Why Won’t My Teen Go to School? School Avoidance and Mental Health

What is school avoidance? 

Mental health issues can have a dramatic impact on everyday functioning for children and adolescents, including avoidance of daily activities. School avoidance, which is also referred to as school refusal or school phobia, is the refusal to attend school due to emotional distress. While not a diagnosis on its own, it is a common symptom of many mental health disorders, with as many as 5%-10% of children experiencing school avoidance at some point in their lives. School avoidance can be brought on by a multitude of issues, including bullying, school anxiety, or simply dysthymia, so it’s important to determine the underlying issue to help treat the emotional distress associated with it. 

Symptoms of school avoidance and school phobia

Symptoms of school avoidance include 

• Fearfulness
• Panic
• Crying
• Temper tantrums 
• Threats of self-harm 

Physical symptoms can also occur and present as: 

• Headaches
• Stomachaches
• Dizziness
• Nausea 

Symptoms caused by school avoidance tend to resolve if a child is allowed to stay home. On the other hand, these symptoms may worsen if a child attends school. Many of the physical symptoms listed above may be attributed to anxiety, but always consult with a medical doctor to confirm if any other underlying health issues need to be addressed

School avoidance and truancy are often conflated with one another, but there are important differences to be aware of:

School avoidance tends to have anxiety as an underlying factor and parents are aware of the psychological toll it has on their children. Children experiencing school avoidance or school phobia tend to spend most of their time at home. Truancy can have many underlying factors and is usually an act of rebellion. Parents are often unaware that truancy is taking place, as children try to hide it by spending most of their time away from home or their family.

The rest of this article specifically focuses on school avoidance and school phobia. 

What causes school avoidance? 

Underlying mental health concerns are a major component in school avoidance. According to Fremont’s 2003 article School refusal in children and adolescents, “The most common comorbid psychiatric disorders with school avoidance include separation anxiety, social phobia, simple phobia, panic disorder, post traumatic stress disorder, major depressive disorder, dysthymia, and adjustment disorder.” What these disorders have in common is that they tend to present with symptoms of anxiety and fear.

Bullying, which can be physical, verbal, or cyber, has also been shown to be one of the primary contributors to school avoidance in all age levels from kindergarten through high school. According to a 2019 study, students who are bullied at any point in their childhood were more likely to exhibit antisocial behavior and were at significantly greater risk of experiencing school avoidance than their peers who had no history of victimization. Bullying and poor peer socialization can cause increased distress when a child attends school because they anticipate negative situations before they occur, making them too anxious or scared to confront the situation head-on.

Additionally, family dynamics can play an important part in heightening the risks of school avoidance.  One study found that the parents of children struggling with school avoidance have increased rates of panic disorder and agoraphobia. A later study found that children with purely anxious school refusal tendencies were more likely to come from a single-parent home or have parents that had been treated for a mental health issue. 

Longer-term risks of school avoidance 

School avoidance has been associated with many negative outcomes for adolescents. According to the National Association of School Psychologists (NASP), individuals who avoid school are more likely to have long-term issues, such as depression and anxiety, or poor academic achievement. They’re also more likely to drop out of school. In a study that followed up with school phobia patients 20-29 years later, children with school phobia were more likely to need adult psychiatric care, live at home, and have significantly fewer children than the general population sample and the comparison group of other child psychiatric patients. In addition, dropping out of school has been shown to be associated with increased unemployment, dependency on welfare, and incarceration. By avoiding school, children miss important curriculum and knowledge and miss out on socialization opportunities that can set them up for success for the rest of their lives. 

How to avoid school avoidance 

Quick interventions for school avoidance are imperative–the longer a child stays out of school, the harder it can be for them to return. Luckily there are many options to help your child combat school anxiety. Beyond the suggestions listed below, don’t be afraid to reach out if you need professional support to help your family with school avoidance.

Identify the underlying cause

There could be many reasons that a child develops anxiety around attending school. Identifying the underlying cause–be it bullying, PTSD symptoms, or any other number of mental health issues–etc. is necessary for determining the best support plan for your child. 

Collaborate on a plan to return to school

Collaboration with multiple people in your child’s life is key to setting up a return-to-school plan that works. Beyond working with your child directly, make sure to reach out to their teachers, school counselors, coaches, faith leaders, and any of their healthcare providers (physical, behavioral, or otherwise). When everyone is on the same page about the support necessary for getting your child back to school, the system runs much smoother. 

Create routines

Creating routines can help reduce stress and anxiety by making it easier for your child to anticipate what is going to happen throughout the day. An example of a simple routine would be to drop off and pick up your child from school at the same time and place every day. While this may sound obvious, small details can make a big difference for someone who is struggling with anxiety or attachment issues.

Encourage healthy habits

While healthy habits can increase emotional well-being as a whole, they can also boost the routines your child is already used to. Healthy habits include a consistent bedtime, regular exercise, reduced screen time, and eating nutritious foods.

Support social involvement

Children with close friends or a strong relationship with a teacher or other adult at school are less likely to experience school avoidance, and encouraging these relationships may make it easier for your child to return to school. You can help them build these relationships by encouraging your child to try out for a sports team, join a new club, or volunteer in the local community.

Exposure Therapy

Scaffolded and systematic exposure to school (the feared object/situation) can reduce the fear associated with attending. Gradual exposure can start by simply driving past the school, then attending a half day, and working up to being back at school full time. 

Treatment options for school avoidance

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy encourages children to confront their fears and teaches them how to change their negative thoughts in anxiety-producing situations. By modifying their negative thoughts, children are gradually able to return to their school environment with less anxiety. 

Educational-support therapy

Educational-support therapy combines psychoeducation in the form of informational presentations and psychotherapy. Unlike CBT, this intervention does not provide specific instructions for how children should confront their fears, or give positive reinforcement for school attendance.

Pharmacological interventions

Medications used to treat anxiety can be used in conjunction with behavioral interventions, and always discussed with your child’s primary care provider or psychiatrist first. The most common medications used to combat anxiety are SSRIs (Zoloft, Prozac, Lexapro, etc.) and Benzodiazepines (Klonopin, Xanax, etc) for extreme anxiety. 

Student and family support at Charlie Health

School avoidance, school phobia, and school refusal can significantly interrupt a child’s life and learning progress if not addressed quickly. By understanding the signs, symptoms, and risk factors associated with school avoidance, you can help your child overcome some of the greatest risks associated with skipping school. 

For more help combatting school avoidance, and to learn more about our virtual Intensive Outpatient Program, reach out to Charlie Health today.