School refusal (school avoidance)
A child’s repeated refusal to go to school, or great difficulty staying there, driven by distress such as anxiety, low mood or fear of something at school. The child usually stays home with a parent who knows, which sets it apart from truancy. It ranges from tears and stomachaches at the door to months at home.
What drives it
Staying home brings instant relief from the dread, and that relief makes the next morning harder. Kearney groups the reasons into four: avoiding feelings that school brings on, escaping social or evaluative situations, wanting attention from a parent, and getting rewards outside school. For identification it helps a family see the morning battle as distress with a function that can be named.
How it shows
Work
A parent arrives late or calls in again, with a boss losing patience, and spends the working day waiting for the school to phone.
Relationships
Stomachaches and headaches on school mornings that fade by ten. Crying in the car outside the gate. Sunday nights get worse. Parents disagree about whether to insist or let the child stay home, and the school sends letters about attendance.
Self
Notice what your child says, and what their body does, on a school morning compared with a Saturday, and what happens in your house once the decision to stay home is made.
What tells it apart
Generalized anxiety: Generalized anxiety is worry across many areas of life. School refusal may grow out of it, or out of separation fears, social anxiety, bullying or a learning difficulty, so the anxiety may be the cause and the refusal the sign.
After-school restraint collapse: After-school restraint collapse is a meltdown at home after a school day the child has managed. School refusal is more likely when the distress comes before school and keeps the child from getting there.
Social anxiety: Social anxiety centers on fear of being judged. It may be what drives school refusal when the dread is about the class, the lunchroom or speaking up, more than about leaving home.
A test
Look at when the distress peaks and what it is about: leaving a parent, something at school, or something that happens at home on a day off. Physical complaints that vanish on weekends and holidays may point to school refusal, once a doctor has ruled out illness.
Questions to carry
- On the last morning my child couldn’t go, what were they most afraid of?
- What happens in me when I picture making them go, and when I picture letting them stay?
Go deeper
- Read: The Kazdin Method for Parenting the Defiant Child, Alan E. Kazdin with Carlo Rotella, 2008. Written for parents by a Yale psychologist who spent decades testing parent management training: praise and small rewards for the behavior a parent wants to see, built up in small steps. That approach has many controlled trials behind it with children referred for defiance and aggression, though Kazdin's own 1997 review said questions remained about how large, wide and lasting the effects are. The book itself does not walk through the studies. It carries the Association for Behavioral and Cognitive Therapies' Self-Help Seal of Merit.
How strong the research is
moderate. In the Great Smoky Mountains Study of children aged 9 to 16 (Egger, Costello and Angold, 2003), anxious school refusal went with depression and separation anxiety disorder, truancy went with oppositional and conduct disorders and depression, and the two often overlapped. A Campbell review of 8 trials (Maynard and colleagues, 2015) found that psychological treatments, mostly cognitive behavioral, improved attendance (g = 0.54) without a clear drop in anxiety. Kearney and Silverman’s four functions are assessed with the School Refusal Assessment Scale-Revised (Kearney, 2002).
Where it comes from
Christopher Kearney and Wendy Silverman, functional model, 1990. Christopher Kearney, School Refusal Assessment Scale-Revised, 2002. Earlier called school phobia