What Is School Refusal? A Parent's Guide to Understanding School Avoidance

You’ve tried everything. The gentle wake-ups. The rewards for making it through the week. The conversations about why school matters. And still, every morning feels like a battle—tears, stomach aches, panic, bargaining. By the time the bus has come and gone, you’re exhausted, confused, and wondering what you’re doing wrong.

If this sounds familiar, you’re not alone. And what you’re experiencing isn’t a discipline problem or a phase your child will outgrow on their own. It has a name: school refusal. At Bio Behavioral Institute, we’ve worked with hundreds of families navigating this exact struggle—and we know that with the right support, it gets better.

School Refusal Is More Than “Not Wanting to Go”

What School Refusal Actually Means

School refusal is a term clinicians use to describe a child’s difficulty attending school due to emotional distress. It’s not a diagnosis in itself—it’s a behavior that signals something deeper is going on.

Research suggests school refusal affects 2–5% of school-age children (Fremont, 2003). It tends to peak at transition points: ages 5–7 when children start elementary school, around 10–11 when they move to middle school, and again at 14 when high school begins. There’s no significant difference between boys and girls—it affects children across genders equally.

What makes school refusal distinct is the intensity. Every child occasionally says they don’t want to go to school. But for children experiencing school refusal, the distress is persistent, disruptive, and often accompanied by physical symptoms that feel very real.

School Refusal vs. Truancy — Why the Difference Matters

One of the most important things parents need to understand is that school refusal is not the same as truancy—and the distinction matters for how you respond and what kind of help your child needs.

This distinction matters because a child experiencing school refusal isn’t being defiant—they’re struggling. And approaches that work for truancy (consequences, discipline, “tough love”) often make school refusal worse.

If your school has mentioned truancy proceedings, knowing this difference can help you advocate for your child and seek appropriate support.

What School Refusal Actually Looks Like

Physical Symptoms Parents Often Mistake for Illness

Many parents first notice school refusal through their child’s body, not their words. Stomachaches. Headaches. Nausea. Dizziness. Complaints of feeling sick that seem to appear every school morning—and mysteriously resolve by the weekend.

These are called somatic complaints, and here’s what’s important: they’re real. Your child isn’t faking. Anxiety produces genuine physical sensations. The stomach aches are real stomach aches. The headaches are real headaches. The distress your child feels about school is manifesting in their body.

This is why trips to the pediatrician often come back with “nothing wrong”—because the source isn’t physical illness. It’s anxiety.

Emotional and Behavioral Signs

Beyond physical symptoms, school refusal often shows up as:

• Crying, tantrums, or panic attacks in the morning
• Clinging to parents at drop-off
• Begging to stay home, negotiating for “just one more day”
• Morning battles that escalate over weeks or months
• Increasing difficulty getting out of bed or ready for school
• Irritability, shutting down, or withdrawing when school is mentioned

You may notice these episodes getting longer or more intense over time. What started as occasional reluctance becomes a daily crisis.

How It Looks at Different Ages

School refusal doesn’t look the same at every age.

Elementary school: Younger children often experience separation distress—they don’t want to leave you. They may cling, cry, or complain of physical symptoms. They might not be able to articulate what they’re afraid of; they just know they don’t want to go.

Middle school: As children get older, school refusal often shifts toward social and evaluative fears. They may avoid specific classes, dread presentations or group work, or worry intensely about peer interactions. Physical complaints may continue, but you’ll also hear more about what’s making them anxious.

High school: By adolescence, school refusal can look like withdrawal. Teens may refuse to leave their bedroom, become increasingly isolated, and experience academic decline. Some stop attending entirely. The anxiety has often become deeply entrenched.

Why Children Refuse School — The Four Functions

Researchers Christopher Kearney and Anne Marie Albano developed a framework that helps parents and clinicians understand why a child is refusing school. Understanding the function—the underlying reason—is essential for effective treatment.

Avoiding Things That Cause Distress (Function 1)

Some children refuse school to avoid stimuli that trigger anxiety: the noise of the cafeteria, the chaos of hallway transitions, the unpredictability of the school day. They may not be able to name exactly what’s wrong—they just know school feels overwhelming.

This pattern is often associated with generalized anxiety or specific phobias.

