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School Refusal
School refusal is used to describe behaviors associated with children who refuse to attend school for many reasons. Estimates of prevalence generally range from 2% to 5%. School refusal may happen at any age, although it is most commonly associated with school transitions (such as preschool to elementary school, elementary to middle school, etc.) or following stressful events (divorce, death, move) or holiday recesses. Children with poor academic or social skills may also be at a higher risk.
The severity of school refusal behavior varies, ranging from frequent complaints and reluctance to attend school, to frequent absences for entire or partial days, to more severe instances of absences for weeks, months, or even longer. Many school refusers complain of somatic ailments such as headaches or stomachaches.
Although both truants and school refusers avoid school, a distinguishing characteristic is that parents of school refusers know where their child is when he or she is not at school (typically at home or at the parent's place of work). The parents of truant children typically are unaware of their child's whereabouts. The school refuser is typically avoiding or escaping negative situations or seeking adult attention, whereas the truant frequently avoids school in order to engage in delinquent behavior.
Children with school refusal behavior are a heterogeneous group, which makes diagnosis and treatment difficult. Behaviors associated with school refusal may include severe anxiety, crying, panic, depression, social anxiety, separation anxiety, sever acting out (kicking, biting, screaming, clinging, etc.).
Outcomes
Untreated, school refusal behavior may result in negative outcomes for the child and the family. Academic difficulties frequently result when the child misses significant amounts of school because he or she has fallen behind academically. The academic problems make it even more difficult for the child to return to school. Frequent absences may result in impaired peer and social functioning, which makes returning to school more complicated. Some children with unresolved school refusal behavior become adults with significant fears of social situations, difficulty leaving the house (agoraphobia), and difficultly maintaining employment. School refusal behavior can also create significant stress within the family because of parents' absences from work to take care of their child or having to go to meetings with school personnel to discuss their child's problematic behavior, as well as daily conflict and emotional stress associated with their child's extreme or manipulative school avoidance behaviors. The problems are exacerbated if there are additional difficulties within the family such as parental conflict, poor parenting, financial, or emotional issues.
Causes
In the past, these behaviors were thought to be caused by school phobia, an unreasonable and extreme fear of attending school. Other researchers believed that school refusal was a separation anxiety disorder. Separation anxiety, which consists of the child becoming upset when separated from primary caregivers, is a normal developmental stage for very young children. Developmentally inappropriate and excessive anxiety concerning separation from home or from caregivers that impacts a child's ability to function is typically considered to be separation anxiety disorder. Frequent absences from school may be one of the behaviors exhibited by children with separation anxiety disorder.
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