School Avoidance: What to Do When Your Child Refuses to Go to School

advocacy

It’s a core memory from my childhood. 

I remember it like it was yesterday.

I was 9 years old, in the 4th grade. 

The week prior I had been home “sick” with a queasy stomachache. No fever, headache, or any other symptoms. My mom either dragged me to work with her and set me up on a couch in the conference room or asked friends to watch me. I could tell her frustration was waxing as her patience waned. A veteran mom, she knew I wasn’t seriously ill. Meanwhile, I was convinced I might vomit at any moment. 

I was adamant. 

I knew it to be true. 

I know now that I was experiencing somatic symptoms due to anxiety.  

When the following Monday morning rolled around, my mother put her foot down. I absolutely had to go to school.

Sheer panic set in. I remember begging and kicking and screaming, convinced I wasn’t in any condition to return. I remember crying to the point of gagging, which only reinforced my fear of getting sick at school. My mom though, she had had enough. She physically pushed me out the door, tears streaming down my face. 

Then locked the door behind her. 

Deadbolt for emphasis.

When she pulled her car out of the garage an hour later, there I was. Still standing in the exact same place on the doorstep. The fear of my mom’s wrath was no match for my intense fear of going to school. I could have sworn my legs were trapped in cement. I simply could not take one step.  

It’s not that I didn’t want to.

I just couldn’t.  

The details of what happened next are murky. Trauma will do that to you.

Somehow, my mother managed to get me in the car with my stomach feeling queasier than ever and marched me into Stockton Elementary drill sergeant style. I remember sitting in the main office while she spoke to the principal and nurse behind closed doors. My teacher, Mrs. Popper, took me back to her quiet classroom and let me catch up on missed work while everyone else was at Gym. She was not a particularly warm teacher, but that morning she was gentle and kind. I was one of her best students; she was concerned. 

When my classmates returned, I was greeted with surprised smiles and whoops and hugs. By lunchtime, it was like I had never missed a beat.


I don’t recall any other episodes of school refusal after that. Which, knowing what I know now, means I was EXTREMELY fortunate. My symptoms didn’t require medical or educational intervention. Many many students and families, however, don’t rebound so quickly. Their lives are turned upside down.

The cases of school refusal are some of the most complex and challenging that I encounter as an advocate. And in these anxiety-laden, post-pandemic times, they are on the rise. Traditional consequences and discipline simply do not work. Filing truancy charges against a parent who is trying their best is certainly NOT the solution either. I created this resource for parents based on my experience connecting families to resources in the community and helping them advocate for more support in school.

Two important things to note...I’m not a therapist or an attorney and my thoughts here do not constitute medical or legal advice. Also, I will be using the terms school refusal and school avoidance interchangeably.

 

What Exactly is School Avoidance?

School avoidance is when a student refuses to go to school or has difficulty remaining in school the entire day. It’s important to note that school refusal is a symptom, not a diagnosis. Typically, it occurs in children and teens who have an underlying mental health condition such as anxiety (generalized anxiety, social anxiety, or separation anxiety), depression, or post-traumatic stress disorder. School-based anxiety that leads to school refusal could result from an aversive experience that occurred there such as bullying or academic struggle from an undiagnosed learning disability. Several school-avoidant students I’ve spoken with describe not feeling “safe” at school. The thought of being forced to go to school and stay there is extremely distressing.    

Psychologist John Duffy, who works with this population, describes some of his patients, “One child I work with refused to attend school due to profound social anxiety, fearful that other kids would ignore him, make fun of him, or bully him. Another teen was deeply depressed about her appearance and could not stand the idea of peers seeing her and potentially judging her. And a high school sophomore client fell far behind in tests and assignments, and feared facing his teachers, so he refused to attend school for the remainder of the semester. Many school-refusing kids suffer a combination of these stressors.” You can read more in his article published by CNN linked here. 

From what I’ve personally seen, these students are experiencing paralyzing levels of emotional turmoil, and the entire family unit is affected. Parents are often late to work after a nightmarish morning or have to miss it completely. Siblings feel neglected and like they’re walking on eggshells in their own homes. Their needs shift to the back burner as exasperated parents focus on putting out the fire in the front. These families are in crisis.   

 

SCHOOL REFUSAL IS NOT A TRUANCY ISSUE!!!!!

I’m using shouty caps here for the administrators in the back. Principals, I know you have a job to do. I also know what the research says about the importance of student attendance. BUT come on. As an educator and a parent, there is nothing more disappointing than when a school throws salt into the wound of a family in crisis by threatening them with truancy charges. It’s such a lazy, punitive stance to take against a family who “just needs to get their kid to school.” As if it was that easy. Lumping these families into the truancy category demonstrates a complete lack of empathy and understanding, in my humble opinion.

