School refusal refers to a child’s resistance to attend school. While it is most common in younger children, it can happen anytime between the ages of 5 and 17 years. Children or teenagers with school refusal problems may exhibit one or more of the following characteristics:
- Complete absence from school
- Attendance in some classes, then leaving school at some time during the day
- Severe misbehaviours (crying, throwing tantrums or even threats of self- harm) in the morning before attending school
- Attending school under great duress, with frequent pleas to be allowed to stay home
School refusal must be differentiated from truancy. The latter is a type of acting-out behaviour, often associated with delinquency and disruptive behaviour. School refusal, on the other hand, is often characterised by anxiety and fearfulness. Hence, it is not unusual for a child with school refusal to complain about physical symptoms of anxiety such as stomach aches, nausea, headaches, rapid heartbeat, hyperventilation, and panic attacks.
In some cases, school refusal may be associated with a child’s anxiety about a school-related object or situation. Hence some events that commonly precede school refusal include starting school for the first time, starting a new school, experiencing changes at school (e.g., a new teacher, changes to friendship groups, or even a new seating position), bullying, or a school-related frightening event. However, it is not always the case that the triggers are school-related. School refusal can also be precipitated by unrelated events such as a legitimate absence from school for a period of time (e.g., due to illness), experiencing a stressful event, or a change in the family situation (e.g., birth of a sibling, house move, or marital conflict).
The factors that maintain a child’s reluctance to go to school are often more important in considering treatment options than the original event that triggered school refusal. By continuing to be absent from school, children may be achieving one or more of the following desirable outcomes that is reinforcing their school refusal behaviour:
- Avoidance of unpleasant feelings (such as anxiety or depression) caused by school-related issues or situations
- Escape from unpleasant situations (tests, specific lessons) or unpleasant interactions with certain people in school
- Increased positive or negative attention or sympathy from parents or others outside school
- Increased time to pursue enjoyable activities (watching television, playing computer games, etc.)
If left untreated, school refusal can result in more serious consequences. In the short-term, continued absence from school can lead to severe distress in the child, problems with homework and declining grades, social alienation, and increased risk of legal trouble, especially if there is a lack of supervision at home. The severe disruption in the family’s daily routine can also create or aggravate family conflict, additional financial expense for the parents and the potential for child maltreatment. If the problem persists for a longer period of time, the effects of the absenteeism tend to linger, even when the child or teenager does return to school. Research shows that about one-third of youths who are school-refusers continue to have serious adjustment problems later in life.
Early intervention for school refusal is one of the key factors of success in treatment. Depending upon the functions served by school absenteeism, treatment may involve Cognitive Behavioural Therapy for the child, Parent Training, or Behavioural Family Therapy or a combination of these.
If you would like to find out more about our treatment for School Refusal, or to book an appointment with one of our child clinical psychologists who provides treatment for this condition, please email or call the clinic on 02 9438 2511.