School Anxiety and School Refusal

School Anxiety: Why Children Chronically Resist Going to School

Most children claim to “hate school” or “play hooky” on occasion during the course of their primary and secondary education (grades K-12). That’s to be expected.

Chronic resistance or refusal to attend school is another matter. “School anxiety/refusal” sometimes is fueled by a legitimate concern or fear, such as bullying. But an estimated two-thirds of school refusal cases result from an underlying psychiatric disorder—usually anxiety. For these children, attending school causes extreme emotional distress. Some even develop physical symptoms such as headaches, dizziness, or nausea.

An occasional absence, even for less-than-completely-convincing reasons, is generally no cause for concern. But if you’re noticing a pattern of school resistance or school refusal, this is a serious problem, often indicating an underlying anxiety disorder, and can easily become chronic. You may need to intervene, as it’s likely there’s a bigger issue to address.

Causes of School Anxiety

There are many reasons children may feel anxious about school. Sometimes there’s an easily identifiable concern, like bullying or difficulty with a teacher. Other causes include: social pressures, entering a new school, not enough sleep, academic challenges, and difficulties keeping homework assignments organized. However, the cause is not always obvious.

The most common cause, however, is an anxiety disorder. Anxiety that contributes to school avoidance behaviors commonly occurs between the ages of 5 and 6 and between 10 and 11, and at times of transition such as entering middle or high school. Anxiety disorders that contribute to school refusal behaviors typically arise through some combination of biology/genetics, learning/modeling, and life circumstances.


Some children may be born with a lower tolerance for stress and higher susceptibility to anxiety. Children of anxious parents are 7 times more likely to develop an anxiety disorder than are children of non-anxious parents.


Besides a possible genetic connection, anxious parents also influence the way their children view and interact with the world. Even well-meaning parents who aren’t overly anxious themselves may try to shield an anxious child from stressful situations, reinforcing the notion that anxiety is warranted.

Life circumstances

Anxiety is a common response to events that disrupt a child’s sense of order or safety – divorce, death of a parent, relocation, or trauma, for example. Normally it resolves on its own after an adjustment period. If not, treatment is indicated.

The Importance of Intervention

Some parents ignore the problem of school refusal, thinking it will run its course or even that this method will encourage their child to resolve things on his or her own. Others allow their child to stay home in an effort to shield him/her from stressful experiences. Though well-meaning, neither approach is advisable. The longer that school-refusal behavior is not addressed, the more entrenched it becomes and the worse the short and long-term consequences can be.

It doesn’t take long for a child who misses school to fall behind, which only compounds the anxiety. Children with unresolved anxiety often self-medicate with drugs and alcohol. They may make decisions that protect them from stress in the short term (such as not going to college, or choosing a less challenging career) but can hold them back down the road and limit their ability to fully enjoy life. One study found that teenagers and young adults ages 14 to 24 with social anxiety were nearly 3 times as likely to develop depression later in life than those without the anxiety disorder.

Identifying and Dealing With School Refusal and Anxiety

Obviously, no parent wants their child to be truant or drop out of school, so proactively handling this issue is a must. That means knowing what’s going on at home and school in order to address issues as they come up.

Review the actions in this checklist to help determine what you can do if you feel your child may be suffering from school anxiety.

  • Talk and LISTEN to your child daily. Make communication a constant in your relationship.
  • Establish a regular schedule for your child to get adequate sleep, exercise and healthy meals.
  • Encourage your child to remember what he likes about school.
  • Give praise freely and criticism sparingly. Let your child know how proud you are of her accomplishments, and use empowering phrases like “you must be proud of yourself” or “you worked hard for that!”.
  • Enlist teachers, principals and school counselors for help identifying issues, as well as working on resolutions.
  • Seek help from a mental health professional if anxiety interferes with school attendance. Anxiety disorders affect up to 25% of 13- to 18-year-olds. (National Institutes of Health)

Treatment For School Anxiety – CBT

If a child’s anxiety is interfering with his ability to function, prompt professional treatment is best. The main treatment for school-refusal behavior and underlying anxiety disorders is cognitive behavioral therapy (CBT). Medications such as antidepressants also may be prescribed.

CBT teaches patients how to confront and change negative thoughts and behaviors. Typically it starts with “psychoeducation”—in this case explaining what anxiety is, how it is triggered, and how it differs from danger. “Cognitive restructuring” helps the child change how he evaluates a situation. Instruction in breathing and relaxation techniques help the child calm the physical response he may experience. Then “exposure therapy” involves breaking down of anxiety-producing situations into small, manageable steps through which the child gradually faces and overcome his fears. For example, he may start by attending his favorite class while his parent waits in the car. After a while, a second-favorite class is added, and so forth.

Setbacks do occur, but the success rate is high: About 70 percent to 80 percent of children experience a significant improvement in function and decrease in symptoms.

With treatment and parental/family support, children can learn how to successfully manage the symptoms of anxiety disorder. In addition to living a more normal childhood, they will be much better prepared for adulthood.

Related Topic

If you found this resource interesting or helpful, check out our related resource which offers information on how to recognize the signs bullying and how to support a child who is being bullied.


Or if you enjoyed this resource, please print a copy of our white paper for someone you know with a child also struggling with school anxiety.