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Understanding School Refusal

Back-to-school is an exciting time of year for most students, who anticipate buying new school supplies and clothes, seeing friends, and having new adventures. However, the return of school brings some students and their families feelings of dread. There are many students who find the thought of going to school daunting, stressful, and overwhelming. Unfortunately, these students usually frustrate teachers and parents. They are viewed negatively and are often written off as truants, lazy, or simply disengaged. However, there is a real condition recognized by every educational and mental health organization called “school refusal” that educators frequently overlook instead of providing students and their families with the support they need.

School refusal is an anxiety disorder that impacts between 3-5% of students each year. In a school system like Indianapolis Public Schools, this means that there may be 1000-2000 students who meet the criteria for school refusal disorder. These students experience overwhelming feelings of anxiety and panic in going to school. Unfortunately, their needs and fears are usually minimized; instead of being met with interventions, supports, and care, these students are punished for their mental health needs. As with many anxiety disorders, students who are experiencing stress from chronic medical conditions, changes at home, absent parents, bullying, learning challenges, or community stressors are more vulnerable.

There are four typical reasons why students do not want to go to school. The first three require supportive and intensive interventions. They last also requires students receive support; but these students also personalized and consistently applied consequences and rewards.

Students refuse to go to school:

  1. Because of how it makes them feel (anxious, overwhelmed, fearful), as school is associated with bad memories or feelings.

  2. Because of pressures—testing, performance, social—that cause anxiety.

  3. Because they are overly connected to or concerned about their families.

  4. Because they want to spend time with friends or engage in behaviors they find more rewarding (video games, sleeping, watching TV).

If you’re a parent or teacher who is trying to diagnose school refusal, here are a few signs that they should be accessed for school refusal:

  • If a young person misses 2-3 days of school per week for more than 2 consecutive weeks.

  • If they report frequent physical/somatic problems (headaches, stomachaches, chest pains) that have no medical cause on test days or when assignments are due.

  • If they make excuses to come home or stay home.

  • If they have meltdowns, tantrums, or even anger eruptions that require them to go home at regular intervals (maybe in the morning, before a certain class, after lunch, or during a transition).

Typically, the way you can differentiate a student who is truant from one impacted by school refusal is by paying attention to how that student behaves when they are not attending school. Truant students are not anxious about attending school; they frequently miss school to spend time with friends, are secretive about not attending school, and are disconnected with the work.

Parents are usually aware if their student refuses to attend school. The student will have crying spells, temper tantrums, and somatic symptoms like constant midday stomachaches that do not have a medical cause.

As with many mental health needs, early identification is the key. If you feel like something is wrong, speak up. It is imperative that school refusal not be treated like truancy. Many schools can assess for school refusal, which is the recommended place to start. School refusal requires a team approach that includes school personnel, the student, their caregivers, mental health providers, and outside supports. It requires identifying the student’s needs, fears, and concerns and providing a safe, consistent environment for the student to learn the skills to deal with their anxiety and practice coping mechanisms. Untreated, these students will drop out of school with mounting fears and anxieties. We cannot leave them behind.

If you would like to learn more about this issue, the website Kids Matter, the American Association for Anxiety and Depression, and NAMI are places to start. NPR also did an excellent story showcasing one school district’s strategies to meet the needs of students impacted by this disorder. You should check it out!

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