School Refusal and Anxiety: Advice for Teachers and Parents

It is common for children to, at times, not want to go to school. In fact, most children will experience this occasionally. Children with school refusal, however, will consistently display extreme anxiety at the thought of going to school and will try to avoid it at all costs. 

Although school refusal is often dismissed as a child’s stubbornness, it is commonly linked to anxiety and can be a sign of a far more serious underlying problem. Thus, it is well worth parents and teachers learning more about this condition and how to take action if a child displays continuous symptoms of school refusal. 

In this article, we will explain what school refusal is as well as how it links to school anxiety, outline the possible causes of school refusal, give advice on how to spot signs of school anxiety in children, and discuss how to help a child with school anxiety or refusal. 

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What is School Refusal?

School refusal is when a child displays intense anxiety at the prospect of going to school and therefore regularly refuses to attend or has problems with staying at school once there. It is also often called school avoidance or school phobia and can range from attending school with morning resistance to being completely absent from school for extended periods.

School refusal was, in the past, often considered to be synonymous with truancy. It is important to state that school refusal is not the same as choosing to skip school due to the allure of having more fun elsewhere. Rather, it is caused by an aversion to school itself. To avoid the implication that a child is making a choice, school refusal is sometimes now referred to as emotionally-based school avoidance (ESBA). 

How Does School Refusal Link to School Anxiety?

School refusal is often directly linked to anxiety, as anxiety is frequently the underlying cause of a child refusing to attend school. In these cases, the refusal is created by a building increase in anxiety that accumulates in a child feeling such an intense fear or phobia of attending school that they no longer feel able to.

School Refusal and SEN

School refusal is often more common in children with Special Educational Needs (SEN). This is because these children may experience a higher level of daily anxiety due to factors related to their educational needs, such as social or environmental issues, sensory requirements, or learning barriers. 

It is well known that children with SEN sometimes mask their individual needs in the classroom, which can cause additional stress as they’re essentially hiding pieces of themselves. If a child feels they’re no longer able to maintain their masking at school, this could lead to anxiety and a sudden change in attendance culminating in school refusal. 

Discover more about what masking is and learn strategies to support children who may be experiencing this in our article on What is Autistic Masking.

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School Refusal Causes

School refusal is completely normal for children first attending school as this is a new experience where everything is unknown, and thus some anxiety is to be expected. This reluctance is age-appropriate and often resolves independently and quickly.

In older children, however, school refusal can be derived from a fear of something specific occurring at school which causes the anxiety about attending. Some of these anxiety inducing causes of school refusal may be:

Bullying

Six out of ten children who struggle with school refusal have experienced bullying at school. Bullying can take many different forms, such as physical, cyber, or verbal, and is one of the principal causes of school refusal in children of all ages. Bullying can be a highly traumatic experience for children and thus is likely to cause increased distress for children around attending school as they’re anticipating the bullying and are reluctant to face the situation, therefore making them too anxious to attend class. 

To learn more about bullying, read our article on Why is Cyberbullying Harmful and What Actions Can You Take, or take our Bullying and Harassment Quiz to test your knowledge.

Separation Anxiety

Separation anxiety in children is the experience of getting anxious or distressed when separated from their parent or primary caregiver. In severe cases, the anxiety of being separated from a parent can become so extreme that it causes school refusal in a child. Separation anxiety can be caused by anything from a change in environment such as moving house or changing schools, a stressful scenario such as a bereavement or divorce, or it can even be inherited or fed from a parent’s own anxiety. 

Discover more about what separation anxiety is, its symptoms, and causes in our article on How to Help a Child With Separation Anxiety at School.

Mental Health

Whilst school refusal is not an official mental health diagnosis, it is considered to be a symptom associated with known mental health disorders such as:

• Social Anxiety Disorder
• Generalised Anxiety
• Depression
• Post Traumatic Stress Disorder

For children suffering from any form of anxiety, the anticipation of school can trigger and increase in their anxiety or panic attacks, making the classroom an unbearable source of distress. For those with depression, their symptoms of low mood, hopelessness, and fatigue can remove any motivation needed to attend school and engage in learning.

