Merck Manual

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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 Dec 2019| Content last modified Dec 2019
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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 of school avoidance 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 such as a childhood depressive disorder or one or more of the anxiety disorders, particularly social anxiety disorder, separation anxiety disorder, and/or panic disorder. 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—see School Problems in Adolescents); chronic truancy is often present in children with a conduct disorder.

In the absence of a significant underlying disorder, 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 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 psychologist. Therapy includes treatment of underlying disorders, adaptation of the school curriculum for children who have learning disability or other special education needs, and behavioral techniques to cope with the stresses at school.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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