School Refusal – What to Know

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Everybody has days when the call to climb back under the covers can be deafening.

While taking the occasional day off is the key to a healthy mind, research shows that problems arise when these days are the norm – especially for kids who consistently refuse to go to school.

Called School Refusal (SR), this avoidant behavior is defined as a “child-motivated refusal to attend school or difficulties remaining in school for the entire day” (Kearney and Silverman, 1999, p. 345, as cited by Havik et al., 2021). Children experiencing SR show extreme emotional distress related to school and can exhibit many behaviors, including tantrums, yelling, and crying. Physical symptoms such as headaches or tummy troubles can accompany SR, leading to frequent trips to the school nurse.

Reasons for refusal can be as simple as enjoying the comforts of home, including their parents. Other factors at play for a child who refuses to go to school include social anxiety, depression, and concerns about school safety (Allen et al., 2018).

Research shows that children who regularly refuse to attend school share risk factors that help set the stage for these episodes. Havik et al. (2021) and Sinha (2021) found that the children shared a lack of belief in their own coping skills and other factors, such as high family stress levels, bullying, and pressure to achieve.

Undoubtedly, children are under immense pressure from all sides, but they’re not the only ones who feel the effects of SR. SR and other school-avoiding behaviors have a ripple effect reaching teachers, parents, fellow students, and the school population at large. Understanding and helping children deal with the risk factors leading to SR is essential for their academic and social development. Unfortunately, incidents of SR are rising, with nearly 10 percent of children missing 1-2 days a week, according to Yale Medicine (2022).

Everyone’s needs are different regarding therapy, and treatment for SR is not a one-size-fits-all proposition. Recognizing this, many institutions are creating customized programs to combat SR. One such organization is Rogers Behavioral Heath, a national not-for-profit with offices as close as Philadelphia that provides mental health and addiction treatments for children, teens, and adults. Programs such as those offered at Rogers often include Cognitive Behavioral approaches, which allow the child to create new pathways to help them successfully process the stressors they associate with attending school. Relaxation treatment that teaches children how to cope with stressors also has been successful (Maynard et al., 2018). 

Refusing School? Get to the bottom of it!

  • Investigate: Reach out to school resources such as your child’s teacher or a guidance counselor to understand potential stressors.
  • Quiz the Kid: If possible, ask your child to pinpoint their stressors.
  • Nip it: Skipping too many days can impact your child academically and socially. Early detection is vital!
  • Keep it boring: Ensure a dull day at home by restricting screens or other entertainment – it will put the school in perspective!
  • Stand firm: Explain in an empathetic way that school is necessary and should be attended unless they are physically ill.

*Information courtesy Harvard Health Medical School.

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Allen, Claudia W., Diamond-Myrsten, Sharon, Rollins, Lisa K. (2018) School Absenteeism in Children and Adolescents. University of Virginia School of Medicine, Charlottesville, Virginia American Family Physician. 12(15) 738.

Birch, Julia Martin. 2018. School refusal: When a child won’t go to school. Harvard Health Publishing.

Gonzálvez, C., Díaz-Herrero, Á., Sanmartín, R., Vicent, M., Pérez-Sánchez, A. M., & García-Fernández, J. M. (2019). Identifying Risk Profiles of School Refusal Behavior: Differences in Social Anxiety and Family Functioning Among Spanish Adolescents. International journal of environmental research and public health16(19), 3731.

Havik et al.  (2021) How to Understand School Refusal. Frontiers in Education. Sec. Educational Psychology. 9 (9)

Lingenfelter, N., & Hartung, S. (2015). School refusal behavior. NASN School Nurse, 30(5), 269-273.

Maynard, B. R., Heyne, D., Brendel, K. E., Bulanda, J. J., Thompson, A. M., & Pigott, T. D. (2018). Treatment for School Refusal Among Children and Adolescents: A Systematic Review and Meta-Analysis. Research on Social Work Practice, 28(1), 56–67.

Sinha, S. (2021). School refusal: A psychological analysis. Indian Journal of Health and Wellbeing, 12(4), 485-488.

Yale Medicine. (2022) Avoiding and Refusing to go to School.

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