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


Parenting Topics, Reading Resources

Reading Recommendations

Parents frequently ask me for relevant books on topics related to parenting their anxious children.  I always encourage parents (and children or teens) to increase their understanding and knowledge, though with so many options out there it difficult to know what to choose.  The list below includes resources for both parents and  youth.

Complete Booklist – Anxiety Resources for Families

Generalized Anxiety + Parenting 


*What to Do When Your Child Worries Too Much.  Aureen Wagner

*Helping your Anxious Child, a Step-by-step Guide for parents.  Ronald Rapee, S. Spence, V. Cobham & A. Wignall

*Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries and Phobias.   Tamar Chansky

*Keys to Parenting Your Anxious Child. K. Manassis

Your Anxious Child:  How Parents and Teachers Can Relieve Anxiety in Children.  John Dacey and Lisa Fiore


*What to Do When You’re Scared & Worried. by James J. Christ (for kids and discusses different types of Anxiety Disorders)

I Bet I Won’t Fret:  A workbook to help Children with Generalized Anxiety Disorder.  Timothy Sisemore

*What to Do When You Worry Too Much (younger child).  Dawn Heubner

David and the Worry Beast: Helping Children Cope with Anxiety.  Anne Marie Guanci and Caroline Attia (younger child)

School Phobia, Social Anxiety & Panic Attacks


 School Phobia, Panic Attacks and Anxiety in Children.  Marianna Csoti

Overcoming School Anxiety:  How to Help Your Child Deal with Separation, Tests, Homework, Bullies, Math Phobia and Other Worries.  Diane Peters Mayer

Helping Your Child Overcome Separation Anxiety or School Refusal:  A Step-by-Step Guide for Parents.  Andrew Eisen, Linda Engler and Joshua Sparrow

The Sky Is Falling: Understanding & Coping with Phobias, Panic & OCD. Raeann Dumont 

Helping Your Socially Vulnerable Child: What to Do When Your Child Is Shy, Socially Anxious, Withdrawn, or Bullied.  Andrew Eisen, Linda Engler and Joshua Sparrow.


I Don’t Want to Go to School: Helping Children Cope with Separation Anxiety (Let’s Talk).  Nancy Pando.  (Younger children)



The Hair-Pulling Problem: a Complete Guide to Trichotillomania. Fred Penzel

Help for Hair Pullers: Understanding and Coping with Trichotillomania. Nancy Keuthen, et al

Obsessive-Compulsive Disorder


*Freeing Your Child from Obsessive-Compulsive Disorder: a Powerful, Practical Program for Parents of Children and Adolescents. Tamar Chansky

*Talking Back to OCD: The Program That Helps Kids and Teens Say “No Way” — and Parents Say “Way to Go.”  John March

Helping Your Child with OCD: a Workbook for Parents of Children with Obsessive-Compulsive Disorder. Lee Fitzgibbons & Cherry Pedrick

Obsessive-Compulsive Disorder: New Help for the Family. Herbert Gravitz

Obsessive-Compulsive Disorders: a Complete Guide to Getting Well and Staying Well, Fred Penzel, Ph.D.

Obsessive-Compulsive Disorder: Help for Children and Adolescents. Mitzi Waltz

Teaching the Tiger: a Handbook for Individuals Involved in the Education of Students with Attention Deficit Disorders, Tourette Syndrome or Obsessive-Compulsive Disorder. Marilyn Dornbush & Sheryl Pruitt


**Kissing Doorknobs. Terry Spencer Hesser

*Mr. Worry: a Story about OCD. Holly Niner (younger child)

**What to Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD (What-to-Do Guides for Kids).  Dawn Heubner 

Blink, Blink, Clop, Clop: Why do We Do Things We Can’t Stop? An OCD Storybook, by E. Katia Moritz, Jennifer Jablonsky, and Rick Geary

Touch And Go Joe: An Adolescent’s Experience of OCD. Joe Wells

**Up and Down the Worry Hill: a Child’s Book about Obsessive Compulsive Disorder and Its Treatment. Aureen Pinto Wagner & Paul Jutton