Yes, school refusal and instances of truancy both impact attendance. But the answer to WHY the student is not in school is completely different. Truancy is when a student engages in a pattern of behavior such as cutting class or cutting school entirely, often without the parents' knowledge. It’s a disregard for school policies and societal expectations or a general apathy toward education. Parents can contribute to the problem by being non-responsive to communication attempts from the school and/or not making a good-faith effort to get their child to school each day. 

 

What Should Parents Do First?

 

1. Act swiftly.

The longer your child misses school, the harder it’s going to be to get them back on track. Do whatever it takes to address the issue as quickly and aggressively as possible. “Forcing” a child to go to school (like my Mom did) may be a strategy for parents to consider with younger students, those who have more mild anxiety symptoms, and when you’re confident that the function of the behavior is attention-seeking. Kearney and Albano (2007). Also, be careful not to reinforce stay-at-home behavior. For example, when a student is not able to attend school, they should not have access to social media, video games, special attention from parents, extra snacks, etc. Missing school should not be a fun day off. Students should also be held responsible for missed work.

2. Consult with your pediatrician.

Make sure there isn’t anything physical going on and then ask for a referral to a mental health provider. Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy techniques can all be helpful for students with school refusal. Medication may also be a treatment to discuss at some point. Each state has a Family Crisis unit parents can contact for help. Click here for the list. Once they evaluate your family’s needs, counseling and/or behavior services within the home may be offered and extremely helpful. If this level of intervention is not enough for your child, partial hospitalization programs and intensive outpatient programs can also be explored.  

3. Request help from school.

If your child doesn’t already have an IEP or 504 plan, send an email to the principal requesting that your child be evaluated to see if they’re eligible for special education. If your child does have an IEP, send an email to the case manager to request an IEP review meeting as soon as possible. At the very minimum, students with a medical diagnosis of anxiety (or anything else) should be entitled to accommodations through a 504 Plan.    

4. Educate yourself.

Learn as much as you can about school refusal, what causes it, the best interventions, and your family’s rights. The School Avoidance Alliance is a wealth of information and a great place to start. They offer courses and free resources and even host a private Facebook group for parents. Click here for help. 

 

In a best-case scenario, some simple interventions at home and school will be enough to get school-avoidant students back on track. Establishing consistent routines and clear expectations at home provide the boundaries that students stuck in flight/freeze mode need to cope with high anxiety. Having a trusted staff member help them transition to school each morning and provide check-ins throughout the day might be all that it takes. I share a list of other common accommodations below. 

But remember, no two cases of school avoidance are exactly alike. Sometimes there are layers upon layers to unravel and address. Habits, behaviors, and patterns of thinking that have become ingrained can be hard to break. Two steps forward, one step back is common, as is relapse. For more severe, persistent symptoms, formal support through a 504 Plan or IEP is needed.

 

Advocating for More Support at School

 

Child Find Mandate

Public schools are obligated to identify and evaluate students with disabilities, per the section of the federal law known as Child Find.

Even if the student exhibiting school refusal is bright and capable of learning under normal circumstances, a high number of absences should trigger the intervention/referral system a school has in place for at-risk students. I’ve seen some schools take more of a hands-off approach for cases of school refusal though. They consider it to be a “home” or a “parent” problem exclusively. But I couldn’t disagree more. The school holds a responsibility to provide the services needed for students with disabilities, including mental health and emotional challenges, to access their education. Especially if the school environment is contributing to the avoidance behavior.

I’m working with a family right now in this exact situation. Jack* has been struggling with attendance for over a year. He has been bounced around from home instruction to a partial care hospitalization program, to an inpatient psychiatric facility, with a few days in school here and there. His parents have him working with a psychiatrist, taking four medications, and receiving in-home counseling and behavior support. Even with all of this intervention, it’s still a massive daily struggle for Jack to go to school. Every night he talks about wanting to go to school the next day. And then in the morning, he cannot. 

Jack’s parents first reached out to me when the assistant principal mentioned truancy charges would be filed if he missed any more days. Talk about a punch in the gut! They were doing every single thing possible to support their child in getting to school, short of physically dragging him onto the school bus. Since Jack is now close to 6ft though, forcing him against his will simply isn’t an option. What these families need from schools isn’t judgment and punitive consequences, it’s support, services, and resources. And good grief, a little compassion would be nice too.     

Even if the school does not refer a student for a special education evaluation, parents can do so at any time. This is the email I suggested writing in Step 3 above, and the one I helped Jack’s parents send as soon as we started working together.

