Is your child or teen refusing to go to school?

Are mornings in your home a constant struggle due to school anxiety?

Have you received calls from your child’s school that your child is skipping classes or school altogether?

Does he or she struggle with depression, anxiety or a social or learning issue that is impacting school attendance?

Is your child complaining of unexplained physical symptoms on school days, such as headaches, stomach aches or nausea?

Does the thought of going to school cause considerable fear and distress for your child?


Children and teens with school refusal (previously known as school phobia) typically experience significant anxiety about attending school. It is important to point out that these children are not simply “playing hooky” or looking to have a good time playing with friends. School refusal is driven by an aversion to school rather than simply seeking out pleasurable activities outside of school. For both students and families, school refusal can be a concerning, difficult and frustrating ordeal. The problem can be complex and multi-faceted.


The good news is that with the proper support, school refusal can be managed and your child can return to school and thrive.


Who is affected by school refusal?


School refusal affects a significant portion of the population in the United States (2-5%). Source: School Refusal. (n.d.) Retrieved August 03, 2017, from

Boys and girls have roughly the same rate of school refusal.

School refusal is not classified as an independent diagnosable disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), but school refusal is often linked to separation anxiety, social anxiety, general anxiety disorder or depression (Source: Ingles, C.J., Gonzalvez-Macia, C., Garcia-Fernandez, J.M., Vicent, M., & Martinez-Monteagudo, M.C. (2015). Current Status of Research On School Refusal. European Journal of Education and Psychology, 8(1), 37-52).


What are some reasons children refuse to go to school?


There are many reasons for school refusal. Some common causes are:



Students who struggle with school refusal often have severe anxiety, which can present in different forms:


Separation Anxiety

Separation anxiety is common, especially among younger children (but not exclusively), who may become preoccupied with fear about being separated from a loved-one.


Social and Performance Anxiety

These students worry about how they are judged and perceived by others. They may fear humiliation and/or failure socially, academically or athletically.


Generalized Anxiety (GAD)

Students experience excessive anxiety and worry which impacts daily functioning. They often have trouble controlling the worry, can be perfectionistic, restless, irritable and have difficulty concentrating. Trouble falling asleep or staying asleep is also common.



Some students who refuse to go to school suffer from depression. Children and teens with depression may experience the following symptoms:


  • Depressed mood
  • Irritability
  • Lack of interest in activities that the child usually enjoys
  • Change in sleep or appetite
  • Fatigue
  • Feelings of guilt, inadequacy or hopelessness
  • Difficulty concentrating
  • Risky behavior (including self-harm in some students)
  • Depression and anxiety are often experienced together


Physical Complaints

At times, school refusal has roots in medical issues. For example, a child who missed time from school with asthma, a GI issue or another health problem may be anxious about returning or leaving the safe setting of home. Caregivers may also have conflicts about their child returning to school after an illness.


Transition or change in family


The following are some of the stressors that may trigger school refusal in some children:


  • Starting a new school (or new level of school: Kindergarten, middle school, high school)
  • New sibling
  • A move
  • An illness of a loved-one
  • Divorce
  • Death in the Family


What are red flags for school refusal?


  • The child complains of stomachaches or headaches on school days and the symptoms vanish when he or she is allowed to stay at home
  • The child frequently goes to the nurse’s office with no apparent signs of illness
  • Regular unexcused absences or lateness
  • Great difficulty and resistance to getting out of bed in the morning on school days
  • Major changes in mood, behavior, sleep, appetite, concentration


 How to help students to return to school:


It is important that steps are taken to address school refusal as quickly as possible. If left untreated, school refusal can lead to prolonged absence and serious consequences. The longer a child is allowed to stay home from school, the harder it becomes to re-enter the school setting.

Each case of school refusal is unique and has its own set of challenges. For this reason, it is important to develop a comprehensive plan involving the child or teen, family members/caregivers, the school and the treatment team.


 Individual therapy

 Individual therapy can help a child who is refusing to go to school by:


  • Examining fears and exploring reasons the student is not going to school
  • Looking at all the factors that may be contributing to the refusal: eg anxiety, depression, learning or social challenges, bullying, difficulties at home, etc
  • Developing a plan to get the child back in school as quickly as possible
  • Validating the child’s feelings and difficulty about attending school
  • Teaching new coping strategies
  • Expose child to fears in way he or she can tolerate rather than avoiding
  • Providing support and encouragement


The therapist can also act as a liaison to the school to help ensure that every step is being taken to facilitate a smooth transition back to school. This can involve speaking with teachers, administrators and counselors to make sure everyone is on the same page. It is important to have a plan in place for the child to catch up with work, a timetable for return (e.g. shortened school days can be helpful in some cases) and a supportive person to check in with at school.


Family Therapy and Parent Counseling


School refusal affects the whole family and requires a team approach for the best results. Family therapy and parent counseling can help in a number of ways:


  • Help family members to understand the roots of the school refusal as well as how the child is feeling
  • Assist the family in establishing routines
  • Explore family dynamics that might be factors in school refusal
  • Ensure the anxiety of attending school is not being reinforced by avoiding the problem, but rather working toward a return to school
  • Work with family members to help the child to use new coping strategies


If your child or teen is refusing to go to school, it can be a time of intense sadness, confusion, helplessness and frustration for the whole family. Fortunately, you do not need to endure this difficult time alone. The therapists at Cope With School NYC specialize in helping children, teens and young adults thrive in school. We tailor treatment to meet the unique needs of each individual and family. Our therapists can help get your child back on track.




How effective is treatment for school refusal?

Success rates of therapy in general depend on several factors, including consistency, rapport with the therapist and the nature of the problem. If the treatment recommendations are followed, there is generally a high rate of success.

How long does treatment usually take?

Duration of treatment varies based on the severity of the problem and the factors described above (regular attendance, having family on-board, relationship with therapist, etc). Some students stay in therapy until the symptoms subside. Others choose to continue and receive support or work on other goals. For instance, some children may wish to join a social skills group.

Do you accept my insurance?

 Cope With School NYC is out of network with all insurance carriers. We provide a receipt with all the information you need to submit claims to your insurance carrier. Check with your provider to see if you have an out of network behavioral health benefit.

 If you are in the New York City area, contact us today for a free 10- minute phone consultation.