School refusal is different from truancy, where young people don’t want to attend school because they’d rather do something else. Instead, it’s when kids simply refuse to go to school, or fight going to school so hard that each morning becomes a wrenching battle. School refusal isn’t a behaviour problem that needs to be punished—it’s a form of anxiety and emotional distress that requires treatment. Kids may refuse to go to school for reasons such as separation anxiety or somatic (extreme physical) symptoms, social difficulties, undiagnosed learning difficulties or uncomfortable social situations such as bullying.
Signs of school refusal include visible symptoms of anxiety and distress prior to school, sometimes even starting on Sunday night. Kids may complain of such physical symptoms such as stomach aches, headaches, nausea, dizziness, fatigue and often a general sense of “not feeling well.”
Some families can easily identify a single reason why their child is struggling. But for others, a child’s reasons for refusing to go to school may be vague, diverse, or even confusing. For example, some kids who refuse to go to school are worrying so much about their caregivers, that they’re afraid something terrible might happen to their parents during the school day. For others, the school environment is part of the problems, such as difficulty with teachers or classmates. A lack of friends can also make school attendance difficult.
Regardless of the reason (or reasons), school refusal can significantly interfere with—and pose severe limits on—the life of a child or teen. Youth who refuse school can fall behind or fail to meet academic milestones. They may also have difficulty developing and maintaining friendships, and become isolated from peers, thus missing opportunities to learn new things, and engage in fun activities. Some youth may also engage in high-risk behaviours, such as drug or alcohol use, to manage the boredom that comes from lengthy and unstructured time away from school.
When younger children refuse to go to school, the best treatment strategies are those that return them to school as quickly as possible. Often, the hardest part is for parents, who must take a firm approach in having the child return to school. Creating structure at home to support school return is helpful, as is positively reinforcing school attendance. For younger children, the work of returning a child to school is done more with the caregivers. With older children, it’s crucial to developing a strategy with the school that will help the child return.
The key to treating school refusal in youth is getting them to buy into the process. Often youth want to return, so they can do what their peers are doing, but they find it difficult to do so. Even if they have only a small desire to get back to regular teen activities, this can still be something to build on and, in turn, develop a return-to-school plan. Other proven strategies include developing structure and routine; teaching the youth relaxation techniques; graduated exposure to the school environment; helping them understand the mind-body connection to their behaviours and, in some cases, pharmacology.