Escaping Social or Evaluative Pressure (Function 2)

Other children are specifically avoiding situations where they feel evaluated or judged: tests, presentations, being called on in class, group projects, or social interactions with peers.

This pattern is common in children with social anxiety. It’s also seen in children with OCD-related perfectionism—they may avoid school because the fear of making mistakes or not performing “perfectly” becomes unbearable.

Staying Close to Parents (Function 3)

For many younger children, the core issue is separation anxiety. They’re not necessarily afraid of school—they’re afraid of being away from you.

This is the most common driver of school refusal in elementary-age children. Research shows that approximately 75% of children with separation anxiety disorder exhibit school refusal behavior (Last et al., 1987).

Preferring Activities at Home (Function 4)

Some children avoid school because they’d rather be doing something else: gaming, sleeping, watching videos. This is the pattern that looks most like truancy, and it’s more aligned with oppositional behavior than anxiety.

However, it’s important not to assume this is what’s happening without assessment. Many children who appear to “just want to stay home and play video games” are actually using those activities to cope with anxiety they can’t articulate.

Most children don’t fit neatly into one category. They often show a mix of functions, and understanding the full picture requires careful assessment.

The Anxiety and OCD Connection Most Parents Don’t See

Here’s something many parents don’t realize: school refusal is almost always connected to an underlying anxiety disorder.

More than 50% of children who refuse school meet criteria for an anxiety disorder. And as mentioned, 75% of children with separation anxiety exhibit school refusal. But there’s another connection that often goes unrecognized: OCD.

Obsessive-compulsive disorder can drive school avoidance in ways that aren’t immediately obvious. A child with contamination fears may dread using school bathrooms. A child with “just right” OCD may become paralyzed by the need to do assignments perfectly. A child with intrusive thoughts may avoid school to escape triggers. The school refusal is visible; the OCD underneath often isn’t.

At BBI, we frequently see children referred for school refusal whose OCD has been missed entirely. The school refusal is the symptom that brought them to treatment—but the OCD is what’s driving it.

The Post-COVID Surge

School refusal has always been a significant issue. But since the pandemic, it’s become dramatically more common.

Before COVID, chronic absenteeism (missing 10% or more of school days) affected about 15% of students. After the pandemic, that number nearly doubled to 28%, according to the American Enterprise Institute’s Return to Learn Tracker.

Many families assumed their child’s attendance problems would resolve once schools reopened. For some children, they didn’t. The extended time away from school allowed anxiety to strengthen. The avoidance became a habit. And now, years later, those patterns have become entrenched.

The Avoidance Cycle

This is the mechanism that makes school refusal so difficult to break without treatment:

Avoidance works—in the short term. When your child stays home, the anxiety drops. The stomach ache eases. The panic subsides. Your child feels better.

But here’s what happens in the long term: the brain learns that school is dangerous and that avoiding it is the solution. Each day of avoidance strengthens the anxiety. The longer a child is out, the harder it becomes to go back. The relief of staying home becomes the trap.

This is why “waiting it out” rarely works—and why early intervention matters so much.

What Happens When School Refusal Goes Untreated

Academic and Social Consequences

The immediate consequences are often visible: falling grades, missed assignments, academic gaps that widen over time. But the social consequences can be just as significant.

Children who miss school lose peer connections. They miss the daily social practice that builds friendships and social skills. They become increasingly isolated from their classmates. And the longer they’re out, the more overwhelming the idea of returning becomes.

There’s a window where return is difficult but manageable. The longer a family waits, the harder that return becomes.

Long-Term Mental Health Impact

The research on untreated school refusal is sobering. Studies suggest that 30–50% of school-refusing adolescents go on to develop psychiatric disorders in adulthood, including:

• Worsening anxiety disorders
• Depression
• Agoraphobia (fear of leaving home)
• Employment difficulties
• Long-term social isolation

School refusal often does not resolve without intervention. The anxiety generalizes. The avoidance expands. What started as avoiding school can become avoiding college, avoiding work, avoiding life.

This isn’t meant to frighten you—it’s meant to help you understand why getting the right help matters.

When to Seek Professional Help

Parents often ask us: how do I know when this is serious enough to need professional help?

