School refusal, or school avoidance, 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 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. And 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. 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 the supports the student may need at school. 

Child and Teen Solutions (CATS) is a mental health clinic based in Seattle, Washington. We are staffed by psychologists and therapists who specialize in children, teens, young adults, and parent coaching. We offer both in-person and telehealth services. Our office is located in the Madison Park neighborhood, near Lake Washington.