Understanding School Anxiety and Refusal: A Complex Challenge for Students, Parents, and Educators

By Dr Megha Desai Shah (Consultant Child and Adolescent Psychiatrist, Ahmedabad)

School related anxiety and refusal affects a significant number of students worldwide. It is characterised by a child's persistent resistance or refusal to attend school or engage in school-related activities. It’s more common in children aged 5-6 years and 10-11 years.

This is not a formal psychiatric diagnosis but more of an emotional problem.

The term ‘school refusal’ at times doesn't justify the child’s struggle as it may imply refusing school is a choice.

It can be better justified as “Emotionally-based school avoidance (ESBA) or “Anxiety-related absence”.

When a child is refusing to go to school, school nights and mornings are like battle for parents.

Signs of Emotionally-based school avoidance (ESBA) or school refusal

• not wanting to get up and get ready

• not sleeping well or eating well

• being angry or upset, or acting out – at school or at home

• frequent physical complaints (headaches, stomachaches),

• excessive clinginess

• frequent crying

• withdrawal from social interactions.

Why it happens?

There’s rarely a single cause of school refusal, often stems from a combination of factors. It might be due to anxiety or worries about leaving home, a phobia, learning difficulties, social problems at school, or depression.

School refusal might start gradually or happen suddenly. It can happen at the same time as or after:

• stressful events at home or school or with peers

• family and peer conflict

• starting or changing schools

• moving home

• bullying or teasing

• problems with a teacher

• poor school results.

By not going to school, a child might be able to:

• avoid scary things – for example, tests, certain teachers, the canteen and so on

• get out of social situations with peers or teachers

• keep an eye on what’s happening at home – for example, if a family member or pet is ill.

Impact of school refusal

School refusal can have profound consequences for a student's academic progress, social development, and overall well-being.

• Academic performance may suffer due to missed classes and falling behind on coursework.

• Socially the student may feel isolated, leading to decreased self-esteem and strained peer relationships.

• Emotionally the fear and anxiety associated with attending school can intensify, making the prospect of returning increasingly difficult.

It is essential to address school refusal promptly to provide the necessary support and prevent long-term consequences.

How to help the child?

This situation can be incredibly stressful and exhausting for parents and really tough for children.

If child's anxiety about school has built up to the point where they can't go,

it's a good idea to get them some professional mental health support.

Interventions and Support

There are several evidence-based interventions available to support students struggling with school refusal.

• Cognitive-behavioral therapy (CBT) can help students identify and challenge negative thoughts and beliefs, develop coping skills, and gradually re-engage with school.

• Individualized education plans (IEPs) can provide accommodations and support tailored to the student's needs, ensuring academic progress. In some cases, a gradual reintroduction to school through a step-by-step reintegration process may be necessary.

What can parents do?

• Open communication is vital to understand the underlying causes and develop effective strategies.

• Parents should actively listen to their child's concerns, empathise with their emotions, and seek professional help if necessary.

What can educators do?

• Educators can create a safe and inclusive learning environment, implement accommodations, and collaborate with support staff, such as school counselors or psychologists.

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