School Refusal - A Growing Concern

School Refusal- A Growing Concern                                                               

Written By: Shelby Witmer


The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association have joined together to declare A National State of Emergency in Children’s Mental Health. We are seeing increased cases of anxiety, depression and trauma impacting families, schools, and communities 

As a family and child services advocate at MHA Lancaster, I am noticing an increase in school refusal, also called school avoidance or school phobia. This differs from the traditional sense of truancy as purposely skipping school. There is often an underlying emotional concern such as anxiety at work preventing the child from being able to go to school.  

According to the School Avoidance Alliance: School Avoidance 102 – School Avoidance Alliance  

28% of youth display school refusal at some point during their lives 

18% of kids who have anxiety disorders that actually receive treatment  

1,680,000M #of American youth who are currently school avoidant 

Early intervention is best so if you notice red flags trust your gut.  Contact the school and your pediatrician to discuss your concerns. You are their best advocate! 

 Let your child know their anxiety isn’t their fault and explain what happens during fight, flight, or freeze.  Here are some helpful videos that can help them understand 



Red flags: 

Crying, distress, anxiety, anger, and tantrums that center around school and persist for more than a couple of weeks 

Tantrums, distress, or difficulty falling asleep at night in anticipation of school the next day or similar behaviors in the morning 

Increased school avoidant behaviors or unusual distress after a weekend or holiday break  

Avoiding a certain class or leaving school early 

Faking an illness to avoid school or having physical symptoms such as upset stomach, headache, chest pain 

Chronic tardiness 

Steps to take next: 

Schedule a meeting with the school to discuss your concerns. 

Try to identify the root of the issue and identify triggers (anxiety, depression, bullying, academic struggles, fear of failure, separation anxiety, social anxiety) 

Collaboration between school and home is crucial, work together to develop a support plan and be sure to get your child’s input 

Support your child at home before school by letting them know you understand how hard it is for them, but you believe in them and know they can do it. Remind them of the support plan 

-Remind them about how our brains interpret anxiety as a threat and activate the fight, flight, or freeze response. Practice some calming, grounding activities like breathing in and out like ocean waves, hold onto something comforting, 5,4,3,2,1 activity, name 3 favorite foods or 3 favorite animals, imagine a happy place. Practice this often so these coping skills are easily accessible prior to an escalation. 

Ideas for a school/home plan: 

-Have a daily check in with a trusted staff member at arrival. This could include meeting the student at a separate entrance or starting the day in an identified safe place rather than reporting directly to class 

-Identify a trusted staff member they can turn to in distress 

-Provide them with opportunities for breaks as needed 

-Build on their strengths to instill confidence and a sense of accomplishment 

-Celebrate the successes, no matter how small! 

-Have a trusted staff visit the home or call home to connect with the child and ease anxiety. 

-Consider the possibility of modifying the day or schedule to gradually transition the child back to school or class. Exposure therapy is an evidence-based intervention to deal with school refusal. 


Check out the School Avoidance Alliance school refusal alliance – Search ( as well as their Facebook page for support and helpful resources.   

Most importantly be patient, have empathy and show grace to you and your child. It’s hard on all of you and you aren’t alone.