School Refusal in Kids & Teens

School plays a significant role in a child’s early development, so refusing to attend school can harm their growth. Dealing with school refusal early can prevent academic decline, social anxiety, and the risk of long-term avoidance patterns.

Learn how school refusal manifests, what causes it, and what school refusal interventions can be effective for your child.

What is School Refusal?

School refusal is when a child or teenager is too anxious or distressed to attend school. While not a clinical diagnosis, Scolionophobia (an overwhelming fear of school) can occur as a symptom of other anxiety disorders.

What Causes School Refusal?

Sometimes, there isn’t a clear cause for school refusal, but it can result from the following:

• Severe bullying or teasing from other schoolchildren
• Fear of criticism or punishment from teachers or authority figures
• Extreme academic pressure from family members or teachers
• Intense fear of catastrophic or dangerous events occurring in school, such as a school shooting
• Learning difficulties like dyslexia or dysgraphia that hinder a child’s academic performance
• Fear of taking tests or exams
• Anxiety or depression

Problems at home and stressful life events can also contribute to school refusal. For instance, children are more likely to develop school refusal if they experience violence at home or in their community. These changes may also increase with: 

• Financial and resource instability
• Inadequate housing or homelessness
• Significant life changes like divorce or death in the family
• Complete dependence on a parent or caregiver
• Parent divorce

How Common is School Refusal?

School refusal occurs in 2% to 5% of children (or one in 20)[*]. It most commonly occurs in children between 5 and 6 or middle school. School refusal may also occur during transition periods, such as when a child starts high school.

Some children are more likely to develop school refusal than others, especially when they are:

• Chronically ill
• The youngest or only child

While school refusal doesn’t have specific diagnostic criteria, a healthcare provider can understand the root of the problem by reviewing your child’s symptoms, when they appear, how long they last, and what helps eliminate them.

Signs of School Refusal

Children with a phobia of going to school may experience the following physical symptoms when exposed to an academic environment:

• Diarrhea
• Headaches
• Nausea and vomiting
• Tremors and uncontrollable shaking
• Sweating

Psychologically, children might also experience: 

• Extreme clinginess to their parents or caregivers
• Nightmares about going to school
• Becoming overly preoccupied with their safety.

Teenagers with school anxiety might experience more severe symptoms, such as mood swings, substance use, feelings of hopelessness, and withdrawal from social interactions.

School Refusal Tips for Parents

Dealing with school refusal can frustrate parents, but supporting your child is necessary for their future success. Here are some things you can do to help.

Identify underlying issues at home

Consider why your child might not want to go to school. Do they complain about a particular teacher, or did they recently fall out with a friend? Have regular conversations and try to identify triggers.

Suppose you’ve discovered your child has test anxiety. You can help them by practicing test-taking basics at home and introducing relaxation strategies, such as visualization and listening to calming music.

Validate and listen to your child

It can be tempting for parents to dismiss a child’s fears because they believe they can “get over them.” However, listening actively and validating their feelings is essential to convey that you understand their anxiety.

Reinforce to them that their feelings are valid but that they can also work through overcoming them.

Reinforce positive behavior

Reward positive behaviors instead of punishing your child for refusing to go to school. Use an age-appropriate reward system, such as giving a younger child extra play time or treating an older child to a movie.

Personalize these rewards by making them meaningful. For example, if your child is a sports lover, reward them with extra time for physical activities or provide sports-related prizes like a new jersey. For social kids, reward them with experiences like pizza parties or movie nights.

School Refusal Tips for Teachers

Teachers play a significant role in a child’s academic life. They can rebuild confidence and encourage consistent attendance by fostering welcoming classroom environments and staying attuned to their students’ emotions. Here are some helpful tips for teachers.

Communicate with parents

Stay in regular contact with the child’s parents to provide context for their behavior. Collaborate with parents and the child’s healthcare provider to determine methods for making school less intimidating.

