On our Minds

School Refusal and Anxiety

School refusal is a growing problem for all ages of children and adolescents.  The reasons for this vary, and to treat it appropriately it is essential to determine the specific reasons for each individual child/teen.  However, it is understandable that school-based anxiety is higher among students in general with the increasing demands of modern schools.  My young clients often report more bullying, social cliques and increased academic expectations/workload than in previous years, even impacting children as young as 8 or 9.  In fact, many children and teens report their social anxiety related to peer relationships as a primary reason for resistance to attend school. 

Unfortunately, this often results in increased difficulties across the board, including growing distress in the child and for the family due to increased conflicts over missing or being late to work and school.  At times, school refusal can result in aggressive and highly oppositional behavior from the child/teen, leading parents to feel unprepared and helpless as what to do next.   Most parents hope this will subside, and in some cases it will.  However, the longer this behavior continues, the more difficult and serious it often becomes, as it then becomes habitual to the child and harder to redirect. 

While school refusal can occur at any age, it is most common among children 5-7 and 11-14 years-old, which coincide with the increased academic and social challenges of those grades.  Due to the complications associated with school refusal behavior, it often requires a multi-pronged intervention, including close collaboration among the parents, the school Staff and often a therapeutic professional to transition the child/teen back to school in a supportive manner. 

Common reasons for school refusal behavior can include:

– Fear of separating from the family (which can include fear of harm coming to themselves or the family)

– Social stressors, including bullying, peer conflicts and fear of social embarrassment or getting in trouble

– Academic fears, including fear of making mistakes, reading aloud, tests, etc.

– Depression, with loss of motivation and sleep disturbance

Common signs of Separation Anxiety:

– Frequent physical complaints, including stomach aches, head aches, fatigue, or “feeling sick” before school or any separation (which often disappears once at school)

– Clingy behavior and/or excessive shyness with new people

– Severe tantrums or panic symptoms when expected to leave for school or leave the parents, which can include opposition, arguing, defiance and aggression

– Difficulty sleeping alone or frequent nightmares

– Fear of being alone and excessive reassurance seeking behavior

School Refusal is a challenging but treatable concern.  Interventions often include a focus on relaxation skills, problem-solving skills, cognitive restructuring and parent training, which assists parents in increasing rewards for attendance and decreasing rewards for refusal.  Both parents and School Staff are provided recommendations for decreasing uncertainty through consistent routines and preparation, increasing social rewards for participation and minimizing negative “pressures,” both academically and socially.  With such collaboration, children and teens are often able to successfully transition to school and cope more effectively with their stressors. 

Ariel Shea, LCSW

The Looking Glass, LLC

Denver, Colorado


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