Understanding and treating school refusal

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Starting the school year with new schedules, classmates, and experiences can cause feelings of excitement for some students, and nervous anticipation for others.

Rogers Behavioral Health’s David Jacobi, PhD, psychologist and Sheboygan clinical director, and Andrea Hartman, PsyD, psychologist and Seattle clinical director, explain what school refusal is and how Rogers uses evidence-based treatment to help kids get back to class.

What is school refusal?

School refusal is when children and adolescents refuse to attend school or are unable to remain in school all day due to anxiety. Looking at all forms of school refusal behavior, not just those motivated by anxiety, about one-third of children – boys and girls equally - demonstrate some school refusal behaviors. That’s a large number of kids who are missing school on a fairly regular basis due to various issues.

While data shows school refusal tends to happen in young children, it can occur during any life transition, like starting high school.

The consequences of school refusal are associated with lower academic achievement which increases the chance of school dropout, involvement with the juvenile justice system, and the likelihood for mental, occupational, and even marital problems in adulthood.

What are some contextual factors that might influence school refusal behavior?

When looking through the lens of diversity, there can be several contributing factors:

• Child – Past trauma can impact the child’s current functioning. A history of school absenteeism can lead to competency problems, which leads to more absenteeism. Also, there could be language and cultural differences between the caregivers and school personnel.
• Parent/caregiver – They can have low expectations for school performance and attendance, giving the child too much freedom and too few rules.
• Family – They could have poor access to educational aids and live in poverty.
• Peer – The child could be involved in gang activity, feel pressure to leave school, or be the victim of bullying.
• School – It may be in a dangerous location, or the personnel could inadequately respond to diverse needs.
• Community – The child could be living in an unsafe neighborhood where there’s gang activity in addition to a lack of support or educational services.

What are symptoms of school refusal behavior?

There are internal and external symptoms.

Internal symptoms include:

• Social anxiety
• Withdrawal
• Depression
• Fatigue
• Stomachaches
• Headaches

External symptoms include:

• Tantrums
• Verbal or even physical aggression
• Reassurance seeking
• Clinginess
• Refusal to move
• Noncompliance
• Running away from home

How does Rogers treat anxiety-related school refusal?

Multidisciplinary teams, led by a board-certified psychiatrist, use evidence-based therapies to treat the anxiety associated with school refusal.

Through cognitive behavioral therapy, we help patients understand the relationship between their thoughts, behaviors, and emotions. Identifying and challenging negative thoughts leads to more positive emotions and behaviors.

Through exposure and response prevention, or ERP, we help patients gradually face their fears, supporting them as they practice coping skills so that their anxiety decreases. We try to reintegrate the child back into school during their treatment. This could take the form of attending a class or two and then working up to full days.

Rogers offers multiple levels of care in communities nationwide. For a free, confidential screening, call 800-767-4411.