The Back-to-School Blues: When Your Child Refuses to Go

Does your child try to refuse to go to school?

School-avoidant behaviors can include:

• a child frequently complaining of stomachaches or headaches when it’s time to get ready in the morning
• a teenager admitting they want to avoid a particular social or academic issue at school
•  general excuses about why he or she should get to stay home or spend the day with their parents 

Some students roam the school hallways or hang out in the nurse’s office all day to avoid their school-based anxieties. Others say they just can’t get out of bed in the morning or out of the car in the school parking lot.

“School phobia is not a diagnosis, but the symptoms are similar to those you might see in someone diagnosed with an anxiety disorder or a specific phobia,” says Elizabeth R. Pulgaron, Ph.D., a licensed pediatric psychologist at the University of Miami Health System and associate professor of clinical pediatrics at the University of Miami Miller School of Medicine.

A child’s anxiety about school can be a response to being held back a grade or changes like entering a new school, divorce, moving to a new town, a death in the family or a new sibling. Younger children may develop a fear of being away from their parents or caregiver. Some children are trying to avoid a bully or a specific teacher. Others are responding to personal trauma. 

How to help your child overcome their school phobia

It may seem harmless at first, but allowing your child to play hooky regularly teaches them that attendance isn’t mandatory. It can also reinforce the power of a conflict or challenge they are afraid to face at school, regardless of how irrational that fear may be.

“As with any behavior change, it is important to understand the function of the behavior — in this case, avoidance — and the consequence associated with this behavior,” Dr. Pulgaron says.

If your child actually avoids the situations and people that trigger their “school phobia,” school can become an intimidating place. If you add on the additional consequences of missed classes and extracurricular commitments, incomplete assignments, and questions from classmates about their absence, it can become a nightmare. 

But, missing school should not be rewarded with playing video games all afternoon or spending a leisurely day with a stay-at-home parent. Instead, parents can leverage one-on-one attention with their child and playtime or screen time as rewards for consistent school attendance.

Other ways to respond to your child’s school refusal:

“Be consistent and honest with your child regarding your expectations and the consequences for not attending school,” Dr. Pulgaron says. “Follow through is key. Empty threats or false promises should be avoided.” 

• Don’t use a letter from your pediatrician to excuse your child from school unless it is for a valid medical reason.
• Keep your goodbyes short and positive at drop-off.
• Maintain a consistent weekday schedule.
• Spend quality time with your child outside of school hours (such as eating meals together, having dedicated reading or conversation time, and going for an evening walk to reflect on their day).
• Ask your child about specific aspects of school, such as a particular class, teacher, or classmate, that triggered their anxiety. Speak with curiosity and helpful intentions without accusing them of mishandling their interactions at school.
• Validate their feelings.

Their school is a helpful resource.

If you need help encouraging your child to attend class without a daily struggle, speak with their school. “The teacher, counselor, or other school staff may have insight as to why this is occurring and how to manage during school hours,” says Dr. Pulgaron. 

School administrators or teachers may recommend creating an Individualized Education Program (IEP) or 504 plan tailored to address your child’s academic and social challenges and attendance goals. 

“These plans can assist students with a condition that’s impacting their ability to participate in schooling,” Dr. Pulgaron says. “IEPs and 504 Plans are typically used to document and inform the caregiving team (teachers, parents, counselors, etc.) of the recommended accommodations for a child to be able to succeed at school.”

Things to remember when considering an IEP/504 plan:

• These plans are helpful to document the student’s goals, progress, and transitions
• They are often based on a psycho-educational assessment or physician recommendations
• Eligibility varies based on the student’s presenting problems
• Plans are created by the school with the various parties involved 
• Accommodations vary based on individual needs, goals, and resources available

“If help is still needed,” Dr. Pulgaron says, “most pediatricians can refer you to a psychologist or therapist for further consultation.”

When your child could benefit from professional help

Your pediatrician can rule out any health problems that may contribute to a child’s school refusal, such as a developmental issue, learning disorder, medication mismanagement, sleep disorder, or hearing or vision loss. Your provider will review your child’s health history and conduct a physical exam. They may contact the school for more information.

If your family is referred to a child psychologist, treatment for school-based anxiety may include exposure therapy or cognitive behavioral therapy focused on specific skills that can help the child learn to cope with the thoughts, emotions and behaviors associated with school. “The coping skills are similar to those used in anxiety treatment generally, such as exposures and reinforcement systems for school attendance,” Dr. Pulgaron says.

Many students who are regularly distressed about attending school are also diagnosed with mental health, learning, and neurological disorders, including:

• attention-deficit/hyperactivity
• generalized anxiety
• major depression
• separation anxiety
• social anxiety
• specific phobias
• oppositional defiance
• post-traumatic stress and adjustment disorder

If a child’s school avoidance stems from trauma or a conflict at home, family counseling can ease communication with an angry or withdrawn child and encourage healing.

Helping your child get an accurate diagnosis, the proper treatment, accommodations at school, and support and love at home can make a big difference. Left untreated, persistent school refusal can lead to negative outcomes, including academic underachievement, school dropout, social isolation and poorer mental health.

If you live in South Florida and are seeking an evaluation of and treatment for your child’s anxiety, contact the University of Miami’s Child and Adolescent Mood and Anxiety Treatment (CAMAT) program. Call (305) 284-9852, ext. 1 or email [email protected]. They offer cognitive behavioral therapy and exposure therapy at low to no cost.

Click here to watch a CBS4 News segment on back-to-school anxiety, featuring advice from Jill Ehrenreich-May, Ph.D., director of the CAMAT program.

Dana Kantrowitz is a contributing writer for UHealth’s news service.

Tags: child behavior, child development, child psychiatry, Dr. Elizabeth Pulgaron, kids health, school stress