Anxiety in Teens

School Refusal

What is School Refusal?

Going to school can be exciting and fun for many young people, and the experience of going to school can be affected by a variety of factors including the home environment, friendships at school, and learning ability. Some days, it is not uncommon for adolescents to express some reluctance to go to school. However, there are some adolescents who may find going to school so difficult that they refuse to go. When this occurs on a regular basis due to anxiety or other emotional disturbances, this is known as school refusal.

School refusal has been shown to occur more commonly in high school and during periods of transitions, such as changing schools or moving from primary to high school. Of the variety of factors that contribute to school refusal, anxiety and bullying appear to be the most significant factors impacting a young person’s willingness to go to school. School refusal differs from truancy, in that truancy is not a result of anxiety and often parents are unaware of truancy occurring.

Symptoms of school refusal tend to begin gradually, typically after a holiday or illness. Some adolescents may also experience difficulties returning to school following vacations or weekends. Often, teenagers will report experiencing physical ailments including headaches, stomach aches, nausea, dizziness, chest pains, or muscle aches.

School refusal is a serious issue and needs to be addressed early, as it can have lasting impacts on an adolescent. Some short-term consequences of school refusal include: poor academic performance, difficulties establishing and maintaining peer relationships, and family discord. Examples of long-term consequences include academic underachievement, occupational and employment difficulties, and an increased risk for mental health difficulties later in life.

Symptom Checklist

A pattern of school refusal may be evident if you notice your child missing school more than twice over a two-week period in the absence of any physical health illness, and especially if they engage in the following behaviours:

  • Frequently complaining of illness (e.g., stomach aches, headaches, fatigue, dizziness) before or during school
  • Irritability when discussing school attendance
  • Difficulty attending school following weekends, vacations, school camps, or sports day
  • Spending frequent and/long periods in the sick bay or principal’s office
  • Frequent requests or attempts to call or text to go home during the day
  • Dawdling, clinginess, tantrums or running away before school or at drop off
  • Reluctance or refusal to get dressed for school
  • Tearfulness and repeated pleas to stay home from school resulting in frequent absences or lateness

Treatment for School Refusal

Treatment for school refusal involves a variety of psychological approaches, including Cognitive Behavioural Therapy (CBT), systematic desensitisation, and exposure therapy. Therapy for school refusal will aim to identify the factors that are contributing to your child’s school refusal and implement strategies to target these difficulties. The best treatment for school refusal involves a team approach, including parents, the school, and a trained psychologist. CBT for school refusal helps adolescents identify and correct maladaptive thoughts and beliefs contributing to their ongoing refusal to attend school, and provide relaxation techniques to manage their levels of anxiety. A graded approach to returning to school is then collaboratively developed to assist your child in making a gradual return to school.

Supporting an Adolescent Experiencing School Refusal

In addition to getting your child mental health support, it is also helpful to engage your teen in collaborative problem solving and asking them open ended questions to allow your child to have the opportunity to express how they are feeling and feel heard. Things that may be helpful in supporting an adolescent with school refusal include:

  • Listening and understanding why your child is experiencing difficulties going to school. Some of the reasons why your child may be refusing to go to school can include difficulties keeping up with their peers in school, experiencing bullying, difficulties with schoolwork itself or family conflict. These issues can be addressed collaboratively with effective strategies once they are identified.
  • Establishing and maintaining a calm and consistent routine to help minimise anxiety in the mornings around going to or upon arrival at school
  • Establish a support team that your child can access at home and at school should he/she face any difficulties. This can provide your child with a sense of relief.
  • Keep communication with the school open about your child’s school refusal and how the school can support your child. This also allows the school the opportunity to share their concerns and your child’s strengths
  • Set small achievable goals to encourage your child to get back into schooling (e.g. going for the morning, sitting near the teacher)
  • Highlight the positives of school for your child. Rather than dismissing their anxiety, help your child see the benefits of going to school (e.g., a favourite subject or activity)

Sources & Useful Links