School Refusal in Children - Bright Tots - Information on child development - Autism information.
School Refusal in Children
One of the additional challenges for parents and a teacher is when, for emotional reasons, a child refuses to go to school. In the
past, the term school phobia was used to describe these children. Today, the term school refusal is used and identifies the fact
that children have significant problems attending school for many reasons that are not necessarily the result of a true phobia,
such as separation or social anxiety. Just as there are many reasons why children refuse school, there is considerable difference
in the severity of the behavior. Severity of school refusal ranges from frequent complaints about school attendance to part or full
day absence from school. For some children absences may last for entire weeks of school or more. School refusal occurs in
approximately 2% of school-age children although some estimates are as high as 5%.

Possible Causes for School Refusal

School refusal may be a child’s reaction to anxiety over separation from a parent, anxiety about performance circumstances such
as taking tests or giving speeches, social anxiety, or other stressful situations at school or home. These children show extreme
distress about attending school, including an increase of physical complaints (stomachaches, headaches). Usually their parents
have knowledge of the absences.
These children are unlike students who are truant, in contrast to school refusal students, they generally hide their absences from
their parents, may be involved in antisocial activities, and typically they don’t show emotional distress about attending or missing

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,
the death of a loved one, or
parental divorce or even academic difficulties for some children. When left untreated, school refusal causes significant stress for
parents. Potential consequences of excessive school refusal are severe, from lack of academic progress, failure to develop
adequate social relationships, and significant family conflict which may develop to adult emotional disorders.

Characteristics of School Refusal

•        Aggression
•        Fatigue/sleepiness
•        Clinging to an adult
•        Fear and panic
•        Extreme comfort seeking behavior
•        General and social anxiety
•        Disobedience and uncooperative
•        Refusal to motivate in the morning
•        Changing anxiety, emotional, social problems into physical complaints
•        Running away from school or home
•        Worry
•        Temper tantrums and crying

Common characteristics and features of children who refuse school due to emotional reasons are varied, and include the

Separation anxiety - Children who refuse school because of separation anxiety may be worried about the safety of a caregiver
or other loved one and fear something bad will happen to that individual. It is common for these children to complain about going
to school and engage in morning battles before school that may involve crying, yelling, kicking, or flight. While many young
children experience separation anxiety in preschool or before going to kindergarten, the behavior is more serious when separation
anxiety is so extreme that it results in refusal to attend school.

Performance anxiety - Some children have extreme anxiety about taking tests, giving speeches, or athletic competition in
physical education class. Those who have anxiety about these types of performance situations worry about being embarrassed or
humiliated in front of their peers.

Social anxiety - Some children may feel social anxiety or worry about social interactions with peers and/or teachers. They are
uncomfortable in social situations and may fear socializing with classmates have a tendency to see the world as threatening and
have general worries about something bad happening. These
children may also have specific fears of disastrous incidents.

Depression - Some children experience depression or both anxiety and depression, and the symptoms include sadness, lack of
interest in activities, sleep difficulties, feeling tired, feeling worthless, feelings of guilt, and irritability. A very serious symptom of
depression is suicidal thoughts. A child who is talking about harming himself or herself should be referred to a mental health
professional to ensure his or her safety.

Bullying - Some children fear being bullied. These children want to avoid school because of very real situations in which they
are physically threatened, teased, or left out by other children.

Health concerns - Some children tend to have frequent physical complaints. Physicians and the school nurse can assist parents
and school staff in deciding whether a child has a real physical problem or if physical complaints are related to anxiety. School
refusal may also develop after a child has been home sick with an actual illness. In these situations the child refuses to go to
school even after recovering physically. The child’s physician can communicate with school officials regarding when the child
who has been ill can return to school or whether there are any restrictions for the child at school. If there is no medical reason
for staying home, the child should be at school.

Warning Signs of School Refusal

Parents and teachers need to recognize the following warning signs of school refusal:

•Frequent complaints about attending school
•Frequent tardiness or unexcused absences
•Absences on significant days (tests, speeches, physical education class)
•Frequent requests to call or go home
•Excessive worrying about a parent when in school
•Frequent requests to go to the nurse’s office because of physical complaints
•Crying about wanting to go home

Intervention for School Refusal

When a teacher sees any of these signs it may be a good idea to speak to the school psychologist or other school support staff
and contact the child’s caregiver. It is important to develop an intervention plan as quickly as possible when these warning signs
occur, because a quick response has been found to increase the chances of successful outcomes.

•If academic difficulties are present, teachers may adjust assignments to the child’s level: Provide tutoring and/or request
evaluation to determine if there is a learning problem or disability requiring other services.

•Provide a quiet and safe area in the school for a child to go to when feeling stressed: This may be the school psychologist’s or
guidance counselor’s office
or another place that feels safe and comfortable to the child.

•Ensure that the child feels safe at school: When a child feels threatened about going to school because of bullying or a
disorganized, unsafe school environment, steps need to be taken to make the child feel safe at school. Many schools have anti-
bullying programs that teach children how to handle themselves when they feel threatened.

Assessing School Refusal

Since school refusal may be the result of many reasons, assessment should involve a variety of methods and sources it should
include information gathered from more than one setting, such as interviews, observation of the child, and a review of academic
records and attendance history. Questionnaires completed by teachers, parents, and the student can provide additional
information about the child’s developmental, social, and emotional condition.

Academic ability testing may be required, especially if there are academic difficulties contributing to the school refusal. An
assessment of the reason for the school refusal behavior also involves determining the causes and reaction of the child’s
behavior. Frequent reasons or causes include escaping from anxiety-provoking situations or to gain attention from a parent or
other caregiver. Some children may avoid school in order to engage in a desired activity at home (watching television, playing
video games). Understanding the satisfaction from school refusal can help in determining the root of the problem.

Assistance with School Refusal

School refusal may involve significant levels of anxiety and/or depression that will need to be assessed and managed by a mental
health professional who will then select intervention strategies customized to the individual child’s difficulties. Some strategies
include relaxation training, social skills training, setting up rewards or opportunities based on school attendance, goal-setting, and
teaching children to use helpful thoughts and actions when they are worried or fearful.

Parent training may be needed to help develop smooth morning and evening routines and to provide attention to positive behaviors
and while ignoring negative behaviors and physical complaints that have no medical basis. It is important to emphasize to parents
that they should not support the school refusal behavior by providing an environment at home that is more desirable than school,
such as letting the child watch television, play video games, or engage in other fun activities when he or she is at home during
school hours. For a child who has experienced the death of a loved one or whose parents are going through a divorce, supportive
counseling may be necessary.
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School Refusal in Children
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