrawal.


Preventing School Refusal

To reduce the risk of school refusal, parents, teachers, and mental health professionals can take proactive steps, such as:

  • Early Intervention – Identifying anxiety, stress, or behavioural changes before they escalate.
  • Positive School Environment – Creating a welcoming and supportive atmosphere that addresses bullying and academic stress.
  • Strong Parent-Teacher Communication – Working together to monitor attendance and address concerns.
  • Encouraging Emotional Resilience – Teaching coping skills, mindfulness, and stress management techniques.
  • Therapy and Counseling – Providing professional support, such as cognitive-behavioural therapy (CBT) for anxiety or social challenges.
  • Gradual Reintegration Strategies – Helping students return to school with partial attendance, flexible schedules, or support systems.


Diagnosis of School Refusal

School refusal is typically identified through parental reports, teacher observations, and professional assessment by a psychologist, psychiatrist, or pediatrician. A proper evaluation considers the following:

  • The child’s school attendance history.
  • Emotional and behavioural patterns associated with school avoidance.
  • Family or social dynamics contributing to school-related anxiety.
  • Possible underlying mental health conditions such as anxiety, depression, or learning disorders.


Treatment and Management of School Refusal

Early intervention is key to effectively managing school refusal. Treatment strategies often involve psychological support, school collaboration, and parental guidance.


1. Psychological Support

  • Cognitive Behavioral Therapy (CBT) – Helps children understand and challenge their fears, develop coping strategies, and gradually reintegrate into school.
  • Exposure Therapy – A gradual approach to helping the child return to school, starting with short visits and increasing attendance over time.
  • Relaxation Techniques – Mindfulness, deep breathing, and progressive muscle relaxation can help children manage anxiety.


2. Parental Support

  • Encouraging and reinforcing school attendance with a structured morning routine.
  • Avoiding enabling avoidance behaviours, such as allowing the child to stay home without addressing the root cause. 
  • It is especially important to ensure that days spent at home are not too ‘reinforcing’, i.e. by ensuring that movies and video game use are kept at a strict minimum (where possible).
  • Communicating openly with the child about their fears and providing reassurance.


3. School Collaboration

  • Working with teachers and school counsellors to create a supportive plan for reintegration.
  • Allowing flexibility, such as initial part-time attendance or a quiet break space.
  • Addressing any academic difficulties or bullying concerns that contribute to avoidance.


4. Medical and Psychiatric Support

  • In cases where school refusal is linked to severe anxiety or depression, professional intervention such as counselling or medication may be recommended.
  • A medical evaluation can rule out underlying health issues if physical symptoms are persistent.


Outlook for Treatment

When addressed early, most children with school refusal can successfully return to school and manage their anxiety.


However, untreated school refusal can lead to long-term consequences, including academic struggles, social isolation, and an increased risk of mental health disorders in adulthood.


Encouraging open discussions, providing emotional support, and collaborating with professionals can help children overcome their fears and confidently reintegrate into school life.