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School Avoidance

By

Stephen Brian Sulkes

, MD, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry

Last full review/revision Aug 2021| Content last modified Aug 2021
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School avoidance is a disorder affecting school-aged children who, because of anxiety, depression, or social factors, avoid attending school because attendance causes stress.

  • Some psychologic and social factors may cause school avoidance.

  • Children may fake illnesses and make up excuses to avoid going to school.

  • To re-establish regular attendance at school, open communication between the child, parents, and school personnel is recommended.

  • Sometimes psychologic therapy may be needed.

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

The cause of school avoidance is often unclear, but psychologic factors (such as stress, anxiety Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances. There are many types of anxiety disorders... read more , and depression Depression and Mood Dysregulation Disorder in Children and Adolescents Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more —see also Overview of Mental Health Disorders in Children Overview of Mental Health Disorders in Children The treatment section for bipolar disorder has been extensively revised with separate treatment sections for mania and for depression. In addition, information has been added throughout to address... read more ) and social factors (such as having no friends, feeling rejected by peers, or being bullied Bullying Many children and adolescents occasionally have physical confrontations with others, but most children and adolescents do not continue violent behavior or engage in violent crime. However, children... read more ) may contribute. If school avoidance escalates to the point that a child is missing a lot of school, it may be a sign of a more serious problem such as a depression disorder Depression and Mood Dysregulation Disorder in Children and Adolescents Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more or one or more of the anxiety disorders Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances. There are many types of anxiety disorders... read more , particularly social anxiety disorder Social Anxiety Disorder in Children and Adolescents Social anxiety disorder involves a persistent fear of being embarrassed, ridiculed, or humiliated in social situations. Children and adolescents with social anxiety disorder typically avoid... read more , separation anxiety disorder Separation Anxiety Disorder Separation anxiety disorder involves persistent, intense anxiety about being away from home or being separated from people to whom a child is attached, usually the mother. Most children feel... read more , and/or panic disorder Panic Disorder in Children and Adolescents Panic disorder is characterized by panic attacks that occur at least once a week. A panic attack is a brief (about 20-minute) episode of intense fear that is usually accompanied by physical... read more . These other disorders differ from school avoidance in that they also cause problems that are unrelated to school. 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 School Problems in Adolescents School Problems in Adolescents School constitutes a large part of an adolescent’s existence. Difficulties in almost any area of life often manifest as school problems. Particular school problems include Fear of going to school... read more ). Children who are frequently truant from school often have a conduct disorder Conduct Disorder A conduct disorder involves a repetitive pattern of behavior that violates the basic rights of others. Children with a conduct disorder are selfish and insensitive to the feelings of others... read more .

In children who do not have a serious psychologic disorder, school avoidance tends to result from

  • Poor academic performance

  • Family difficulties

  • Difficulties with peers

Most children recover from school avoidance, but some develop it again after a real illness or a vacation.

Home tutoring usually 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, the child may need to be seen by a mental health practitioner.

Treatment

  • Communication with school personnel

  • Attendance at school

  • Sometimes therapy

Treatment of school avoidance should include communication between parents and school personnel, regular attendance at school, and sometimes therapy involving the family and child with a mental health practitioner. Therapy includes treatment of underlying disorders, adaptation of the school curriculum for children who have a learning disability or other special education needs, and behavioral techniques to cope with the stresses at school.

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