Treatment for School Refusal

Psychological Interventions

When treating school refusal the primary treatment goal is to get children to return to school as soon as possible.¹ Cognitive-behavioral interventions are well-researched and effective treatments for school refusal. Treatment varies by the age of a child and situational factors impacting the problem (e.g., divorce, bullying, phobias, etc.). Treatment generally includes the following:²

• Education about school refusal
• Relaxation skills to cope with fear
• Social skills training to learn how to interact effectively with peers and teachers
• Cognitive techniques to address maladaptive thoughts (e.g., "Everyone will laugh at me," "I’m not smart," "I’m afraid that you are going to die while I’m at school," etc.)
• Gradual exposure to feared situations, whereby the child learns to be less afraid

Parents learn to consult and problem-solve with school staff about their child’s difficulties and play an active role in the young person’s treatment. For instance, parents can find out what teachers are observing (e.g., any bullying, changes in the difficulty of assignments, problems getting along with other children, etc.). Teachers can try implementing strategies at school, such as giving the child special attention when the child walks in the door, allowing the child to be student of the week, etc.

During a child’s treatment for school refusal, parents also learn how to effectively respond to school refusal behaviors (e.g., praising the successful demonstration of coping skills during practice sessions and ignoring tantrums or excessive physical complaints).

If a child or adolescent meets criteria for an Anxiety Disorder, treatment for that specific disorder is available. Learn more about treatment for Anxiety Disorders in children.

Guidelines for Choosing a Behavior Therapist

Behavior Therapy and Behavioral Interventions for Children and Adolescents
A lot of problems experienced by young people can be helped or treated with behavioral interventions or a relatively quick dose of behavior therapy.

Drug Treatment

Medications, such as some antidepressants and antianxiety medications may be helpful for addressing anxiety symptoms in children. However, the American Academy of Child and Adolescent Psychiatry does not recommend that medications be used as a first line or stand-alone intervention for pediatric anxiety.³ In some cases medications may be used in conjunction with a cognitive-behavioral interventions. Not all medications work the same for everyone; therefore it is important that you consult with your pediatrician or a child psychiatrist to determine which medication (if any) is best for your child.

TRICARE Pharmacy Information

¹Fremont, W. P. (2003). School refusal in children and adolescents. American Family Physician, 68, 8, 1555-1560.

²Heyne, D.  (in press). School refusal. In J. E. Fisher & W. O’Donohue (Eds.). Practitioner’s guidelines for evidence based psychotherapy. New York: Kluwer.

³American Academy of Child and Adolescent Psychiatry (1997). Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy Child Adolescent Psychiatry, 36(10suppl).

TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed psychological disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient’s usual activities. Treatment for school refusal, independent of a diagnosed psychological disorder is not a covered TRICARE benefit.

TRICARE beneficiaries who have a diagnosable psychological disorder are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility. More