School Refusal & School Avoidance Treatment
At GroundWork in Orlando, our child and teen therapists specialize in working with children and teens experiencing school refusal, and school avoidant behaviors. Our therapists provide evidence-based, solution-focused therapy, helping children reintegrate into school through research-validated forms of treatment, and supporting parents with effective parenting strategies. It is important for families to remember that a child refusing school is often experiencing significant discomfort and anxiety from school attendance, and thoughts of attending school.
The ADAA reports “School refusal is often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age children. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school. Children who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.”
Effective Treatment for School Refusal
According to Anxiety and Depression Association of America board member Dr. Pine, “The most important thing a parent can do is obtain a comprehensive evaluation from a mental health professional.”
The most important step in stopping the cycle of school refusal is evaluation and treatment from a trained mental health provider with knowledge and experience treating school refusal behaviors in children, through evidence-based methods.
It is important for parents to understand that without immediate treatment and therapy these behaviors can be come chronic, long lasting, reoccurring, and detrimental to the child’s ability to function and thrive.
At GroundWork we provide evidence-based therapy for children experiencing school refusal behavior, which include Cognitive Behavioral Therapy (CBT), and Exposure and Response Prevention (ERP) to help children face their fears and reintegrate into school with normal attendance.
School Refusal/Avoidance May Present As:
- Complete lack of attendance and refusal to attend school
- Partial attendance (leaving class or school during the day, calling parents, or excessive trips to the bathroom or nurses office)
- Reluctant attendance after extreme misbehaviors in the morning (significant delays in going to school and waking)
- Reports of intense distress during school day
- Separation anxiety from parents or leaving home
- Anxiety attacks or physical complaints during the school day, or in the morning prior to school (ex. stomach aches, nausea, diarrhea, headaches, vomiting, panic attacks)
- Behavioral outbursts, tantrums, and defiance may be present during morning prior to school
While it may be difficult for parents to understand why some children avoid school in such an extreme manner, there are several for reasons for School refusal and avoidance behavior.
Possible Reasons For School Refusal/Avoidance:
Children refusing to attend school may want avoid feelings such as anxiety, panic, or social / performance phobias that are associated with school attendance
- Avoid aversive social situations
Examples of this are when a child thinks, “I am going to be laughed at,” or “Everyone will think I’m stupid.” Many times, this reason for School Refusal is a result from the child also experiencing social anxiety
- Separation Anxiety
Children refusing to attend school may be reinforced from the individual attention of parents and caregivers during the morning struggles. The child may also have fears of something bad happening to their parent while they are in school, and could possibly struggling with separation anxiety.
- Social Challenges
Children refusing to attend school may be experiencing bullying, fear of another student, or negative peer interactions.
Reinforcement my be school absence, as well as privileges in the home, including using technology, TV, access to the kitchen, sleeping in, etc.
- Recent Changes / Transitions
Starting school, moving, or other stressful life transitions may trigger the onset or school refusal. This may include advancing into middle school, high school, or changing schools.
Who Experiences School Refusal/Avoidance?
Children who are at higher risk may have some of the following characteristics:
- Children with a history of anxiety
- Children starting school for the first time, or are starting at a new school
- Children experiencing transition or change (moves, divorce, etc.)
- Children who tend to engage in avoidance from feared situations
- Children who present as socially anxious / withdrawn
- Children who have difficulty separation from parents or leaving home
- Children who have been out of school due to illness or other circumstances preventing attendance for prolonged period
- Children with perfectionistic tendencies
- Family history of anxiety
When a child experiences the following symptoms, their behavior is no longer typical “playing hooky” behavior, but a symptom of a more severe issue.
- Avoidance and Disruption
Child avoids school and/or school-related activities regularly. This leads to a disruption of their life and, ultimately can decrease the child’s overall functioning.
- Interferes with Functioning
School refusal inhibits child from socialization in school, learning opportunities, and developmental growth that results from attending school.
The child feels physically distressed (anxious or depressed) and may experience an upset stomach, panic attacks, and other physical complaints due to their negative feelings and anxiousness about school.
The duration of symptoms is persistent and ongoing