September 8, 2022
A Guide to School Refusal: Common Characteristics and Clinical Recommendations
By: Jessi Kivari, Rachel Piper, LLMSW & Suzi Naguib, Psy.D.
Introduction
As adults, we understand the importance of receiving an education. Therefore, it can be significantly worrisome and frustrating when your child refuses to go to school. Allowing children to stay home may reduce anxiety and stress short-term; however, continual accommodations to a child’s school refusal has long-term implications. While short-term solutions seem effective in reducing stress, the longer a child refuses school, the more likely a negative behavioral cycle will occur. This blog will define school refusal, explain why it is important to address, highlight important implications surrounding school refusal treatment, and emphasize the importance of additional support.
School Refusal Defined
There is a common misconception that school refusal is the same as truancy or school phobia. Truancy and school phobia do not describe all children who may have difficulty attending school. Children may actually be labeled as truant due to other conditions, such as illness, or due to behaviors associated with social anxiety. School refusal, on the other hand, can be defined as “substantial, child-motivated refusal to attend school and/or difficulties remaining in classes for an entire day” (Kearney & Albano, 2000). School refusal is a deliberate act on the child’s part to refuse school based on one of four specific reasons. First, a child may refuse school due to their desire to avoid school-based situations that invoke depression or anxiety. School-based situations that might provoke negative feelings include transitioning to and from classes, or other negative experiences had on buses, in hallways, in cafeterias, and on the playground. A second motivation that might drive a child to refuse school is the child’s inclination to avoid negative social or evaluative situations. This avoidance behavior can be associated with the child’s difficulty in making friends or talking with others, with academic or athletic performances, publicly speaking, and/or walking into class as others watch.
Another motivation that may push a child to refuse school is the desire to get attention from important attachment figures, who are most often parents. The fourth and final reason that a child may refuse school is to obtain tangible reinforcers outside of school. That is, the child is motivated to skip school in order to watch TV, play video games, go to the mall or shopping, sleeping, hanging out with friends, or to engage in alcohol or drug use. This last reason for school refusal is particularly prominent in the adolescent population. Overall, Children and adolescents are either motivated to get away from something or someone unpleasant at school (as described in the first two driving motivations); or they may be motivated to refuse school in order to get something or someone outside of school that is rewarding and positively reinforcing (as described by the second two motivations).
Risk Factors and Indicators of School Refusal
Research indicates that nearly 28% of American school-aged children refuse to go to school at least one time in their life. School refusal is seen equally often in boys and girls; however, it is more prevalent in children and adolescents with conduct-related disorders. Similarly, school refusal is more common in children and adolescents from low socioeconomic status, urban environments, and ethnic minority populations. The research suggests that this association is due to potentially unpleasant school settings and dangerous environments. This can be problematic because these families are often labeled as truant and subject for legal punitive actions, when in fact, school refusal is not the same as truancy.
It is also important to consider the age of your child when they are refusing school. School refusal tends to peak at 5-6 years and 14-15 years as children and adolescents transition to new schools. Additionally, the age of your child may help you determine why they are refusing school. Children ages 5-11 tend to refuse school in order to avoid feeling negatively or to receive attention from caregivers. On the other hand, children ages 12-17 tend to avoid school in order to escape social or evaluative situations, or to pursue tangible reinforcers outside of school.
When children refuse school, they may also be internalizing and externalizing problems that parents can look out for. Common internalizing problems associated with school refusal may include somatic complaints, such as tremors, nausea, stomach aches, and headaches, depression, social anxiety, general anxiety, fatigue, and fear. Externalizing behaviors children and adolescents may demonstrate include verbal or physical aggression like hitting, stomping, or kicking; refusal to move; tantrums including crying, flailing, or screaming; noncompliance and reassurance-seeking behaviors; and/or running away from school or home.
Consequences of Untreated School Refusal
There are both short-term and long-term consequences that impact a child’s well being if their school refusal behaviors persist without intervention. Short-term consequences may include a significant decline in academics, social isolation or alienation, an increase in stress between the child and parent, increased family conflict, greater risk for legal trouble, greater family financial expenses, lack of supervision, and the potential for child maltreatment. Furthermore, there are long-term consequences associated with significant school refusal, such as economic hardship as a result of low academic achievement. Children with untreated extreme school refusal are less likely to attend college, and research suggests that school refusal behavior is associated with marital and occupational difficulties, poor socialization, and alcohol abuse and criminal behavior.
What Parents Can Do: Tips To Encourage School Attendance Both In and Out of Therapy
As a way to ensure successful outcomes, professionals encourage families to adhere to treatment as much as possible. Your child’s school refusal behavior has disrupted your child’s normal routine, so it is critical to get your child in the habit of waking up and preparing for school once again. Bedtime is especially important, so some families find it helpful to make a contract between caregivers and their children ensuring that their children adhere to a regular bedtime. The contract can include expectations that both the child and parent agree on, and these expectations can specify what bedtime could look like. Furthermore, it is important that families understand that behaviors tend to become worse before they get better, so proper treatment will provide guidance and support in shaping your child’s behavior as well as restructuring family routines.
While it is highly recommended that you seek out professional help if your child has extended periods of school refusal, there are additional tips parents can utilize to encourage day-to-day school attendance. As parents, you can slowly expose your child to school in small increments, gradually increasing time spent at school. You can also talk with your child about their fears and feelings surrounding school as a way to decrease them. Moreover, you can assist your child in building their social support system by arranging playdates or facilitating hangouts with peers, organizing a meeting with your child’s teacher and counselor, or encouraging your child to interact with other family members in order to emphasize socialization. Encouraging extracurricular activities and hobbies to build confidence and self-esteem, discussing the positive features of school, such as friends and recess, and emphasizing their favorite subject areas can also work to support consistent school attendance. For more information on personal accounts of families who experienced school refusal, please see this link from the organization School Refusal Hope (https://schoolrefusalhope.org/).
Conclusion
As parents, we want our children to succeed, so we encourage them to attend school and to strive for academic success. It can be both frustrating and worrisome when children actively refuse to attend school, especially when you feel like you have run out of options. If you’ve noticed that your child has refused school for a significant amount of time, we recommend that you seek help from a trained mental health professional in order to mitigate the short-term and long-term consequences of prolonged school refusal. Children are motivated to refuse school for multiple reasons, and with the right intervention, your child may learn to view school more positively once again.
References
Anxiety and Depression Association of America (2018). School refusal: what parents can do. ADAA. Retrieved from https://adaa.org/living-with-anxiety/children/school-refusal
Glasmann, M. & Olympia, D. (2018). School refusal. In E. Braaten (Ed.), The SAGE encyclopedia of intellectual and developmental disorders (pp. 1410-1413). Thousand Oaks,, CA: SAGE Publications, Inc. doi: 10.4135/9781483392271.n436
Kearney, C.A. & Albano, A.M. (2000). When Children Refuse School: A Cognitive Behavioral Therapy Approach Therapist Guide. Graywind Publications. Book.
Lyon, A. R. (2007). School refusal behavior in ecological context: Broadening sample demographics and methods of assessment (Order No. 3322214). Available from ProQuest Dissertations & Theses Global. (304742140). Retrieved from http://proxy.lib.umich.edu/login?url=https://search-proquest-com.proxy.lib.umich.edu/docview/304742140?accountid=14667
Pina, A. A., Zerr, A. A., Gonzales, N. A., & Ortiz, C. D. (2009). Psychosocial Interventions for School Refusal Behavior in Children and Adolescents. Child development perspectives, 3(1), 11–20. doi:10.1111/j.1750-8606.2008.00070.x