School refusal

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School refusal is the refusal to attend school due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. Children's Hospital Boston provides a chart[1] showing the difference between school refusal and truancy.[2]

The term school refusal was coined to reflect that children have problems attending school for a variety of different reasons, and these reasons might not be the expression of a true phobia[definition needed], such as separation or social anxiety.[3]

Signs and symptoms[edit]

Symptoms of school refusal include the child saying they feel sick often or waking up with a headache, stomachache, or sore throat. If the child stays home from school, these symptoms might go away but come back the next morning before school. Additionally, children with school refusal may have crying spells or throw temper tantrums.[4]

Warning signs of school refusal include frequent complaints about attending school, frequent tardiness or unexcused absences, absences on significant days (tests, speeches, physical education class), frequent requests to call or go home, excessive worrying about a parent when in school, frequent requests to go to the nurse’s office because of physical complaints, and crying about wanting to go home.[3]

If a parent wishes to keep their child in school, they must correct the problem quickly; the longer a child stays out of school, the harder it will be to return.[4] However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic symptoms and threats of self-harm. Sometimes, these problems fade if the child is allowed to stay home, or given more freedom in the amount of time they spend in school.[5]

Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it can be associated with several psychiatric disorders, including separation anxiety disorder, social phobia, and conduct disorder.[6] Therefore it is critical that youths who are school refusing receive a comprehensive evaluation by a mental health professional.[7]

Whereas some cases of school refusal can be resolved by gradual re-introduction to the school environment, some others may need to be treated with some form of psychodynamic or cognitive behaviour therapy. Some families have sought alternative education for school refusers which has also proved to be effective. In extreme cases, some form of medication is sometimes prescribed but none of these have stood out prominently as solutions to the problem.[citation needed]

A medical condition often mistaken for school refusal is delayed sleep phase syndrome (DSPS). DSPS is a circadian rhythm sleep disorder which is characterized by a chronic delayed sleep cycle.

The attempt to control by means of threats or pressure, the behavior of the student, is also still in danger as external (extrinsic) motivation to undermine intrinsic motivation and a sense of self-control, self-worth and self-responsibility. Some social scientists and evaluators view the condition as a pseudophobia.[8]


School refusal is complex, as it is not a fixed behaviour, but is rather a multi-dimensional phenomenon that changes and develops over time in response to internal and external variables, including in particular the means chosen to define and address it.

A widespread understanding of school refusal views it as a complex, maladaptive childhood/adolescent behaviour associated with psychopathology of some kind, and requiring therapeutic intervention.[5] On the other hand, a few theorists critiqued the psychological/therapeutic approach, some even questioning the assumption that children should want to go to school, and the definition of school refusal as a childhood disorder.[9][10][5]

Following is a list of suggested factors contributing to school refusal. Some are based on Professor Christopher Kearney’s work on the topic, involving studies in the United States. Notably, some students may be affected by several factors at once.

  • The child might want to be free[further explanation needed], or have the freedom to challenge the social convention of institutionalized schooling.[11]
  • The child possibly wants to avoid school-related issues and situations that cause them to experience unpleasant feelings, such as anxiety, depression, or psychosomatic symptoms. The reluctance to attend school is one symptom that can indicate the presence of a larger issue, such as anxiety disorder, depression, learning disability, sleep disorder, separation anxiety or panic disorder.
  • The child may want to avoid tests, presentations, group work, specific lessons, or interaction with other children. The child should be assessed for learning disabilities if academic performance is average or low.
  • The child may want attention from significant people outside of school, such as parents or older acquaintances.
  • The child possibly wants to do something more enjoyable outside of school, like practice hobbies, play computer games, watch movies, play with friends such as riding bikes, etc., or learn autodidactictally.[12]

Other factors can be:


Certain children who are particularly attached to their mother or other family figure due to separation anxiety or attachment theory often suffer the onset early, in pre-school, crèche or before school starts.

School phobia is diagnosed primarily through questionnaires and interviews with doctors. Other methods like observation have not proven to be as useful. This is partly because (school) anxiety is an internal phenomenon. An example of a modern multidimensional questionnaire is the "Differential Power Anxiety Inventory 'approach, with twelve scales to diagnose four different areas: anxiety-inducing conditions, manifestations, coping strategies and stabilization forms."

  • Cognitive and lifestyle exploration
  • 'School Phobia Test' (SAT)
  • 'Anxiety questionnaire for students', (AFS)


Approximately 1% to 5% of school-aged children have school refusal,[13] though it is most common in five- and six-year olds and in 10- and 11-year olds,[4] it occurs more frequently during major changes in a child’s life, such as entrance to kindergarten, changing from elementary to middle school, or changing from middle to high school.[3] The problem may start following vacations, school holidays, summer vacation, or brief illness, after the child has been home for some time, and usually ends prior to vacations, school holidays, or summer vacation, before the child will be out of school for some time. School refusal can also occur after a stressful event, such as moving to a new house, or the death of a pet or relative.[4]

The rate is similar within both genders,[4] and although it is significantly more prevalent in some urban areas, there are no known socioeconomic differences.[6]

See also[edit]


  • Fremont, Wanda P.; Smucny, John (2003). "School Refusal in Children and Adolescents". American Family Physician. 68 (8): 1555–1561. PMID 14596443.


  1. ^ "School Refusal approach at CHB". Retrieved 2012-10-26.
  2. ^ "School Refusal". Children’s Hospital Boston. Retrieved 2012-10-26.
  3. ^ a b c Wimmer, M. "School refusal: Information for educators" (PDF). National Association of School Psychologists. Archived from the original (PDF) on 2014-02-11. Retrieved 2012-10-26.
  4. ^ a b c d e "Information from your family doctor: What to do when your child refuses to go to school". American Academy of Family Physicians. 2003. Retrieved 2012-10-26.
  5. ^ a b c Stroobant, Emma; Jones, Alison (June 2006). "School Refuser Child Identities". Discourse: Studies in the Cultural Politics of Education. 27 (2): 209–223. doi:10.1080/01596300600676169. ISSN 0159-6306.
  6. ^ a b Setzer, N., & Salzhauer, A (2001). "Understanding school refusal". New York University Child Study Center. Retrieved 2012-10-26.CS1 maint: Multiple names: authors list (link)
  7. ^ "School Refusal". Anxiety Disorders of America. Retrieved 2012-10-26.
  8. ^ Trueman, David. "What are the characteristics of school phobic children?." Psychological Reports 54.1 (1984): 191-202.
  9. ^ Pilkington, Cynthia L.; Piersel, Wayne C. (October 1991). <290::aid-pits2310280403>;2-k "School phobia: A critical analysis of the separation anxiety theory and an alternative conceptualization". Psychology in the Schools. 28 (4): 290–303. doi:10.1002/1520-6807(199110)28:4<290::aid-pits2310280403>;2-k. ISSN 0033-3085.
  10. ^ Knox, Patricia (January 1989). "Home‐based Education: an alternative approach to 'school phobia'". Educational Review. 41 (2): 143–151. doi:10.1080/0013191890410206. ISSN 0013-1911.
  11. ^ Shoko., Yoneyama, (1999). The Japanese high school : silence and resistance. Routledge. ISBN 0415154391. OCLC 246015168.
  12. ^ a b Kearney, Christopher A. (2001). School refusal behavior in youth: A functional approach to assessment and treatment. (pp. 3–24). xiii, 265 pp. Washington, DC, US: American Psychological Association; US.
  13. ^ Fremont, W. P. (2003). "School refusal in children and adolescents". American Family Physician, 68(8), 1555–1561. Retrieved 2012-10-26.

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