When Your Child Says No to School: Tips for Handling School Refusal

It’s normal to see young children with trepidation about attending school for the first time. For some, if they are well-bonded with their parents, strong separation anxiety may exist. Some children may outright refuse to go to school, and this digging-in of the heals, so to speak, can happen at a variety of ages. School refusal is more common than many think. It affects between 1% to 5% of school-aged children, according to Nevada Mental Health Co-Founder, Dr. Sid Khurana. Let’s take a closer look at the forces behind school refusal and what parents can do about it.

For pre-school-age children, the one to five-year-old range, separation anxiety is the most common reason children refuse to go to school. Most of us have seen the parent who struggles to drop off their child at daycare. The child may cry and want to leave with the parent.

“This is not a disorder,” Khurana reassures us. “It’s very healthy to have separation anxiety. It’s common for a child to experience the stress of being dropped off at daycare or preschool, and want to run back to the parent.”

However, some children become so emotionally distraught, the school staff may need to call home for guidance or even ask for an inconsolable child to be picked up. They may even have somatic symptoms, such as pain, weakness or shortness of breath.

“That’s when it may have crossed over from healthy to a possible disorder, especially if it’s starting to interfere in the function of the child,” Khurana says.

For elementary school-age children, roughly six to 10-years-old, anxiety is often the primary driver for school refusal. In fact, about 56% of children who either outright refuse to go or continuously try to negotiate staying home with their parents have a primary anxiety disorder, Khurana adds.

For this age range, the anxiety is often peer-related. There may be bullying or teasing by peers, perhaps even school staff. There may also be some anxiety around issues at home, which could also lead to the early onset of depression, Khurana says.

For middle school and high school-aged children, school refusal is often associated with three things: the onset of an anxiety disorder, depression, or bullying. By this time, the symptoms and actions may be more severe. Children could be hiding absences, acting out in other ways, and showing anti-social tendencies, too.

For preschoolers, Dr. Khurana says reassuring the child and continuing to take them to school is important. In most cases, if the child’s feelings are validated, in time, they are able to work through their separation anxiety. For more extreme cases, where a child cannot adjust to the situation, counseling or medications may be needed. Check with a mental health professional for guidance, Khurana advises.

With elementary school-age children, parents may need a school-refusal treatment plan. Khurana and his team have found the successive approximation approach to be helpful. With this type of plan, a child slowly integrates into the school environment. In some cases, an actual contract is drawn up.

Parents may start by having the student complete work through an online program, but the child visits the school for a certain amount of time each day. Then they graduate to spending a certain amount of time in class and eventually a full day. Individual therapy and collaboration with the teacher are also needed. There is also back to school advice that can help supplement these programs and plans.

“When you are ready to take the next step, you do, but the steps are only forward, never backward,” Khurana emphasizes. “Most kids respond well to this because their anxiety is rooted in their perceptions. For them, their perception is reality. We know there is not a monster in school, but you have to normalize things for them by showing them they can spend periods of time there and that everything is okay.”

Middle and high school cases are usually more complex. These cases benefit from a psychiatric assessment analyzing physical health as well as behavioral and social issues. These cases may be tied to tensions at home or among peers, bullying, depressive feelings of being left out or not belonging. Homebound instruction, with medication to optimize behavioral therapy, along with treatment plans that include reintegration back into the school environment, can lead to success, Khurana says.

With minors, parents are legally responsible for making sure their children are in school. During the middle and high school years, truancy may become an issue. With truancy, school refusal usually becomes an act of defiance. There may also be lying or stealing and other negative behaviors. Some parents often ask: Can I call the police if my child refuses to go to school?

“It’s a scare tactic that could or could not work,” Khurana says, “but a police officer is not going to drag the child to school.”

You can however use the legal system for support. Programs like Clark County’s CHINS (Children in Need of Supervision) effort work with children with underlying psychiatric concerns. Successful outcomes usually involve coordination between the court system, school officials, a mental health professional, and the parents, and involve a delinquency prevention plan.

In most cases, the problem can be solved on a therapeutic level, Khurana reminds us. At Nevada Mental Health, a board-certified psychiatrist will assess overall physical as well as behavioral and social health, and develop a customized treatment plan for your child’s specific needs. He or she can also help to coordinate with outside resources – school staff, the court system, even unique programs developed specifically for your child’s needs.