Stress and worry play a big part in ‘school refusal’ – that is, when a child experiences severe distress at the idea of going to school. Amanda Dudley, Psychologist and Lecturer at Deakin University, describes this important link.  

How is school refusal defined in comparison to occasional reluctance, truancy or school withdrawal? 

School refusal is when a young person experiences severe emotional upset at the prospect of attending school. It can result in prolonged absence from school and these children often report a range of physical complaints, such as headaches, stomach aches or nausea. If they miss school, they are typically at home with parents’ knowledge. This is quite different to an occasional reluctance to attend school. In fact, it is quite normal for a child to have some anxiety or worry about attending school and to miss a day occasionally.

Truancy, also known as ‘wagging’, is where a student heads off to school in the morning or goes to school but then slips off to meet up with friends or hang out in places such as parks and shopping centres. Truancy is also associated with rule-breaking behaviour, such as stealing and lying. A truant usually works hard to conceal non-attendance.

School withdrawal is a term used to describe situations where parents may keep a child at home for a range of reasons. These parents may want the child to help out around the home, support an ill family member, or may fail to appreciate education and regular attendance at school. Distress associated with school attendance is usually not a factor for the child.

How much of a factor is stress in the occurrence of school refusal?

There are many factors associated with the occurrence of school refusal. The reasons for school refusal are complex and can be difficult to tease out. In some cases, school refusal can be triggered by a specific school-related event or situation. Things such as starting school, moving to a new school, bullying, or difficulties with a teacher can precipitate an episode of school refusal. School refusal can also be associated with non-school related factors, such as a legitimate absence from school (eg an illness or a holiday) or experiencing a stressful event like family illness, loss, separation/divorce, or moving house.

Stress is a main factor associated with school refusal. Regardless of the initial reasons for the school refusal, if a young person has missed a significant amount of school, they then become very stressed and worried about what to say about their absence. School refusal not only causes a great amount of stress for a child/adolescent, but also for their parents, family and school personnel.   

Are there any times when school refusal might be more likely to occur?

School refusal can occur at any time throughout a child or teenager’s school life. There are common times when school refusal is more likely to occur – usually at transition times when first starting school, changing from primary school to high school, or moving to a new school.

What are some of the things a professional might need to consider when assessing a child with school refusal?

A comprehensive assessment involving the child, parent/carer(s) and school personnel is most important. Gathering information from a range of sources helps a professional to understand the issues associated with the child’s refusal to attend school and helps to direct treatment. Given school refusal is often associated with a range of physical complaints, a check up with a medical practitioner is important to assess for any general medical problems. The goal of treatment is to assist the child to return to school as soon as possible, therefore, it is important to rule out any underlying medical problems.

What strategies might help to improve stress-related school refusal?

Strategies for coping with school refusal at the policy level in primary schools:

  • Create a positive school climate in which children feel supported by peers and teachers and connected to the school community.

  • Establish peer support or mentoring programs to increase a sense of connectedness among students.

  • Closely monitor student attendance to detect any problems and to follow-up early on with students and their parents. 

  • Communicate the importance of consistent attendance to the school community.

  • Develop effective programs to support children and their families during the transition to school and between schools.

  • Ensure teachers and other school staff have an awareness of the factors that contribute to school refusal and receive support when working with students with persistent school refusal.

Strategies that school staff can use to cope with school refusal at the individual level:

  • Work with families to understand why the child might be refusing school.

  • Work with the school’s wellbeing team, as well as professionals within the broader community, to support the child using a united approach.

  • Support families to implement a school morning routine to convey expectations of school attendance.

  • Provide a flexible timetable to support a graduated return to school – that is, allow the child to attend for a short time as a first step, and then gradually return to a full school day.

  • Provide recognition and positive feedback, such as verbal praise for any efforts towards school attendance.

  • Maintain close contact with the family, even during extended periods of non-attendance.

  • Acknowledge the challenges experienced by parents of children who refuse school.

  • Respond to any school-based needs (eg academic support, dealing with bullying, support with social relationships).

Is it likely school refusal would decrease along with stress levels?

There is certainly a relationship between school refusal and stress levels. When children learn how to effectively manage their anxiety and stress, they are better equipped to face a return to school and to attend school regularly.

What resources can you recommend to health professionals?

For health professionals:

  • Rapee et al (2011). Treating Anxious Children and Adolescents: An Evidenced Based Approach.

  • Kearney (2007). When Children Refuse School: A Cognitive Behavioural Therapy Approach. Therapist Guide.

  • Heyne & Rollings (2002). Parent, Adolescent and Child Training Skills 2: School Refusal.

For school staff:

  • Kearney (2008). Helping School Refusing Children and Their Parents: A Guide for School Based Professionals.

For parents:

  • Rapee et al (2008). Helping Your Anxious Child: A Step by Step Guide for Parents. 2nd Edition.

  • Kearney (2008). Getting Your Child to Say Yes to School: A Guide for Parents of Youth with School Refusal Behaviour.

  • Kearney & Albano (2007). When Children Refuse School: A Cognitive Behavioural Therapy Approach. Parent Workbook.

  • Weaver (2000). The School Wobblies.

For more, see the KidsMatter resource on school refusal.