Wanda Fremont, M.D.
School refusal is a serious problem that is very stressful to children, families, and school personnel. The consequence of failing to attend school has both significant short-term and long-term effects on children's social, emotional, and educational development. It is important to identify problems early, and make appropriate interventions to prevent further difficulties.
Children with school refusal are scared to go to school. Their fear may be so great that they refuse to go to school and are fearful of leaving the safety of their parents and home. Not wanting to go to school is most common in children ages 5-6 and 10-11 years old, times when children are first entering elementary or middle school.
Refusal to go to school often begins after a child has been home for a period of time, such as on a holiday break, a summer vacation, or after a brief illness. It may also occur after a stressful event, such as a move to a new house, the death of a pet or relative, or a change in schools.
Some children refuse to leave home. Other children may leave home in the morning and develop difficulties, as they get closer to school, then are unable to proceed. They may have crying spells or temper tantrums. Some children become so distressed they threaten to hurt themselves. Children frequently complain of feeling sick or having minor physical problems. They may complain of a headache, stomachache, or sore throat in the morning before they have to leave to go to school. If the child stays home, the "illness" frequently goes away, but recurs the next morning before school. The child's panic and refusal to attend school are very stressful for parents and families. The longer a child stays out of school, the more difficult it is to return.
Children with school refusal often have other difficulties. They may have problems with anxiety and worry excessively. They may be overly fearful about the safety of their parents or themselves. Children may feel unsafe staying in a room by themselves and display clingy behavior, following a parent around the house. They may also have difficulty falling asleep, may be fearful of the dark, and may have nightmares. Children with school refusal may also suffer from depression.
Children may refuse to go to school for different reasons. They may want to stay home to avoid specific fears at school such as test taking, bathrooms, cafeterias, or teachers. Some children are trying to escape from uncomfortable social situations including problems with classmates or teachers. Other children stay home because they have problems with separation anxiety, and do not want to leave their parents.
There are significant differences between children with school refusal, and children who are truant, or "playing hooky." Children who are truant are not afraid to go to school the way children with school refusal are. Children with school refusal usually let their parents know that they do not want to go to school, and frequently try to convince their parents to let them stay home. Children who are truant often skip school, but do not let their parents know that they have not been to school. Children with school refusal usually do not display antisocial behaviors such as delinquency, lying, and stealing. Children who are truant frequently have disruptive behavioral problems. Children with school refusal usually stay at home because they feel safe and secure. Children who are truant frequently leave the home and spend time with friends away from school.
Because children with school refusal have a wide variety of symptoms and problems, they should have a thorough evaluation. Parents should schedule an appointment with a physician or primary care provider. The physician will speak with the child and parents. In addition to interviewing the child, a complete physical will be done, and blood work may be requested. The physician will be able to make sure that there is not a physical illness that might be causing the problem. Parents should also talk with the child's teachers and school counselor. The physician may also want to speak with school staff to obtain information to help complete the evaluation.
Unreasonable fears about leaving the home and parents can be successfully treated. Parents must keep trying to get their child back to school. The physician may refer a child to a professional mental health specialist, such as, a psychologist, social worker, family therapist, or child psychiatrist. The therapist will work with the child and family, together with school staff and the physician.
The goal of treatment is to help a child to learn skills to reduce anxiety to help the child return to school. The physician may also prescribe medication to help with the child's anxiety or depression. The longer a child remains out of school, the more difficult it will be for the child to return to school.
Children who do not go to school for long periods may develop serious learning setbacks or social problems. If these children do not receive professional help they may have emotional problems such as anxiety or depression when they get older. Early treatment of this problem is important for a child's development and well-being.
Dr. Wanda Fremont is Assistant Professor, Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, and Director, Child and Adolscent Psychiatry Residency Training Program. She is also a faculty member in the departments of Pediatrics and Family Medicine at SUNY.
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