Here’s a clear framework:

Seek help if your child: - Has missed two or more weeks of school (consecutive or cumulative) - Shows escalating morning distress that’s getting worse over time - Has physical symptoms before almost every school day - Has stopped attending school entirely - Has panic attacks related to school - Shows significant changes in mood, sleep, or behavior

What kind of professional to look for:

Not all therapy is equally effective for school refusal. General talk therapy—exploring feelings, processing experiences—is rarely sufficient when anxiety is the driver.

What works is Cognitive Behavioral Therapy (CBT), often with Exposure and Response Prevention (ERP) for underlying anxiety or OCD. This is treatment that systematically helps your child face feared situations while building skills to manage anxiety.

Look for a clinician who: - Specializes in anxiety disorders or OCD in children - Uses CBT/ERP approaches - Has specific experience with school refusal - Can provide intensive treatment if needed (more than once weekly)

The goal isn’t just to get your child back to school—it’s to address the anxiety driving the avoidance so they can stay there.

Frequently Asked Questions About School Refusal

Is school refusal a mental illness? School refusal itself is a behavior, not a diagnosis. However, it’s almost always connected to an underlying condition—most commonly an anxiety disorder, separation anxiety, social anxiety, or OCD.

Can my child get a 504 plan or accommodations for school refusal? Yes. If school refusal is connected to a documented anxiety disorder or other mental health condition, your child may qualify for a 504 plan that provides accommodations. This might include a gradual return-to-school plan, reduced schedule, or other supports.

Will my child get in trouble for not going to school? Many parents fear truancy proceedings. The key is documenting that your child’s absences are related to emotional distress—not willful truancy. A diagnosis from a mental health professional and communication with the school can help protect your family.

Is school refusal increasing after COVID? Yes. Chronic absenteeism has nearly doubled since the pandemic. Many children who were able to attend before COVID developed anxiety during extended school closures that hasn’t resolved.

How long does school refusal last without treatment? It varies, but school refusal rarely resolves on its own. Research consistently shows that early, evidence-based intervention produces better outcomes. The longer a child is out of school, the more difficult return becomes.

Does forcing my child to go make it worse? This is complicated. Forcing a child to go without addressing the underlying anxiety can increase distress and damage trust. However, long-term avoidance makes anxiety worse. The answer isn’t force or accommodation—it’s treatment that helps your child build the skills to tolerate discomfort while gradually returning to school.

At what age is school refusal most common? School refusal peaks at transition points: 5–7 (starting school), 10–11 (middle school), and 14 (high school). But it can occur at any age.

Is school refusal genetic? Anxiety disorders—the most common drivers of school refusal—do have genetic components. If anxiety runs in your family, your child may be at higher risk. However, genetics isn’t destiny. With proper treatment, children can learn to manage anxiety effectively.

Getting Help at Bio Behavioral Institute

If your child is struggling with school refusal, you don’t have to figure this out alone.

At Bio Behavioral Institute in Great Neck, NY, we specialize in anxiety disorders and OCD—the conditions most commonly driving school refusal. Our school refusal program has an 87% success rate because we don’t just address the behavior. We identify and treat what’s underneath.

What sets BBI apart: - Over 45 years of experience treating anxiety and OCD - Clinicians who specialize in school refusal, not general therapists - Evidence-based treatment using CBT and ERP - Intensive outpatient options when weekly therapy isn’t enough - A collaborative approach that involves parents and works with schools

We’ve helped children who hadn’t attended school in months. We’ve worked with families who had tried multiple therapists without success. We’ve seen what’s possible when school refusal is treated by specialists who understand it.

What to expect in a consultation: Your first conversation with us is about understanding what’s happening with your child—not just the school refusal, but the full picture. We’ll ask about symptoms, history, what you’ve already tried, and what your goals are. From there, we develop a treatment plan tailored to your child.

We work with families across Long Island, Nassau County, and the greater tri-state area.

If your child has been missing school for two or more weeks, early intervention matters. The anxiety-avoidance cycle strengthens over time. The sooner you address it, the better the outcomes.

Schedule a consultation with our school refusal specialists to learn how we can help your family.

Phone: (516) 487-7116 Email: info@biobehavioralinstitute.com

Medical Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If your child is experiencing school refusal or related symptoms, please consult with a qualified mental health professional.

Medically reviewed by the clinical team at Bio Behavioral Institute.