School Refusal

School refusal/ avoidance

The term ‘school refusal’ or ‘school avoidance’ refers to the behaviour of children who experience symptoms of anxiety in relation to school attendance. Though many children will refuse to go to school at some stage in their lives, school refusal is marked by a significant number of absences from school on an ongoing basis with the child usually remaining at home. About 2 per cent of all school-aged children experience school refusal. It tends to peak in the first year of school, at the end of primary school and again in junior secondary school—that is, around transition times. The school refuser is more likely to be a younger member of the family. Children can become quite desperate and creative in their ploys to avoid school. This can result in lots of distress, threats by children to harm themselves and much disruption to the family. Parents can also become very stressed and impatient about this issue and will benefit from support from schools and other professionals so they can in turn, support their child. School refusers are typically of average academic ability or higher, although the longer they miss school, the greater the chance for gaps in learning to develop. When at school, these children are generally compliant in the classroom and well behaved.

Why do children refuse to go to school?

The reasons why children refuse to attend school are often complex and due to a combination of factors, rather than one single issue. These factors may include academic problems; teacher, friendship and relationship concerns; issues at home including family illness, separation or grief or dysfunction; and major transitions for the child such as moving schools, returning to school after a serious illness, or entry and exit into primary school or early or middle secondary school.  School refusal is usually not a result of bullying but, as it is evident in a small number of school refusal cases, teachers should ensure that this is not one of the issues or causes. 
School refusal is typically linked to anxiety in the child, and is often associated with early separation anxiety and/or generalised anxiety disorder (persistent worrying across a range of issues). School refusal can become an entrenched on-going issue. It can become more difficult to address in the later years of schooling because the anxiety may be based on a distant anxious memory and staying at home may have become a comfortable habit.

Is school refusal the same as truancy?

School refusal is different from truancy. Parents of the school refuser generally know their child is not at school, while those of a child who truants may not. The child who truants avoids school because they want to engage in activities (often antisocial in nature) that are typically outside both school and home. The school refuser often wants to be at school but cannot summon the courage to go.  School refusal is also different from school withdrawal, where a parent or parents either condone or collude with the child to stay home.

Behaviours of school refusers

Children who school refuse may exhibit the following signs:
  • Gastrointestinal upset- e.g. stomach aches, nausea, vomiting, diarrhoea
  • Headaches
  • tearfulness
  • Rapid heartbeat
  • Panic attacks
  • Sweating and shakiness
  • Hyperventilation
  • lack of friends, social isolation or withdrawal
  • decreased participation in class activities
  • nervousness
  • difficulty concentrating or remaining on task.
The onset of behavioural signs of school refusal can be very gradual. At home, the symptoms can escalate at night but will diminish once the child is sure they don’t have to go to school.

Strategies to support the child who school refuses

  • Respond to multiple absences immediately. It is important that you or another designated person such as the deputy or assistant principal contact the parents to enquire why the child is absent if they have been away for three or more days or have been absent frequently.
  • Meet with the parents and the child at school. After consulting senior school staff, it can be helpful to request the expertise of the school psychologist and deputy or assistant principal at the meeting. Use the meeting to discuss possible causes of the child’s anxiety. If the child cannot or does not want to tell you the reasons for their school refusal, list reasons they might not want to come to school and carefully observe their body language. Look for head nodding or active avoidance of your gaze after each suggestion as an indicator of a possible cause. If a reason can be identified, ask the child to suggest a solution to the problem, and ask others at the meeting to help brainstorm solutions. 
  • Acknowledge and validate feelings. Parents often ‘shy away’ from doing this because they have concerns that by acknowledging their child’s distress, fear and/or reluctance to attend school, that they will be giving their child a mixed message. It is helpful to think of a two-fold approach in which parents are firstly able listen to and support their child’s expression of feelings. This can include exploring what is happening by asking open questions, getting children to share and discuss their fears, then problem-solving with them.
  • Be firm about school attendance. This is the second step in which your child’s behaviour requires firm boundaries, especially around school attendance. As with any form of anxiety, the best remedy is for children to ‘face their fears’. Children will use all manner of strategies to try and get parents to let them stay home or to bend school rules, so parents will need to be united and consistent in their approach.
  • Avoid punishments and blame. A punitive approach where a parent may yell at, demean or impose harsh punishments on a child for their anxiety is likely to make the situation worse. This will increase a child’s anxiety, as well as making them feel worse about themselves and more anxious about their relationship with their parents.
  • Use consequences wisely. Consequences are different to punishments and can have a place. For example, a child who stays home from school, should not have access to privileges such as watching TV, playing electronic games or on the computer. They can work on homework or school projects. Some consequences may make anxiety worse, for example, restricting your child from spending time with friends or playing sport.
  • Be flexible and creative. Parents frequently need to’ think on their feet’, in order to respond effectively to school anxiety. For example, if one morning a child is very distressed and refusing to attend school, the parent could negotiate with the child for them to attend school for the morning only. This way, the child still experiences ‘facing their fears’. Some parents may have a contract with their child, where they allow their child a small number of ‘mental health’ days per term. That way, the child regains some control and can assess whether their anxiety is so bad they need to use a day. The parent can also put in place an incentive system, whereby if the child has spare days left at the end of term, these can be converted into a reward, such as an outing or treat.
  • Provide lots of praise and positive reinforcement. Pay careful attention to when your child is ‘facing their fears’ and give them specific praise about this. This will help build their confidence. For example, “I know you had a lot of anxiety this morning, so well done for getting to school on time. How did you do this? What helped?”
  • Contain and manage your own anxiety. There is nothing like a child refusing to go to school to make parents feel helpless and then angry or upset. Try to be aware of your own feelings but put them ‘on hold’ whilst you deal with your child’s feelings. Model stress management, for example create a pause in a stressful encounter with your child by taking some ‘time-out’ to gather your thoughts or do some deep breathing.
  • Seek support. Anxiety can be isolating for everyone in the family. Talk to the school about what is going on and see if they are able to put strategies in place at school, to assist your child. For example, your child can see the school counsellor or could have a special place or person to seek support from as needed etc. School liaison officers can help get children to school.