What is school refusal?
Defined as “child motivated refusal to attend school and/or problems remaining in classes for an entire day” (Kearney & Diliberto, 2013), school refusal or avoidance (sometimes referred to as emotionally based school avoidance), is a complex and often misunderstood issue that can have significant impact on both the child and their family. Consistent and excessive school absenteeism can significantly impact a child or adolescents emotional, social and educational development.
It is important to understand that school avoidance is not a clinical diagnosis, it is a symptom of other associated mental health issues and is typically related to other diagnoses such as; social or generalized anxiety disorder, separation anxiety, depression, post-traumatic stress disorder, autism spectrum disorder and attention-deficit/hyperactivity disorder (School refusal: Causes, Symptoms, Treatments | McLean Hospital, n.d.).
What does it look like?
School refusal can present differently but signs may include:
● Frequent complaints of physical symptoms such as headaches or stomachaches
● Avoidance of home work
● Anger/irritability towards family
● Crying, tantrums and pleading with parents to not attend school
● Refusal to get out of bed, leave the house or go to school
● Frequent calls home
● Panic attacks
● Once at school, often leaving class to go home or to the nurses or counsellors office
Refusal to attend school can suddenly occur out of nowhere such as after a significant change in the child’s life, moving schools, transition between primary and secondary school or a break from the regular school schedule (eg after an illness) or gradually over time as the child is less able to cope with the underlying issue ((Williamson, 2023).
Risk factors can be social (bullying, friendship issues, untreated social anxiety), academic (increased academic pressure, homework load, poor executive functioning) or personal (conflict at home, trauma, death or illness) (Cooperman, 2024).
Understanding school refusal (why won’t my child go to school?)
Anxiety and avoidance go hand in hand. Our brains are evolutionarily trained to be vigilant for danger and when it is sensed it triggers our fight, flight or freeze response. For kids who have fear around attending school they do what comes naturally, they avoid it. When they avoid it, the anxiety and distress temporarily reduces and they feel better which in turn means the longer the avoidance goes on, the harder it is to go back to school.
In order to understand why a child is refusing to attend school we need to look at what is motivating the behaviour. “Children often refuse school for more than one of the following reasons:
1. Avoidance of school-based stimuli that provoke distress
2. Avoidance of social or evaluative situations at school that make the child anxious
3. Gaining parent/caregiver attention
4. Gaining access to tangible rewards at home” (Cooperman, 2024)
What can I do?
What do you do when you have a child that refuses to get out of bed or the car and just won’t attend school?
At home, you can encourage open communication by creating a safe space for your child to express their feelings. Let them know you hear them and understand how they are feeling. Encourage them by expressing confidence in their ability to cope, reminding a child of their strengths and other times they have successfully been able to face fears and have been successful.
Reach out for help. Treatment for school refusal is collaborative and team based, it requires families, school and therapists to work together. Reach out to your school’s teachers, school counsellors or administrators to discuss the situation and find out how the school can support and assist.
Seek help and support from a mental health professional who can work with your child, family and the school. Therapeutic interventions for school refusal will most likely include cognitive behavioural therapy (CBT) and exposure therapy.
CBT can help the child identify, challenge and replace negative thinking and worries.
Exposure therapy exposes kids to their fear in a gradual, systematic way to help them to build tolerance of their distress.
On the surface school avoidance may look like a lazy or stubborn child and/or parents who are too permissive or not trying hard enough to get their child to school but it is often a symptom of other associated mental health issues or struggles and it’s important to take it seriously and address the underlying causes.
Additional Resources:
School Avoidance Alliance
Child Mind Institute
https://childmind.org/article/when-kids-refuse-to-go-to-school
To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.References:
References
Cooperman, A. (2024, July 9). School avoidance and refusal: Root causes and strategies for parents and educators [Webinar]. Additude. https://www.additudemag.com/webinar/school-refusal-avoidance-adhd-students/
Kearney, C. A., & Albano, A. M. (2004). The functional profiles of school refusal behavior: Diagnostic aspects. Behavior Modification, 28(1), 147–161.
https://doi.org/10.1177/0145445503259264
Kearney, C. A., & Diliberto, R. (2013). School Refusal Behavior. In The Wiley Handbook of Cognitive Behavioral Therapy (pp. 875–892). American Cancer Society. https://doi.org/10.1002/9781118528563.wbcbt37
McLean Hospital. (n.d.). School refusal: Causes, symptoms, treatments. Retrieved January 2, 2025, from https://www.mcleanhospital.org/essential/school-refusal
School Avoidance Alliance. (n.d.). We help families and schools get students back to school. Retrieved January 2, 2025, from https://schoolavoidance.org/
Williamson, M. (2023). School avoidance: How to help when a child refuses to go. The Journal of Family Practice, 72(7). https://doi.org/10.12788/jfp.0653