School Refusal
No. 7; Updated June 2018
Going to school is usually an exciting and enjoyable event for young children. However, for some it can cause intense fear or panic. Parents should be concerned if their child regularly complains about feeling sick or often asks to stay home from school with minor physical complaints. Not wanting to go to school may occur at any time but is most common in children ages 5-7 and 11-14, times when children are dealing with the new challenges of elementary and middle school. These children may suffer from a paralyzing fear of leaving the safety of their parents and home. The child's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.
Refusal to go to school often begins following a period at home in which the child has become closer to the parent, such as a summer vacation, a holiday break, a long weekend, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.
The child may complain of a headache, sore throat, or stomachache shortly before it is time to leave for school. The illness subsides after the child is allowed to stay home, only to reappear the next morning before school. In some cases, the child may simply refuse to leave the house. Since the panic comes from leaving home rather than being in school, frequently the child is calm once in school.
Children with an unreasonable fear of school may also:
- Display clinging behavior
- Display excessive worry and fear about parents or about harm to themselves
- Shadow the mother or father around the house
- Have difficulty going to sleep
- Have nightmares
- Have exaggerated, unrealistic fears of animals, monster, burglars
- Fear being alone in the dark
- Have severe tantrums when forced to go to school
Such symptoms and behaviors are common among children with separation anxiety disorder. The potential long-term effects (anxiety and panic disorder as an adult) are serious for a child who has persistent separation anxiety and does not receive professional assistance. The child may also develop serious educational or social problems if their fears and anxiety keep them away from school and friends for an extended period of time.
When fears persist the parents and child should consult with a qualified mental health professional. New refusal to go to school in the older child or adolescent may be related to peer/social problems (including bullying) or other behavioral health concerns, and often requires more intensive evaluation and treatment.
Treatment often requires family, child, school, and therapist to work together. In therapy, children learn coping skills to manage fear, and develop a plan to gradually practice returning to school in small, supported steps. This may include shortened school days at first, check-ins with a trusted adult at school, or other supports or contingency plans to make the return feel manageable. The plan should also address underlying problems, such as bullying, learning challenges, social stress, family changes, or other mental health concerns. Schools often work closely with families and therapists to support a structured and timely return to school, which may include accommodations through a 504 plan or Individualized Education Plan (IEP).
In some cases when a child who is refusing to go to school also experiences anxiety or depression, medication may be recommended along with therapy. Medication is not a stand-alone treatment for school refusal. With early treatment and a consistent plan, most children are able to return to school successfully. The sooner help is sought, the better the long-term outcome.
School refusal can feel overwhelming for families, but with the right support, children can regain confidence and return to school.
Your child's school should support your family and your treatment provider's plan for successful school attendance through the development of a 504 plan or Individualized Education Plan (IEP).
Excessive fears and panic about leaving home/parents and going to school can be successfully treated.