School avoidance occurs in about 5% of all school-aged children and affects girls and boys equally. It usually occurs between the ages of 5 and 11.

The cause is often unclear, but psychologic factors (eg, anxiety, depression) and social factors (eg, having no friends, feeling rejected by peers, being bullied) may contribute. If school avoidance behaviors escalate to the point at which a child is missing a lot of school, the behaviors may be an indication of more serious problems (see Mental Disorders in Children and Adolescents: Anxiety Disorders in Children and Adolescents). A sensitive child may be overreacting with fear to a teacher's strictness or rebukes. Changes in classroom staffing or curriculum can precipitate school resistance in children with special educational needs. Younger children tend to manifest somatic complaints (eg, stomachache, nausea) or make excuses to avoid school. Some children directly refuse to go to school. Alternatively, children may go to school without difficulty but become anxious or develop physical 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 (truancy).

School avoidance tends to result from

• Poor academic performance
• Family difficulties
• Difficulties with peers

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 March 2013 by Stephen Brian Sulkes, MD

Content last modified March 2013