Identifying School Refusal

Sometimes children and adolescents have difficulty attending school on a regular basis. When absences are reasonable (e.g., due to illness), missing school is appropriate. When young people fail to attend school for other reasons, the term "school refusal" is sometimes used to describe these occasions. School refusal includes the following circumstances:1

  • Child or adolescent refuses to attend school, which may lead to prolonged or repeated
    absences
  • Child or adolescent usually does not try to hide absences from parents (i.e., remaining at
    home during school hours, rather than skipping school with friends)
  • Child or adolescent becomes upset (e.g., excessive anxiety or sadness, temper tantrums, unexplained physical symptoms) about having to attend school
  • Caregivers try (or have tried) to force the child or adolescent to attend school

School refusal can come on suddenly or escalate gradually. Young people can exhibit a number of behaviors when confronted with the requirement to attend school when they do not want to:1,3

  • Temper tantrums
  • Intense emotional displays
  • Complaints about school
  • Threats to run away or harm themselves
  • Physical complaints (e.g., illness, headache, stomachache)
  • Irrational belief that something might happen at school
  • Nightmares and insomnia
  • Excessive worry about safety-related issues
  • Clinginess

Sometimes children and adolescents will refuse to go to school or will skip school because of behavioral problems as seen in Oppositional Defiant Disorder. or Conduct Disorder. You may also find Self-Help Resources to be helpful. More information about truancy.

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Clinical Assessment Tools


Even though school refusal is a not a DSM-IV diagnosis, children and adolescents exhibiting this behavior may meet diagnostic criteria for a mental disorder.

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Treatment Resources


Evidence-based treatment strategies for children and adolescents exhibiting school refusal behavior.

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TRICARE Behavioral Health Benefits


The U.S. Department of Defense military health care system offers TRICARE Prime, Extra and Standard benefits to active duty service members, families and retirees. TRICARE Reserve Select is a premium based health plan for Guard and Reserve service members and families.

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Self-Help Resources for Patients


Find a variety of tools; including fact sheets, videos, books and web sites to support service members, families and friends in understanding school refusal and providing the right support.

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