Picture this: Your morning alarm goes off and you pull yourself up out of bed to start your morning routine and get the kids off to school. But then, you’re met with the complaint, “I don’t feel good, I don’t want to go to school today.” Sound familiar? Every parent’s probably been there at least once. And while the occasional sick day isn’t usually a cause for concern, if these complaints begin happening on a regular basis, it may be something more serious.
According to a recent study by researchers at University Cattolica del Sacro Cuore in Rome, school refusal is an issue that can affect as many as 5% of young people. The complaints about having to go to school, which are often also accompanied by physical symptoms such as headaches or stomach pains, can pose a significant threat to children and adolescents’ mental health and well-being — as well as their education.
John Dominguez, PhD, of Meridian Psychiatric Partners’ Child & Adolescent Division, explains that “school refusal is extremely disruptive to children’s functionality and can snowball very quickly,” ultimately leading to or worsening symptoms of mental health conditions like depression and anxiety.
How to spot the early signs of school refusal in your child
Due to the serious threats that school refusal poses to your child’s mental health, academics and overall well-being, early intervention is key. Here are some signs that Faith Reynolds, PhD, a child and adolescent mental health specialist at Meridian, says to watch out for:
- Having a specific fear about a certain aspect of school (e.g., taking test, teachers, classmates or riding on the bus)
- Reporting physical or somatic symptoms
- Throwing temper tantrums
- Refusing to get out of bed or get ready for school
- Clinging to parents
- Repeatedly asking the same questions, such as, “Can I stay home today?” or, “Can we do homeschooling instead?”
- Showing up late for classes
- Crying at school
- Missing school on the days of tests or presentations, or missing certain classes
- Going to the school nurse and asking to go home
- Being extremely shy or withdrawn (different behaviors in certain classes may be a sign of bullying or poor relationships with peers)
Nick Hatzis, MD, medical director of Meridian’s Child & Adolescent Division, explains that once a young person falls into a pattern of school refusal behavior, the issue often compounds as part of an anxiety-avoidance cycle. “It becomes harder and harder for the child to attend school since the alternative to school is either perceived as safer by the child, or the alternative is just more comfortable,” he says.
At what age is school refusal most common?
According to the University Cattolica del Sacro Cuore study, young people most commonly demonstrate school refusal behavior between the ages of five and six years old and 10 and 11 years old, but it is possible for children and adolescents of all ages to be impacted. At Meridian, Sarah Biehl, LCPC, a child and adolescent mental health expert and registered play therapist, says she frequently works with high schoolers who are experiencing school refusal.
“Having positive relationships with peers is important at this age, so if a child is struggling with loneliness, social anxiety or their self-esteem, going to school can feel so distressing and uncomfortable and the avoidance becomes a short-term way to cope,” she explains. “Students are also expected to be more independent and there is less structure than in middle school or elementary school, so it can be more difficult to intervene.”
How can parents help kids who are struggling with school refusal?
Biehl says getting an evaluation for a 504 plan or individualized educational plan, which are designed to provide structured supports in school for students with disabilities, may be necessary in cases where school refusal is being driven by mental health symptoms.
Whether or not this formal approach is part of your response to school refusal, Biehl says that strong communication with your child’s teachers will be crucial. “Building a positive relationship with their teachers can help you feel more at ease and model positive feelings that can be transferred onto your child and their teachers,” she says.
At home, Dr. Hatzis says parents should make the environment as structured as possible, so as to lessen the contrast between the more familiar, comfortable home setting versus what’s perceived as overly rigid or frightening at school.
“Oftentimes, part of treatment is trying to make the home environment replicate the school environment more,” he explains. “One would not want the child to be able to do things that he would not be able to do in school, even [something] as simple as watching television.”
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Interested in getting some extra support for your child? Discover more now about how Meridian’s Child & Adolescent Division can help
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While it may be tempting for parents to offer their child a “mental health day” to help cope with school refusal, Dr. Dominguez says it’s imperative that such days are planned in advance, rather than impromptu. That’s because offering an unplanned mental health day can “reinforce the myth that school refusal is necessary or healthy,” he explains.
Biehl echoes Dr. Dominguez’s sentiment, adding, “Avoid accommodating your child. Instead, validate their emotions to help them feel seen and that they aren’t alone in feeling this way, but also that they are capable of accomplishing something even when afraid.”
Is it time for your child to see a mental health professional?
In addition to giving your child the proper supports at school and at home, help from a child and adolescent mental health specialist can provide them the opportunity to work through some of the underlying mental health conditions that may be contributing to school refusal.
Dr. Dominguez says cognitive behavioral therapy, which is largely centered around replacing problematic ways of thinking with healthier alternatives, and dialectical behavior therapy, which is designed to empower patients to manage extremely intense emotions they’re feeling, can help young people “through behavioral activation, increasing distress tolerance and self-advocacy.”
In her work with young people, Biehl explains how play therapy can be especially useful for helping patients build resilience for overcoming school refusal behavior. ”Play is often non-threatening and the safety experienced in play helps children work through their problems and adopt a more positive and realistic view of themselves and their relationships with others,” she says.
Book recommendations for parents and children
If you’re interested in learning more about supporting your child who’s experiencing school refusal, picking up a book at home can be a great place to start. Below are a few recommendations from the Meridian team for parents and children.
For parents
- “Getting Your Child to Say ‘Yes’ to School: A Guide for Parents of Youth With School Refusal Behavior,” by Christopher A. Kearney
- “Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parents,” by Andrew R. Eisen, Linda B. Engler and Joshua Sparrow
- “Raising a Secure Child: How Circle of Security Parenting Can Help You Nurture Your Child’s Attachment, Emotional Resilience and Freedom to Explore,” by Glen Cooper, Kent Hoffman and Bert Powell
- “When Children Refuse School: A Cognitive Behavioral Therapy Approach Parent Workbook,” by Christopher A. Kearney and Anne Marie Albano
For children
- “Someone to Be With,” by Deidre Quinlan
- “Riley the Brave Makes It to School: A Story With Tips and Tricks for Tough Transitions,” by Jessica Sinarski
- “A Smart Girl’s Guide to Starting Middle School: Everything You Need to Know About Juggling More Homework, More Teachers and More Friends,” by Julie Williams