*Indigo Dreams: Relaxation and Stress Management Bedtime Stories for Children, Improve Sleep, Manage Stress and Anxiety (Indigo Dreams) [AUDIOBOOK]  by Lori Lite

*The Goodnight Caterpillar:  A Children’s Relaxation Story to Improve Sleep, Manage Stress, Anxiety, Anger (Indigo Dreams).  Lori Lite and Kimberly Fox

When My Worries Get Too Big!  A Relaxation Book for Children Who Live with Anxiety.  Kari Dunn Buron

Behavioral Problems & Parenting Strategies:

*The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. Ross Green. Harper Collins, 2005.

Parenting the Explosive Child: the Collaborative Problem Solving Approach. VIDEO: Featuring Ross Greene & Stuart Ablon, VHS and DVD format $65.95 each

*Taking Charge of ADHD: the Complete, Authoritative Guide for Parents, Revised 2000. Russell Barkley

The Incredible Years: A Trouble-Shooting Guide for Parents of Children Aged 3-8.  Carolyn Webster-Stratton.

*1-2-3 Magic: Effective Discipline for Children 2-13. T. Phelan, $22.95; Video, $59.95; DVD, $55.95; More l-2-3 Magic Video, $59.95; DVD $55.95

*Angry Children, Worried Parents: Seven Steps to Help Families Manage Anger. Sam Goldstein et al

*The Angry Child: Regaining Control When Your Child is Out of Control. Tim Murphy

*Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Brenda Smith Myles & Jack Southwick

Parenting a Child with Asperger Syndrome: 200 Tips and Strategies.  Brenda Boyd, 2003.

*The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction, Revised 2005. Carol Kranowitz

Ariel Shea, LCSW

The Looking Glass, LLC

Denver, Colorado


Parenting Topics

When Do I Need Help?


Children and adolescents often struggle to communicate their needs in ways that parents can understand.  However, parents are often the first and best experts on recognizing that their child is experiencing difficulties, whether emotionally or behaviorally.  Many parents can often identify the “cues” their children present but struggle with how to approach or manage these cues.   Talking with your child is always an important first step, as it opens the door for communication and shows your child that “feeling talk” is safe and important to you.  Gathering information from your child’s Teachers and other supportive adults can also give you more insight as to how your child is doing in all areas of his or her life.  Sometimes, simply talking with your child about their feelings helps to reduce their distress.  In other cases, your child or teen’s distress may be significant enough that additional help or evaluation may be necessary. 

Below are a few signals that your child or teen may benefit from a professional evaluation or treatment:

Younger Children:

– Noticeable change or decline in school performance

– Behavioral difficulties, including frequent or intense tantrums, aggression, persistent opposition/defiance

– Hyperactivity, impulsivity and distractibility that impact their ability to maintain appropriate academic or social expectations

– Significant fears or worries that may include school refusal, resistance to socialize or engage in age-appropriate activities

– Excessive or odd behaviors that are not common to their age group

– Frequent complaints of headaches, stomachaches or “feeling sick”

– Persistent sadness that includes frequent crying spells, sleep problems, self-injurious behaviors or comments

Pre-Adolescents and Adolescents:

 Marked change in school performance  

– High-risk or dangerous behaviors, including sexual acting out, aggression, running away, stealing

– Persistent changes in mood, including severe irritability or sadness

– Noticeable changes in sleep or appetite patterns

– Social withdrawal or isolation

– Threats to harm oneself or others or self-injurious behaviors

– Fears or worries that impact daily functioning

– Behaviors or beliefs that appear unusual, strange or “out of character,” including reports of hearing or seeing things

– Abuse of alcohol or drugs

– Frequent or intense emotional outbursts; inability to manage stressors

– Consistent defiance of rules or expectations; opposition to authority or disregard of others’ feelings


If your child or teen is exhibiting the above difficulties to the point you or others are concerned, it could be helpful to seek consultation.

Ariel Shea, LCSW

The Looking Glass, LLC

Denver, Colorado