School avoidance occurs in about 5% of all school-aged children and affects girls and boys equally. It usually occurs between ages 5 and 6 and between ages 10 and 11.
The cause is often unclear, but psychologic factors (such as anxiety and depression) and social factors (such as having no friends, feeling rejected by peers, or being bullied) may contribute. Sensitive children may be overreacting with fear to a teacher's strictness or rebukes. Younger children tend to fake illness or make other excuses to avoid school. Children may complain of a stomachache, nausea, or other symptoms that justify staying home. Some children directly refuse to go to school. Alternatively, children may go to school without difficulty but become anxious or develop various symptoms during the school day, often going regularly to the nurse's office. This behavior is unlike that of adolescents, who may decide not to attend school (called truancy or "playing hooky”—see see School Problems in Adolescents).
School avoidance tends to result in
Most children recover from school avoidance, although some develop it again after a real illness or a vacation.
Home tutoring generally is not a solution. Children with school avoidance should return to school immediately, so that they do not fall behind in their schoolwork. If school avoidance is so intense that it interferes with the child's activity and if the child does not respond to simple reassurance by parents or teachers, referral to a mental health practitioner may be warranted.
Treatment should include communication between parents and school personnel, regular attendance at school, and sometimes therapy involving the family and child with a psychologist. Therapy includes treatment of underlying disorders as well as behavioral techniques to cope with the stresses at school.
Last full review/revision February 2009 by Stephen Brian Sulkes, MD