A Guide to Helping Kids with School Refusal or Avoidance Get Back on Track

School refusal, school avoidance, and school anxiety has the potential to snowball fast. 

One day becomes two days, which can become a week and even months or years. The most common cause of school refusal is anxiety as opposed to delinquency. Many circumstances can kick off missed school, including genuine illness, but anxiety is typically the factor that keeps the student out of school. The longer the student stays at home, the more entrenched the anxiety becomes. The sooner we can intervene, the easier it is to get the student back on track with their education.

School refusal usually requires a multimodal, team treatment approach. 

Treatment for school refusal requires participation of the school, student, and household. It also requires a compassionate, non-blaming, and nonjudgmental approach. Most students who are avoiding school want to go back to school, but the anxiety has felt insurmountable and they don’t know how to manage the return. 

Effective treatment for school refusal requires that we first address environmental considerations that might be contributing. For example, some students with school refusal have a learning disability that either has not been identified or that is not being adequately supported. Or maybe the student lacks a sense of belonging at school, and we need to find ways to get them more engaged in school-related activities beyond the academic day. We also need to consider how to set up the home environment in a strategic way so as to avoid accidentally reinforcing the school avoidance. 

School avoidance or refusal and its link to ADHD, autism, and learning disabilities

For students whose school refusal might be related to learning or neurodevelopmental issues (e.g., ADHD or autism), a comprehensive evaluation may be a helpful adjunct to treatment in order to identify what kinds of support or intervention the student may need at school in order to be successful. 

School refusal or avoidance and its link to anxiety

Of course we also need to work directly with the child or teen to build skills in coping with anxiety, and to build willingness to agree to a re-entry plan. Parents of students who have been refusing school also need to build skills in how to respond to their child’s anxiety and avoidance in ways that will build more resilience. 

The cycle of anxiety and avoidance: Understanding and breaking the loop

Anxiety and avoidance often form a self-perpetuating cycle that can be difficult to break. This cycle is particularly relevant in the context of school avoidance. Understanding this cycle is crucial for developing effective interventions and support strategies. 

Components of the anxiety and avoidance cycle

• Triggering event

• Anxiety response

• Avoidance behavior

• Short-term relief

• Long-term consequences 

• Accidental reinforcement of anxiety

• Increased anxiety

Triggering Event

The cycle typically begins with a triggering event or situation that causes anxiety. In the case of school avoidance, this could be anything from a difficult test, social interactions, bullying, or even the general environment of the school. A common trigger is having been away from school because of a holiday break, an illness, or even just a weekend. Probably most of us can relate to the emotional challenge of transitioning back into work or school following a period when the routine has been disrupted.  

Anxiety Response 

The triggering event leads to an anxiety response. This can manifest as physical symptoms (e.g., stomachaches, headaches, sweating), emotional symptoms (e.g., fear, dread, panic), or cognitive symptoms (e.g., negative thoughts, worry). 

Avoidance Behavior 

To alleviate the anxiety, the individual engages in avoidance behavior. For a student, this might mean refusing to go to school, feigning illness, or finding excuses to stay home.

Short-Term Relief 

Avoidance provides immediate, short-term relief from anxiety. The individual feels better temporarily because they have escaped the anxiety-provoking situation.

Long-Term Consequences 

While avoidance reduces anxiety in the short term, it has negative long-term consequences. The individual misses out on important experiences, such as learning opportunities and social interactions. This can lead to academic decline, social isolation, and increased anxiety about the avoided situation.

Accidental Reinforcement of Anxiety 

The relief experienced from avoidance reinforces the behavior, making it more likely that the individual will avoid similar situations in the future. This reinforcement strengthens the association between the triggering event and anxiety, making the anxiety more intense over time.

Increased Anxiety 

As the individual continues to avoid the anxiety-provoking situation, their anxiety about it grows. The situation becomes increasingly daunting, and the cycle begins anew, often with heightened anxiety and more entrenched avoidance behaviors.

