School Refusal or Avoidance

A child experiencing more than just "school jitters" usually refuses to go to school on a regular basis or has problems staying in school. This should not be confused with truant children who avoid school because they display antisocial behavior or delinquency.

School refusal or avoidance is often a symptom of a deeper problem, and if not treated it can have a negative effect on socialization skills, self-confidence, coping skills and, of course, education. Anxiety-based school refusal affects 2 to 5% of school-age children. It is common at times of transition, such as graduating from elementary school to middle school and from middle school to high school. Anxieties tend to differ among age groups, but these are the most common stressors:

• separation anxiety
• concerns about academic performance
• anxieties about making friends
• fear of a teacher or bully

The most common ages for school refusal are between five and six, and between ten and eleven. Children who suffer from school refusal tend to be average or above average in intelligence.

Their stress may come out in physical symptoms such as the following:

• headaches
• stomachaches
• nausea
• diarrhea

In addition to physical symptoms, they may exhibit behavioral symptoms:

• tantrums
• inflexibility
• separation anxiety
• avoidance
• defiance

Older children not only experience the stress that goes along with transition from one school to the next, but they have the added academic pressure in the higher grades when they begin to consider what their futures hold. These stresses may manifest themselves in an extreme preoccupation with appearance, sleeplessness, or rebellion. As with younger children, it is important that they remain in school, although they may fight it. Missing school reinforces anxiety rather than alleviating it.

There may be many fears related to school, but these are the most common:

• Separation from caregivers
• Riding on the bus
• Eating in the cafeteria
• Using the school bathroom
• Being called on in class
• Changing for gym
• Interacting with other children or teachers
• Getting picked on by peers or older children