What is 'school refusal'? Experts and parents on what happens when your teen won’t — or can’t — go to school.

“It started in sixth grade: First, it was a stomachache. Then it was problems with other kids.” That’s how a New York City mom (who requested anonymity) recalls the start of her daughter’s descent in what’s known among mental health professionals as “school refusal” — or “anxiety-based school absenteeism,” according to the country’s pioneering expert in the field, psychologist Christopher Kearney.

“Then, in seventh grade,” the mom continues, “that was it: suicidal ideations, being hospitalized briefly, then 10 days in a psych ward.”

Eventually, the family began to get a handle on the issues leading to her chronic absenteeism — anxiety, depression and ADHD — by enrolling her in a therapeutic private school. But then everything changed.

“COVID happened, and she plummeted,” the mom tells Yahoo Life. “She was just in bed all day, sleeping, with her computer screen open.” And that’s where she largely remains today, at 16, after a battery of unsuccessful interventions; in fact, she’s “barely” been to school in two years. “I tried kindness, love, harshness,” her mom says. “We don’t have any leverage: She’s already not getting allowance, and she doesn’t need anything when she’s in bed.”

Another mother, who also requested anonymity, tells Yahoo Life that her daughter, 17, has hardly gone to school either this past year. The administration has worked with her on a plan to get her in three days a week for a couple hours at a time. But still, the parent says, “she’s not keeping up with her work,” and has struggled with depression and social issues since middle school, which is when she started skipping classes. It was compounded by the pandemic, and now, though the girl has been accepted into one college for next year, her mom has doubts that she’ll be able to go.

Despite both families feeling isolated, they are far from alone, as school refusal is only becoming more and more common in children and teens, says Kearney, director of the University of Nevada Las Vegas Child School Refusal and Anxiety Disorders Clinic.

When a child experiences this, he tells Yahoo Life, attendance becomes impossible, or close to it, due to “emotional difficulties related to anxiety, worry, generalized anxiety disorder, separation anxiety and … also depression. It’s one subset of what we call ‘school attendance problems.’”

The issue affected an estimated 1% to 5% of students nationwide in the years before the pandemic. And now, between soaring rates of anxiety in youth and post-pandemic fallout, practitioners like himself are seeing school refusal more and more, he says.

“We’ve seen tremendous change — rates of anxiety and depression have skyrocketed, which was already true before the pandemic,” Kearney says. “But a lot of kids have not yet come back to school after the pandemic, and many districts are having trouble locating thousands of kids. It definitely had a devastating effect.”

Often when parents reach out to his clinic for help, he adds, they arrive some combination of frustrated, scared and embarrassed.

“I think there’s a general expectation that our kids do certain fundamental things — that they have friends, eat dinner, go to school. … So, when one doesn’t happen, it can be pretty disruptive,” he explains, adding that blame for the situation is often shifted to parents, who can be accused of spoiling or indulging their kids by not forcing them to attend school under duress. Further complicating the problem, Kearney says, is that there are not a lot of clinicians with expertise in attendance problems, so a child can “fall between the cracks of different health-oriented systems — like pediatricians, school counselors and therapists.”

That was a reality found by Jayne Demsky several years back, when her son, now in his 20s, would be “hiding under his covers, crying and screaming” every morning, refusing to go to school. The absence of any resources about what her family was experiencing only added to the upset.

“Not that many people know about it now, but no one knew about it then, and there was no information online,” she tells Yahoo Life. “It was a very lonely, isolated place — and scary.” To help other parents with what she’d had to learn on her own, Demsky started the School Avoidance Alliance, which provides guidance, through resources, such as educational videos from experts including Anne Marie Albano, a psychologist with Columbia University who has co-researched the issue with Kearney. What Demsky is hearing from fellow parents who reach out is that this type of support is needed now more than ever.

“COVID has totally exacerbated everything, because kids who were on the edge before, with high anxiety but sucking it up, and then were home and realized how comfortable it felt? Forget it,” she says. “Just like we are questioning the balance in our lives as adults, kids aren’t stupid. They’re questioning: What is the value?”

‘Refusal’ is not quite accurate, many say

The official “school refusal” label (which is not an actual diagnosis) is not always a fair or accurate description, Demsky and others point out. Says Kearney, “I actually don’t like the term, because it implies oppositionality — and some do have that, so it can be a little confusing,” adding that, for many of the kids in question, “they want to go, but can’t.”

Most research uses “refusal,” says Demsky, noting that the terms are interchangeable but that she has moved toward using “avoidance,” taking her cue from what appears to be a trend among U.K. parents. Eliza Fricker, for example, an English mom and podcaster, shares what it’s like to parent a teen with autism in her illustrated guide Can’t Not Won’t: A Story About a Child Who Couldn’t Go to School and her Missing the Mark podcast. In an episode called “A Bad Morning,” Fricker talks about the absenteeism situation causing “sad, hurt, shame and anger,” as well as “feeling like a terrible parent, and guilty.”

