Causes of School Refusal

There are a number of factors that cause or contribute to school refusal:^1,3

• Breaks from school when children become closer to a caregiver (e.g., after a summer break or a holiday vacation)
• New challenges at school
• Anxiety symptoms or an anxiety disorder, including Separation Anxiety Disorder, which is more common in young children, or school phobia or Panic Disorder, which is more common in older children and adolescents. More
• Major changes (e.g., deployment, moving or changing schools)
• Significant stressors (e.g., death of pet or loved one, divorce)
• Bullying
• Tests or oral presentations
• Athletic performance
• Undressing for showers in gym class
• Not getting along with teachers or peers

Allowing children to stay home from school can further contribute to school refusal behavior. For example, staying home is more fun: No homework, easy access to television and/or a computer, more time with parent(s), etc. Also, a young person gets to avoid any negative or uncomfortable things that have happened at school or avoid something uncomfortable that they think might happen at school. The more a child or adolescent avoids school the more it reinforces their belief that they cannot cope at school. By staying home and avoiding school, children and adolescents may also become progressively withdrawn from peers, and may become anxious about other situations in life (e.g. leaving the house, being around peers in other settings), and are at risk for developing symptoms of depression.¹

Facts About School Refusal

Although many children and adolescents may refuse to attend school from time to time, it is estimated that between one and five percent of school-aged children suffer from significant problems associated with school refusal. Boys and girls seems to be equally affected.^1,2

According to the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), school refusal is not classified as a mental disorder. However, children who refuse to go to school may be suffering from a mental disorder, such as an Anxiety or Depressive Disorder.¹ Typically there is an anxiety component underlying school refusal, however young people who are refusing to attend school do not necessarily meet criteria for an Anxiety Disorder.

Once school refusal has developed into a regular pattern it has become a significant problem. Children or teens are not likely to "outgrow" the problem, particularly if they are continually allowed to avoid school-related problems and/or fears by staying home. Like many anxiety-related issues, the more the feared situation is avoided, the worse the problem becomes. Symptoms are likely to improve over time for families and young people, who receive treatment or learn coping strategies that they regularly practice while attending school.

¹Heyne, D.  (in press). School refusal. In J. E. Fisher & W. O’Donohue (Eds.). Practitioner’s guidelines for evidence based psychotherapy. New York: Kluwer.

²Burke, A. E., & Silverman, W. K. (1987). The prescriptive treatment of school refusal. Clinical Psychology Review, 7, 353-62.

³American Academy of Child and Adolescent Psychiatry (2004). Children who won’t go to school. Fact Sheets For Families, 7. Accessed 4/18/06.