Consider recommending an individualized education plan (IEP) so the child can maintain their studies more comfortably and in a safer environment.

Provide access to support staff

If a child’s school refusal results from psychological problems, provide them access to support staff, such as school counselors, a school social worker, or a psychologist. These staff members can determine whether the child requires professional help.

Implement accommodations

Working in a traditional school environment can be overwhelming or even impossible for some children. If this is the case, consider providing the child with accommodations like more flexible deadlines or one-on-one sessions.

When to Seek Professional Help

While school refusal isn’t unusual in kids and teens, there may come a time when parents should seek professional help. Here are some instances that may require professional intervention:

• Despite persistent encouragement, the child refuses to attend school for days to weeks.
• The child shows signs of depression, anxiety, or other mental health conditions.
• The school refusal starts abruptly and escalates quickly.
• The child experiences severe emotional distress when in a school setting.
• Parental strategies, such as positive reinforcement and routine changes, fail to work.
• The school refusal negatively impacts the child’s daily life.

School Refusal Interventions

A multifaceted approach is the best way to address school refusal. It can motivate children and teens while treating the underlying causes of their reluctance. Here are some effective interventions your child’s counselor might recommend.

Talk or Behavioral Therapy

Cognitive behavior therapy (CBT) is one of the most effective treatments for school refusal. It encourages students to challenge negative thought patterns about going to school [*].

During a CBT session, therapists will discuss a child’s associated fears with school and provide techniques for managing anxiety, such as deep breathing, meditation, or grounding exercises.

Dialectical behavior therapy (DBT) is another option for treating school refusal. During sessions, therapists teach children acceptance-oriented and change-oriented skills [*].

For instance, a DBT therapist might teach acceptance-oriented skills like mindfulness, which can help kids become more aware of their anxiety without judgment. On the other hand, a change-oriented skill is cognitive restructuring, in which a child challenges negative thoughts associated with their school refusal.

Educational-Support Therapy

Educational-support therapy combines informational presentations and psychotherapy sessions to eliminate a child’s school-associated fears. This type of therapy involves parents, caregivers, and children—therapists relay information about school attendance to parents and provide children with coping strategies for stressful situations.

Medication

If a child has an underlying anxiety disorder or panic attacks about their school refusal, a psychiatrist might prescribe selective serotonin reuptake inhibitors (SSRIs). These medications can reduce anxiety symptoms [*].

Occasionally, psychiatrists prescribe benzodiazepines on a short-term basis to address severe anxiety. Providers start kids and teens on lower doses and eventually increase them to therapeutic levels, depending on the child’s side effects.

The Bottom Line

Addressing school refusal promptly keeps a child’s academic progress intact. It also teaches them to be resilient during stressful times and build the emotional strength to navigate future challenges.

Help your child manage their fears about going to school with our anxiety worksheets. We provide context and solutions for managing anxious feelings during stressful situations.

Sources:

1. Vincenzo CD, Pontillo M, Bellantoni D, et al. “School refusal behavior in children and adolescents: a five-year narrative review of clinical significance and psychopathological profiles.” ˜The œItalian Journal of Pediatrics/Italian journal of pediatrics, 2024.
2. Maric M, Heyne DA, MacKinnon DP, Widenfelt van, Westenberg PM. “Cognitive Mediation of Cognitive-Behavioural Therapy Outcomes for Anxiety-Based School Refusal.” Behavioural and Cognitive Psychotherapy, 2012.
3. Chu BC, Rizvi SL, Zendegui EA, Bonavitacola L. “Dialectical Behavior Therapy for School Refusal: Treatment Development and Incorporation of Web-Based Coaching.” Cognitive and Behavioral Practice, 2014.
4. Yamada N, Yoshihiro Nakadoi, Ryosuke Fukuma, Tetsuro Ohmori. “Two children exhibiting social withdrawal, school refusal, and underlying generalized anxiety disorder successfully treated using a selective serotonin reuptake inhibitor.” The Journal of Medical Investigation, 2020.