Getting Ahead of School Refusal in Children

By: Dr. Sarah Haas 🟡 🔴 🟢 🔵 🟣

School refusal isn’t always as obvious as a child flat-out refusing to get in the car. It can show up in many different ways: frequent stomachaches or headaches, repeatedly asking to stay home, withdrawing from peers at school, or complete refusal to attend.

While it can look like defiance, school refusal is almost always rooted in anxiety about going to school (Kearney, 2018). Kids may be struggling with social anxiety, performance-related worries, eating in front of others, or contamination, and the physical or behavioral symptoms (like defiance) may be their way of communicating distress.

Why School Refusal Matters 🟡 🟡 🟡 🔴 🟡 🔴 🔴 🔴 🟢 🔴 🟢 🟢 🟢 🔵. 🟢 🔵 🔵 🔵 🟣 🔵 🟣

Avoiding school can quickly spiral into bigger challenges: academic decline, social isolation, and worsening anxiety. The longer a child stays out of school, the harder it becomes to return—making early, consistent intervention essential. School refusal has been shown to be linked with lower academic performance, risk of school dropout, and increased risk with later issues in one's career and/or relationships (Kearney, 2016). Effective therapy can negate this negative trajectory, and Anxiety -- which is the underlying concern when school refusal emerges -- is one of the most treatable mental health diagnoses!

What School Refusal Is and What it Looks Like 🟡 🔴 🟢 🔵. 🟣

The definition of school refusal is not attending school or are not staying at school during the full day. It is estimated that 35% to 38% of children, between the ages of 10 and 13 experience school refusal (Kearney, 2018).

School refusal can look like so many things, including:

Social anxiety

Withdrawal and depression

Fatigue

Mood changes (stressed and/or irritable)

Physical complaints (stomach or headaches)

Tantrums (verbal & physical aggression)

Difficulty with bedtime on Sunday night

Reassurance seeking (and/or clinging)

Refusal to move /get up in the morning (especially Monday morning)

Noncompliance

Running away from home

Strategies for Addressing School Refusal 🟡 🔴 🟢 🔵. 🟣

1. Partner with the school. Involve teachers, school counselors, and the school nurse in the treatment plan. Counselors can check in with the child and encourage gradual participation, while school nurses can follow a set protocol if the child visits for physical complaints. The importance of this team approach cannot be overstated.

2. Set clear boundaries. Multiple boundaries need to be identified and implemented when it comes to helping a child or teen's school refusal behaviors. It is recommended that parents avoid pulling their child out of school for vacations or optional activities. Maintain clear rules for when leaving school is acceptable—such as illnesses that are better suited for being at a doctor’s office or in a home setting—so the child understands what is and isn’t a reason to go home. Additionally, parents may want to plan ahead for what the home environment will be like if the child completely refuses to go to school for the day, so that staying home doesn't become a reward itself (e.g., getting to play video games during the day, getting to read during the day when they would otherwise be engaged in a less enjoyable activity if at school).

3. Maintain some level of attendance. Even if a full day is overwhelming, work toward partial attendance rather than keeping the child home entirely. The child understanding the expectation that they go to school, and being present for even part of the day, helps reduce the anxiety barrier to returning to school.

4. Build distress tolerance. Help your child learn that it’s possible to feel uncomfortable and still be OK. This skill—often practiced through therapy and real-life exposure—teaches them that anxiety symptoms are temporary and manageable, and that avoiding situations often makes the discomfort stronger.

The Bottom Line 🟡 🔴 🟢 🔵. 🟣

School refusal is a signal—not simply “bad behavior.” When parents, therapists, and school staff work together—with clear boundaries, consistent attendance expectations, and tools to tolerate distress—children are more likely to re-engage in school and feel capable of managing their anxiety.

School refusal stuff can be hard, and can cause tension in the parent/child relationship, but with consistent attendance expectations, clear boundaries, and collaborative support from the school, most kids and teens can return to school successfully. The earlier it’s addressed, the easier it is to break the cycle of avoidance.

ʕ•ᴥ•ʔ If your child’s school refusal is becoming a pattern, talk to your child's school. School personnel often see school refusal over their careers, and may have protocols that they use to encourage attendance. Outside therapy can be a helpful tool—especially when the therapist works directly with the parents to help them navigate their own feelings in their child's situation while maintaining techniques effective in increasing school attendance. The therapists at the Center for Active Minds are uniquely positioned to help parents and children navigate this challenge. Book your consult here to see if we may be a good fit for your needs.

ʕ•ᴥ•ʔ If you’re concerned that your child’s school refusal is linked to another condition, such as a learning difference, you may want to speak with your pediatrician or school psychologist about whether additional evaluations are needed.

A Personal Note 🟡 🔴 🟢 🔵. 🟣

My work over years of working with many different clients has shown me that people are much more resilient than they think they are! When it comes to challenging kids and teens to face their fears, I often tell parents and kids/teens that they can face their worries and handle the situations themselves, but asking their parent to be there or refusing to face the fears limits their ability to grow their confidence in this way.