Breaking the cycle of school refusal or avoidance and anxiety

Breaking the cycle of anxiety and avoidance requires a multifaceted approach that addresses both the anxiety and the avoidance behaviors. Here are some strategies to consider:

• Gradual Exposure

• Problem-solving 

• Skill building

• Create routines

• Practice what to say

• Don’t make it too comfortable

• Focus on belonging and connection

• See school friends outside of school

• Sleep hygiene

• Treat mental health issues

Gradual Exposure 

Gradual exposure to the anxiety-provoking situation can help build a person’s confidence in their ability to cope. This involves slowly and systematically facing the situation in small, manageable steps, allowing the individual to build confidence and reduce anxiety over time. In the case of school avoidance, the student might pick, as a starting point, their most preferred activity in the school day. Perhaps this is a nonacademic activity such as lunch or art class. This can help the student to gain some traction with re-integrating into the school community. 

Problem Solving

Here, we might ask the student to rate their enjoyment or the difficulty of each period of their day, including transitions between classes. These kinds of ratings can offer clues about where the student might need extra support, and how to troubleshoot fears that the student may have. 

Skill Building 

Teaching coping skills such as mindfulness and problem-solving can help young people manage their anxiety more effectively. These skills can reduce the reliance on avoidance as a coping mechanism. One skill that can be particularly important is to teach the young person about how anxiety functions and creates unhelpful “stories” that get in the person’s way of pursuing what’s important to them. By building awareness of emotions and one’s core values, we can help young people to be more resilient when facing their anxiety. 

Create Routines 

Even when a student is refusing to go to school, it’s important to have the student start out their day by getting ready to go to school. Even if the student never makes it out of the house, it’s practice towards the goal. Consider structuring the day to align as much as possible with the school day’s activities. The student can be expected to stay awake and keep up with assignments. 

Practice What to Say  

Many students are afraid of what to tell their classmates after an extended absence. It can be helpful to problem-solve this common fear directly, perhaps by creating scripts that the student can use as well as by identifying unhelpful beliefs about how others might respond. 

Don’t Make it too Comfortable  

Punishment is unlikely to help, and it might make things worse. That said, it can be important to avoid making home life during school hours too comfortable because this can reinforce the avoidance.Consider banning video games and other forms of tech entertainment during school hours. Keep meals about as interesting as the student would receive at school. Encourage the young person to sit at a desk in the main living area, and not their bedroom. 

Focus on Belonging and Connection 

Part of the school re-entry plan can be about engaging in activities that will foster the student’s sense of belonging and connection. School-based sports and clubs can be a critical part of the plan, as well as enrollment in classes that the student finds genuinely interesting. 

See School Friends Outside of School

Even if your student is not attending school, encourage them to keep up social activities. If your student feels that they do not have friends to reach out to, this can be a clear signal that intervention aimed at building social connections is needed. 

Sleep Hygiene  

Sleep is typically disrupted in students who are missing school. As much as possible, enforce a regular bedtime and wake time. For students who stay up late into the night playing video games and sleep during the day, drastic action might be needed. For example, some families find that the only way to discourage midnight video gaming is to shut down wireless and limit data access during night hours. 

Treat Mental Health Issues  

Students with school avoidance may have more general vulnerabilities to depression, anxiety, and other mental health concerns. Part of the treatment may in fact involve getting the student back to school, but it’s important to attend to any additional mental health vulnerabilities to ensure that the student is receiving any needed treatments. 

Summary of How to Help with School Avoidance or Refusal

School avoidance is typically an all-hands-on-deck kind of problem. Without getting on top of the problem, there is a risk that the student will become increasingly stuck in the avoidance cycle and experience unwanted long-term educational and vocational consequences. The cycle of anxiety and avoidance is a challenging pattern to break, but with the right strategies and support, it is possible to disrupt the loop and help young students get back to school. 

If you have a student with school refusal and need a provider in the Seattle area, you can reach out to us or to resources in your community. We can also meet with families who are in Washington State who may be seeking online services or parenting guidance.