KidsMD Health Topics

School Refusal

  • Overview

    There are a few common reasons for your child's refusal to attend school. You might notice your child's phobia in these common situations:

    • Going to school for the first time: This is a normal type of school refusal. This develops with a child's normal separation anxiety, or uneasiness about leaving a parent figure. This type of fear usually goes away within a few days.
    • Fear: Older children may have school phobia based on a real fear of something that may happen to them at school, such as a bully or a teacher being mean. In this situation, it is important to talk with your child to determine what is causing his fears.
    • Distress: Some children are truly distressed about leaving their parent and going to school. Usually, these children enjoy school but are anxious about leaving their parents.

    How Boston Children's Hospital approaches school refusal

    Children's unique Advocating Success for Kids (ASK) program works with children under age 14 who are having learning, developmental, emotional or behavioral problems in school or at home. Our multi-disciplinary team evaluates their developmental, learning and/or behavioral difficulties, and refers families for appropriate support services.

    school refusal, truancy, school refusal vs truancy chart

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    Children's Hospital Boston
    300 Longwood Avenue
    Boston MA 02115
     617-355-6680


  • In-Depth

    School refusal is the third most common cause of children missing school.

    • Fifty percent of children with school refusal have other behavioral problems.
    • Twenty percent of parents who have a child with school refusal have a psychiatric problem.
    • There is usually a strong bond between the parent and child.
    • Children may be depressed.
    • School refusal is more common in girls than in boys.

    What are the signs of school refusal?

    Your child:

    • may complain of other symptoms (stomach ache, headache) that get better as soon as she is allowed to stay home
    • may tell you that she is anxious or afraid of a certain situation that happens at school
    • may not want to leave you because of a change in her life, such as the following:
      • new school
      • has just moved
      • new brother or sister
      • a sick brother, sister or parent
      • divorce
      • death in the family

    Clinician Q&A

    School refusal, which affects around 4 percent of school-aged children, can lead to long-term school absence and have serious consequences if left untreated. We spoke with Jayne Singer, PhD, clinical psychologist in Boston Children's Hospital's Developmental Medicine Center, to learn more.

    Q: What should a parent do if her child refuses to go to school?

    A: Treatment depends on the root cause, so moving quickly is crucial. A child who's afraid to leave her mother requires very different management than a child who has a phobia of a fire alarm. The longer the child is allowed to stay home, the harder it is for her to get back into the routine of feeling comfortable in school. So the sooner the root is identified and treated, the better.

  • Tests

    School refusal is usually diagnosed with a team approach, including your physician, you, the child and teachers and counselors. Your child's doctor will be involved to rule out any medical problems that your child may have.

  • These interventions might be helpful as you try to ease your child into a school environment:

    • Return your child to school. Make sure school officials understand the situation and do not send your child home for the wrong reasons.
    • Consider family counseling if other problems exist.
    • Allow your child to speak about her concerns and fears.
    • Talk to a Children's psychiatrist or psychologist.
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