*Name changed for confidentiality. 

A Comprehensive Evaluation

After requesting an evaluation, you will be invited to a meeting at the school to discuss your concerns. 

**If it’s determined that a special education evaluation is NOT warranted, then parents should request accommodations through a 504 Plan. Here is a link with more information about your child’s rights under Section 504. 

If the school DOES agree to evaluate your child, you’re going to want to make sure the evaluation is comprehensive, assessing all areas of suspected disability. You can and should ask the school team to consider including each of the following in the Evaluation Plan:

  • Psychological evaluation (including behavior rating scales completed by the student, parents, and teacher)
  • Learning evaluation (to identify any learning disabilities that may be present and causing distress)
  • Social history (to document your child’s background including any family history of anxiety or other mental health diagnoses)
  • Functional Behavior Assessment (FBA) (to identify the function of the school refusal behavior and help develop a behavior intervention plan)
  • Psychiatric evaluation (to diagnose any mental health conditions contributing to the school refusal, and make educational recommendations)
  • Occupational therapy evaluation (if unmet sensory or fine motor needs are contributing to the student’s discomfort at school)

Here are a few other school-refusal-specific assessments you can request to be included as part of the Psychological Evaluation:

  • The School Refusal Assessment Scale-Revised
  • School Anxiety Scale-Teacher report
  • School Anxiety Inventory
  • School Refusal Evaluation Scale 

If your child already has an IEP, but this is the first time school refusal has been an issue, it’s the perfect time to request updated evaluations. A formal discussion about re-evaluations must take place every three years, but the date can be moved up if requested by a parent.   

**This is important! If everyone is in agreement to proceed with the evaluation process, it can take a few months (up to 90 days in NJ) before an IEP is developed. I recommend that parents request a 504 Plan to provide the student with relief via accommodations in the meantime. 

 

Making the Case for Eligibility 

Once the evaluations have been conducted, you will get together with the school team to review their findings and determine if your child qualifies for special education services. Students experiencing school refusal often qualify under the Emotional Regulation Impairment (ERI) classification, which some states still refer to as Emotional Disturbance (ED). Some students may qualify under the Other Health Impaired (OHI) classification umbrella.  

Remember, in order to be eligible for special education, your child needs to meet these three eligibility criteria: 1-has a qualifying disability, 2- the disability impacts educational performance, and 3-as a result, they need special education and related services. If the school team tells you that your child doesn’t qualify for special education because they are “strong academically,” “do not have a learning disability,” “get good grades when they’re in school,” “had high scores on their learning evaluation,” or are “proficient on statewide testing measures,” these are all red flags. Special education is NOT just about academics. A student can have an IQ of 140 and still qualify for special education if their disability impacts their educational performance. As a reminder, Educational performance = Academic performance (grades and test scores) + Functional performance. Functional performance encompasses many domains including behavior, social skills, daily living skills, etc. If a student cannot physically get into the school building to access their education, then logically, their disability is impacting their educational performance.  

If your child’s school refusal symptoms are not adversely affecting their education and/or if they do not require specialized instruction, they will not be eligible for an IEP. Parents should advocate for continued accommodations via a 504 Plan going forward.  

 

Developing the IEP

IEP Goals

Once a student’s needs are identified through the evaluation process, and they’ve been found eligible to receive special education, IEP goals will be written to target specific skills for development. If a Behavior Intervention Plan is created, IEP goals can be included to teach appropriate replacement behaviors. For students with school refusal behavior, here are three broad goal areas for parents and the rest of the IEP team to consider:

  • Attendance (with the number of minutes and days in school increasing over time)
  • Using coping skills for anxiety 
  • Self-advocacy skills (so the student can work towards monitoring and managing their symptoms more independently and ask for help when needed.)
Strategies/Accommodations/Modifications

Parents and school teams should be willing to think outside the box and really get creative here. Anything that will make the student feel more comfortable going to school and while there (and is reasonable) should be on the table. Here are some suggestions for consideration:

  • A modified schedule such as coming to school late or leaving early, especially when a student is transitioning back to school after an extended period at home. Based on exposure therapy principles, the student would gradually increase the time spent in school. They can even start by attending one/two class periods, then work up to half days and full days.
  • Permission to report to school a little late, after the hallways have cleared.
  • Use of an alternate entrance in the morning to avoid crowds.
  • A familiar staff member who picks the child up from the car or bus and helps them transition into the school day. 
  • An “anytime” or “flash” pass that allows the student to leave the classroom when feeling anxious or uncomfortable. When a student knows they have an out and aren’t trapped, it can bring tremendous relief. 
  • Frequent check-ins with a counselor or another trusted staff member throughout the day.
  • Access to calming tools such as headphones to listen to music, fidgets, a weighted lap pad, etc.
  • Access to a calm, quiet space or a sensory room during the day.  
  • An alternative location for lunch if the cafeteria is overwhelming.
  • An alternative location for Phys Ed if the gym/class size is overwhelming. 
  • Pair the student with a positive peer mentor or buddy.
  • Assign students to classes with at least one preferred peer.   
  • Preferential seating where the student feels most comfortable in the classroom.
  • Extended time to complete assignments and take tests.
Related Services 
  • Counseling services (to work on coping skills and self-advocacy skills)
  • Parent training services (to practice behavioral and anxiety reduction strategies at home)
  • Occupational therapy services (if sensory or emotional regulation are areas of student need)
  • Behavior consultation services (to track target behaviors, monitor behavior intervention plans, and provide specialized instruction on replacement behaviors)
  • Transportation services (if the child needs additional support transitioning from home to school) 
Placement

When considering placement, students with disabilities must be educated in the general education classroom, with their nondisabled peers, to the greatest extent possible. This legal principle is known as the Least Restrictive Environment (LRE). If a student’s needs cannot be met in general education, then a continuum of alternative placements can be considered.

For some students exhibiting school refusal, a loud, busy classroom is too overwhelming. These students often feel more comfortable in a smaller classroom with fewer students and more individualized support. Some public schools even have specialized programs designed for students struggling with school-based anxiety. Or, IEP teams may determine that home instruction is the most appropriate placement. Students would either work with a teacher (in-person or virtually) or keep up with classwork using an online learning platform. Home instruction is not a long-term solution but does allow all parties time to strategize about the next steps. In my experience, the longer a child is at home, the exponentially harder it is to get them back into a school routine. A residential setting, while most restrictive, is the most appropriate placement for some students, and the only way to meet their educational needs.  

Disagreements about educational placement can be extremely challenging for parents to navigate. If you’re not seeing eye to eye with the school team, I recommend the assistance of an attorney or experienced advocate. Some families who don’t have the energy or resources for litigation choose to withdraw their school-avoidant children from public school and homeschool them. Parent placement in a private school is another route some families take. Again, I recommend consulting with an expert to make sure you fully understand your family’s rights before making any decisions.                                                                                                                             

Final Thoughts

For families living with school avoidance, an all-hands-on-deck approach is absolutely essential. The expertise of parents, medical providers, and therapists on the homefront, combined with the efforts of administrators, teachers, and counselors at school, is the dream team needed to help students persevere through school refusal behavior. To protect the rights of your family, I suggest communicating with the school as early and as often as possible. Always document your conversations in writing. Also, keep track of everything you’re doing at home and what has been tried at school. If you find yourself facing truancy charges, you will be able to prove to the judge that you’re not a negligent parent; in fact, you’re doing everything in your power to get your child to school. Or if you find yourself in a dispute about your child’s IEP eligibility, services, or placement, you’ll have the list of strategies that didn’t work to help make the case that more intensive intervention is needed.     

My personal advice to families is twofold. First of all, please know you’re not alone. Families from all walks of life and backgrounds are wrestling with this, at higher rates than ever before courtesy of the pandemic. 

Secondly, take it one day at a time. School refusal symptoms do resolve, and your kiddo (and you!) will get their life back. I wish I had magic advice about the approach or intervention that will be most impactful for your family. From what I’ve seen though, there is not a one-size-fits-all solution. A teenage client of mine was resistant to counseling but did a complete 180 when he got his first girlfriend! A 6th grader’s social anxiety dissipated when she started taking medication. A close friend’s daughter was on home instruction for a few weeks and then transitioned back to school gradually using a modified schedule. And an autistic teenager I work with started attending a specialized school for students with disabilities and hasn’t missed a day of school since.  

There is light at the end of the tunnel, I promise. Stay the course!

 

Resources

In addition to the School Avoidance Alliance linked above, here are a few other resources:

 

Podcasts (click to listen)

Beautifully Complex: School Avoidance and Refusal

Understanding School Refusal Podcast Series by Rogers Behavioral Health

Conversations About Student Mental Health:  School Refusal Series Part 2, What Parents Can Do

 

Books

Nowhere to Hide: Why Kids with ADHD and LD Hate School and What We Can Do About It by Jerome Schultz, PhD

When Children Refuse School: A Cognitive Behavioral Therapy Approach (Parent Workbook) by Christopher A. Kearney and AnneMarie Albano

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