School refusal: what it is, and how districts/parents can help

Attendance Institute
Posted Feb 22, 2018

Some mornings, getting a child ready for school can be difficult. They’re too tired to wake up on time; they left their lunchbox at school; or they lost one of their shoes.

But for parents of students who face overwhelming waves of anxiety or some irrational fear that lead to what experts call “school refusal,” even getting a child dressed can become an all-consuming activity. Kids may be struck with a crushing sense of dread and fixate on questions such as “What if my underwear accidentally shows?” or “What if my sock gets twisted up and makes me uncomfortable?”

The answers may seem simple, but for students who experience school refusal, such fears may feel debilitating, while simple answers provide little comfort.

School refusal refers to absenteeism caused by a student’s refusal to attend class due to fears typically caused by an underlying anxiety disorder. While school refusal is not itself a disorder as defined by medical professionals, missing school is considered a symptom characterized by avoidance behaviors to cope with one’s anxiety.

Experts in treating it say it’s nearly impossible to pinpoint exactly how many children are effected, in large part because the research on school refusal is conducted by so many different disciplines that define it in different ways, that there is no universally agreed upon definition of what school refusal actually is.

Jonathan Dalton, a Maryland-based psychologist specialized in treating anxiety and behavioral disorders, with a particular interest in school refusal and Social Anxiety Disorder, said the rate at which students are affected ranges from 1 to 28 percent in different studies because some studies conflate truancy and refusal (which is distinctly anxiety or mental health related).

A common statistic cited by organizations that advocate for increased mental health awareness suggests school refusal affects 2 to 5 percent of school-age children.

Without treatment, research shows that children with anxiety disorders are at higher risk to perform poorly in school. A key factor is because students are so focused on whatever they are anxious about–be it reading aloud in class, or having a panic attack in front of their peers–and how to avoid it, that they can’t process and retain new information, according to Dalton.

“They’re processing threat cues like we would if we were in a hijacked plane, and so they aren’t going to process information that doesn’t seem so vitally important, like how to conjugate a verb in a foreign language, for example,” Dalton said. “I describe it like you’re trying to learn calculus while you’re next in line to go bungee jumping.”

Dalton notes that developing a pattern of poor attendance often starts gradually. Among many of his patients, Dalton says it’s common to see that a student has missed more than a dozen days of school in first grade, followed by maybe 23 days in second grade and 36 days the following year.

Some schools are ahead of the curve when it comes to implementing programs targeting children who experience school refusal.

One charter school in Maine, for instance, send teachers to select students’ homes in an effort to keep children affected by school refusal or other barriers in regular school attendance on track to graduate.

While Dalton said the intention of the charter school is a good one, there is a risk: If the overall goal is simply to help students graduate instead of helping them reenter school, such programming would only further enable students to continue relying on avoidance behaviors like school refusal.

It’s vital that the underlying cause of the anxiety that pushes a student to cope by refusing to go to school be addressed–although pinpointing that cause can be incredibly difficult. In fact, Dalton describes school refusal as an allergic reaction to a casserole, and in order to help the student, one must know what ingredient they’re allergic to.

Only once experts are able to determine the cause of a child’s anxiety can they move forward in teaching children, their parents and teachers and administrators alike that avoiding school to deal with anxiety isn’t a viable coping method.

Although diagnosing the root of a child’s anxiety and treating those experiencing school refusal can be difficult, Dalton highlights a handful of success stories. For instance, one student he treated had at one point not stepped foot in a school building in three years–and now he’s on track to graduate high school and is in the process of filling out college applications.

His opening sentence on university applications illustrates perfectly the feeling that Dalton says other students who experience school refusal often try to communicate:

“Having an anxiety disorder is like being stuck in that moment when you realized you’ve leaned back too far in your chair, but have not yet fallen.”

Parents and school officials can find additional resources at the Anxiety and Depression Association of America, as well as School Refusal Hope.