Learning Differences

Children may experience anxiety around going to school, and therefore refuse to attend, due to finding it difficult to thrive academically and learning differently to others in their class. This is especially the case in children with Special Educational Needs and Disabilities (SEND).

Additionally, children with SEN may struggle more with sensory overload at school, as the classroom can be a busy and noisy place. Anticipating this sensory overload may also be a cause of anxiety which ultimately leads to school refusal.

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Signs of School Anxiety

As mentioned, there are many reasons why a child might feel extreme anxiety about attending school, leading to school refusal. But how can you spot these anxieties before they reach this level? There are a few key symptoms of school anxiety that you should be aware of and monitor for. If you begin observing one or more of these symptoms consistently in a child, it may be time to take action. 

Possible symptoms of school anxiety in young children, particularly those of 10 or under, may include:

• Irritability, tantrums, excessive crying, or screaming, particularly when being left at school.
• Refusal to get ready for school in the morning. 
• Loss of appetite or feeling sick as the time to go to school draws near.
• Nightmares or difficulty sleeping.
• Shortness of breath or panic attacks.

In older children, whilst some of the symptoms above may still be present, you may also observe any of the following signs of school anxiety:

• Truancy or absence from class.
• Refusal to participate in school activities.
• Self-harm.

Symptoms of school anxiety span across physical, emotional, and behavioural impacts. Physical effects of anxiety are often nausea, headaches, dizziness, and sweating. Emotionally, your child may feel fearful, full of dread, irritable, and depressed. These symptoms are likely to manifest in behaviour such as refusing to go to school or leaving school once there. 

To learn more about how to ease these symptoms and safeguard an anxious child, read our full article on How to Help a Child With Anxiety in the Classroom.

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How to Help a Child With School Anxiety and How to Deal With School Refusal

When aiming to help a child with school anxiety or refusal, the first step is to identify what it is that’s causing their distress. Once you understand the problem, you’re in a much better place to try and make changes that will help. 

The School Refusal Assessment Scale

Young people can find it hard to explain exactly what is causing their feelings, so it can be helpful to use the School Refusal Assessment Scale to assess what is causing the problem and then inform your interventions.

The School Refusal Assessment Scale is a psychological assessment tool created by Dr. Chris Kearney and Dr. Wendy K. Silverman in 1993, but which has since been revised. The assessment identifies four areas of school refusal:

• Escaping from aversive social or other negative situations, such as playground play, school staff, or avoiding particular children.
• Staying away from objects or situations that may be unpleasant and cause physical symptoms or distress, such as tests, reading out loud, presenting, or athletic performance.
• Gaining attention from others, sometimes fuelled by separation anxiety.
• Pursuing a physical reward outside of school, such as playing online games or watching television.

Whilst the first two centre on negative reinforcement at school, the second two are around positive reinforcement at home. 

Once you know which of the above causes is the principal reason for a child’s school anxiety and refusal, you can determine the best ways to try and help. 

Strategies for Helping a Child Displaying Symptoms of School Anxiety and School Refusal

The most important step in helping a child battling school anxiety or school refusal is to have continuous and effective communication between the child’s parents/caregivers, and school staff. It may be a good idea to have regular meetings where you can each suggest specific changes that could help the child. 

Helping a child with school anxiety usually involves making supportive changes both in the classroom and at home.

Support Strategies for the Classroom

Below are some recommended changes to make in the classroom for children with the following points of anxiety at school:

Support Strategies for at Home

Although making changes at school, where the point of distress occurs, is often crucial to overcoming school anxiety or school refusal, there are also strategies that parents can implement at home to help their child with anxiety:

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School refusal is when a child regularly refuses to attend school, or struggles to stay present once there. Often, school refusal is caused by intense anxiety which causes a child to feel unable to attend. There are many causes of school anxiety and refusal, but you can help to determine what is the source of your child’s issues using The School Refusal Assessment Scale. Once you know why a child is struggling with attending school, there are many strategies you can implement to support them both at school and at home. 

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Further Resources:

• What is the Importance of School Attendance?
• How to Support SEMH in Schools
• How to Create a Positive Learning Environment