School avoidance behavior occurs in approximately 1 to 15% of school-aged children, with equal rates in girls and boys. It usually occurs between the ages of 5 and 11 (1).
The cause of school avoidance is often unclear, but psychological factors (eg, anxiety, depression) and social factors (eg, social isolation, feeling rejected by peers, being bullied) may contribute. A sensitive child could be overreacting out of fear to a teacher's strictness or rebukes. Changes in classroom staffing or curriculum can also precipitate school resistance in children with special education needs.
If a child begins to miss significant amounts of school because of avoidance behaviors, it may be a signal that the child has a more serious problem, such as a childhood depressive disorder or one or more of the anxiety disorders, particularly social anxiety disorder, separation anxiety disorder, panic disorder, or selective mutism. Chronic truancy is often present in children with a conduct disorder. A differentiating factor between school avoidance and underlying psychiatric disorders is that children with school avoidance manifest difficulties only in relation to school, whereas with other disorders, children typically also have symptoms that involve other areas of their life.
Younger children tend to report 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 altogether.
In the absence of a significant underlying psychiatric disorder, school avoidance tends to result from the following:
Poor academic performance
Family difficulties
Difficulties with peers
In most children, school avoidance behavior occurs only one or a few times, but in some it can develop again after an illness or a vacation.
Children with school avoidance should return to school so that they do not fall behind in their schoolwork. Families should work with school staff to provide adaptations and supports to address and reduce precipitating factors. If school avoidance is so intense that it interferes with the child's activities and if the child does not respond to simple reassurance by parents or teachers, referral to a mental health professional may be warranted. Home schooling is generally not a solution because having the child be able to function in a school environment is often a goal.
(See also Overview of Behavioral Problems in Children.)
Reference
1. Leduc K, Tougas AM, Robert V, Boulanger C. School Refusal in Youth: A Systematic Review of Ecological Factors. Child Psychiatry Hum Dev. 2024;55(4):1044-1062. doi:10.1007/s10578-022-01469-7
Treatment of School Avoidance
Communication with school personnel
Attendance at school, with social or emotional support if needed
Sometimes therapy
Treatment of school avoidance should include communication between parents and school personnel, regular attendance at school with in-school counseling (if available), and sometimes therapy involving both the family and child with a psychologist.
Therapy includes treatment of underlying psychiatric 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.
