School Refusal

By Lou Mongillo, LCSW

Case Study

Jack began to feel overwhelmed within a few weeks of beginning middle school. Although he was a good student, he worried his work was not good enough to meet his teachers’ expectations. He soon began to experience stomach aches that kept him home from school. His parents took him to see his pediatrician who told them she could find nothing physically wrong. She said that he might be feeling stress from his new school and recommended they contact the school for help if the problem persisted.

What is School Refusal?

School Refusal is a complex issue that requires home and school cooperation and collaboration. It is important to note that the longer a child stays out of school, the more difficult it is to get the child to return. Prompt recognition and action is key to resolution of the problem. Once a pattern of missing school begins to take place, that pattern is hard to break. School refusal may take the form of physical symptoms, emotional distress, or behavioral problems. A student might have frequent complaints about stomach aches or headaches. Another symptom is difficulty getting up in the morning which can lead to being tardy to school. In order to help the student return to school, parents and helping professionals need to thoroughly investigate the factors underlying the student’s refusal to attend. The best predictor of a successful return to school is parent and school collaboration toward an appropriate plan of action.


School refusal can happen with any segment of the population. Although there may be specific triggers such as interpersonal, family, medical, or academic problems, there is oftentimes an emotional disorder such as anxiety and/or depression present. Both the immediate stressors and underlying emotional disorders need to be addressed. For example, a student may have fallen behind in their work to the point where they feel overwhelmed. In turn, they may start to avoid school because of their anxiety over what will happen when they return. Transitions such as a move or the beginning of the school year might result in a student having difficulty attending school. Without good planning, the problem may get worse.


Consideration needs to be given as to what structure, support, or strategies can help students manage both the academic expectations and emotional issues that might be impacting the students’ return to school. Possible support might include an academic assistance period or person, shortened day, or monitoring for possible bullying situations. At times, these supports may need to be in the form of accommodations through a 504 plan if there has been a medical or emotional issue, or an Individual Education Plan (IEP) if the student needs direct support from a special education teacher. Students might also benefit from working with a school social worker to develop coping skills such as relaxation techniques or cognitive behavior strategies to manage anxiety and/or depression. In some situations parents may need to seek an evaluation from a psychiatrist who can give treatment recommendations such as medication or counseling. Parents also might participate in counseling to help establish the necessary routines that can help their child return to school.


Since school refusal can lead to prolonged periods of nonattendance, it is important to act quickly. If a student finds it difficult to cope with the problems that are causing his/her attendance problems, close collaboration between parents and the school are necessary to resolve the underlying difficulties. The good news is that with appropriate interventions students can develop the coping skills which will enable them to manage their emotions and function in school. In Jack’s case, his teachers modified their expectations temporarily until he caught up with his assignments. In addition, he began working with both an outside therapist and the school social worker to learn how to cope with his anxiety over the transition to middle school and deal with the expectations of his new school. Fortunately, through quick action by his parents and a plan with the school, which included academic and emotional support, Jack ultimately returned to school full-time.