She adds that, too often, “the narrative around attendance is a choice … this idea that they’re choosing not to be with their friends; they’re choosing to have these dramatic and distressing mornings. That’s not a choice … and gives a very simplistic spin on something that’s very complicated.”

Reasons for school avoidance

It's always important to try and pinpoint the reason for a child not wanting to go to school, says Kearney, who explains that it’s most often due to some form of anxiety, which can occur at any age.

“Younger kids will have more generalized anxiety and are not able to articulate why, while in middle school and high school it oftentimes boils down to social or performance anxiety, or difficulties interacting, or with academic or athletic performance in front of others,” he says. Other times, there is a bully or an otherwise oppressive environment that a child is trying to avoid — or, as is more common with younger kids, separation anxiety and fear that something terrible will happen to a parent while they are at school.

Or sometimes, Kearney says, “it’s a sleep issue, so they can’t get out of bed in the morning and just miss part of each day.”

The School Avoidance Alliance lists these and other possible reasons for chronically missing school, which include panic disorder, social anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, learning differences, grief, perfectionism and ADD/ADHD.

Benchmarks for assessing school avoidance

“Children all go through … transient pleas” of wanting to miss school, explains Albano in one of her video lectures. “‘The teacher is mean, the kids area mean, I’m not ready for the test’ … and parents usually coax the kid to school in some way.”

When parents are unable to do so is when red flags are raised, and when it’s time to assess the situation a bit more carefully, possibly with professional help.

“Are they missing school? That’s the obvious benchmark — if they are home and should be at school and they’re not ill,” says Kearney.

Another tip-off, he says, is “having substantial behavioral problems around getting to school in the morning — if it’s a battle to get the kid in every day to the extent that it’s causing lots of family disruption and chaos and distress.”

More signs, he says, include that the child’s academic performance is suffering, grades are declining and key exam periods are missed, causing them to fall behind. Socially, signs could include a child avoiding parties and activities, or have difficulty keeping friends.

“What you look for is if a pattern develops,” says Albano, in another video. She further warns that intervening with some sort of plan or support is important to do as soon as possible, hopefully by the two-week mark, which is when patterns can set in — not only for the teen, but for the parents, and how they react.

While “acute” school refusers have generally been out of school for two weeks to a year, “chronic” refusers have been out a year or more, and are typically harder to treat, as they are more liable to be depressed, anxious and possibly oppositional, with “family dysfunction” around the refusal, says Albano. “Now everybody’s got to be involved” in the treatment process, she explains.

How to find help and support

Fricker tells Yahoo Life that her family and others she speaks to “have continued in this push-pull of witnessing their children’s distress and school/professionals putting the pressure of maintaining attendance targets over young people’s well-being.”

It’s a painful tension that the New York City mom feels, as well. “I think in all these years, I missed maybe three to five days that I haven’t tried to get her to school. … I try every single day, and then I have to go [to work] and I check her location — ‘Did she go? Did she go?’ No, she didn’t,” she says. “Lately, I have accepted it. A family therapist told me, ‘Do yourself a favor: She is not going.’ But then I feel like I’m condoning her languishing.”

Experts stress the importance of toeing the line between not causing further distress by forcing kids to go to school and also not giving up hope.

Finding the right therapist is key. Both Kearney and Albano are proponents of goal-oriented cognitive behavioral therapy (CBT); the School Avoidance Alliance also discusses exposure therapy and dialectical behavior therapy (DBT), the latter of which is a type of CBT.

“Each case is a little different,” says Kearney, who says that while working with those who “want to go but can’t,” he will often start by offering accommodations. “Let them go for an hour, or even just lunchtime, so they’re getting exposed. Once they do that and realize, ‘OK, I can do it,’ then we gradually add on time.”

Adolescents require a family-based approach, he says, with “written contracts to increase incentives for going to school and disincentives for not going,” and sometimes a “part-time schedule.” More difficult cases, he said, typically wind up with more of a hybrid situation — and sometimes completely remote — depending on how well school officials will work with the families needing support.

“We get quite a range of responses from schools. … A lot of them are, ‘Let’s work with you,’ others are more of a ‘my way or the highway’ approach — you’re either here or at truancy court,” Kearney says. “If schools are willing to work with us with gradual reintroduction and makeup work, we will have more success.”

Most important, he says, is for parents to talk to others about what’s going on at home with their child. “A school counselor is good place to start, as they likely have connections to mental health support in the community. But be open about some of the struggles you’re having … because it’s important to have a lot of people working together.”

It’s also essential to know you’re not alone — something the New York City mom wishes she had learned years ago. “We thought it was just our family,” she says. “One day, after my daughter was struggling for a while, I said something about how weird we were, and the guidance counselor said, ‘You’re not the only ones.’ I said, ‘You’re kidding.’ She wouldn’t tell me how many others there were. … But still, it would’ve made such a difference to me to know we were not the only ones.”

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