What to do when your child refuses to go to school

As summer winds to a close, many children are reluctant to greet another school year. Who can blame them? Swapping swimming, lazy days, camp activities, and late nights for classrooms, homework, and early morning bus rides isn’t much of a trade at all. For most kids, any sour taste is short-lived, and they return to the school routine quickly, even if begrudgingly. For others, though, fears and worries about returning to school runs much deeper, and can appear as school refusal.

School refusal goes beyond an occasional “I hate school” or “I don’t want to go to school today.” Children with school refusal may sob, scream, or plead for hours in an attempt to stay home from school. They may complain of illness or even run home from school if forced to go. Absences can last weeks or even months.

The problem may start at any point, but common triggers are the start of a new school year, making the transition to a new school (middle school to high school, for example), or returning from school vacation. An illness or the loss of a loved one may also set off school refusal. Just how many children are affected is unclear, with estimates varying from 5% to 28%. According to the Anxiety Disorders Association of America, this problem is most common between the ages of 5 and 6, and again between the ages of 10 and 11.

School refusal often stems from an anxiety disorder, according to Coping with Anxiety and Phobias, a new Special Health Report from Harvard Medical School. The underlying condition may be social phobia (anxiety caused by social situations or performing in front of a group), generalized anxiety disorder (excessive worry and anxiety about a variety of things), or separation anxiety (fear of being away from a parent). Sometimes a specific phobia is at the root of the problem, such as fear of being called on in class or fear of a critical teacher or bullies.

When a child refuses to go to school regularly, parents should seek help from a mental health professional. A therapist may meet with parents, school staff, and the child to come up with a plan to address the situation. Usually, cognitive behavioral therapy (CBT) is used to manage the underlying anxiety problem. While CBT is the most effective and most commonly used treatment for anxiety disorders in children and adolescents, antidepressants—particularly selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft)—are sometimes prescribed as well. CBT involves using different techniques to change negative thought and behavior patterns.

One of the most effective methods is to gradually expose the child to the feared object—in this case, school. For example, a student may start out by attending just one or two classes a day while a parent or therapist waits outside in the parking lot. Over time, more classes are added until the student is attending school all day. Other helpful techniques include teaching a child how to use deep breathing or muscle relaxation techniques to calm down.

The Anxiety Disorders of America website offers other tips on coping with school anxiety.

Coping with Anxiety and Phobias, a Special Health Report from Harvard Medical School, provides in-depth information on recognizing and treating a variety of anxiety disorders—including social phobia, post-traumatic stress disorder, panic disorder, and generalized anxiety disorder—in adults as well as children. To order this report—or one of Harvard Medical School’s other special health reports and newsletters—visit health.harvard.edu. There you’ll find summaries, excerpts, and the tables of contents from all our Special Health Reports, as well as  free health news articles and blogs from the doctors and editors at Harvard Health Publishing.