At first glance, this blog might seem a bit odd, laughable even - after all which parent hasn’t experienced the morning lament from their child who really doesn’t want to go to school that day? 

But ‘school refusal’ or ‘school phobia’ is much more than just a general feeling of not wanting to go to school and it affects thousands of families each day, with estimates that 1% of children currently fall within the definition of school refusers[1].

School phobia, or school refusal, is a commonly misdiagnosed and misunderstood condition and describes children who show an extreme anxiety or fear about attending school, often to the point where they become physically ill or so distressed they have to remain at home.

For parents it can be a desperately frustrating and worrying time, not only does it put huge pressures on family life, impact on their child’s education and social life but can, of course, impact severely on the parents’ ability to work.

School phobia is thought to be an anxiety driven symptom, attributable to many mental health disorders, including separation anxiety, generalised anxiety disorder, social anxiety or depression.  It can have long term implications in terms of your child’s mental wellbeing, self esteem and of course, educational achievement.

How do I know if my child has ‘School phobia’?

Whilst it’s normal for all children to show some resistance at times to going to school, children with school phobia show extreme and persistent fear.  So if your child has had any of the following symptoms for more than a couple of weeks, it may be time to seek a professional opinion.

The signs of school phobia include:

• Complete absence from school
• Leaving school during the day
• Reluctance or refusal to attend school in the mornings
• Morning tantrums and angry outbursts
• Regular physical complaints such as stomach aches, headaches, vomiting, rapid heartbeat, dizziness
• Pleading or begging to stay at home
• Threatening to harm themselves if made to go to school

What causes school refusal?

School refusal is most likely to start between the ages of 10 and 13, although can be present in children as young as 5.  It affects girls and boys equally.  Causes of school refusal include:

Mental health conditions – 75% of children with separation anxiety will also suffer with school phobia[2].

Life events – children who have suffered a recent bereavement, house move, school move or disruption to the family such as divorce are more likely to become school refusers.  Children who are school refusers internalise their anxious emotions and are often very worried that something will happen to a parent or caregiver whilst they are at school.  These fears can be triggered by a loss or change at home.

Home environment – children whose parents are ill or whose family life is chaotic or dysfunctional, perhaps due to a change in circumstances, are more likely to develop a phobia of school.

School environment – it is no surprise that children who are being bullied or who are worried about their academic performance at school may be more likely to develop a problem with attending school.  Often school refusers are bright, academically able children who like learning, which can make it even more upsetting for them. 

Returning to school after a break – following the long summer holidays or an extended amount of time away from school due to an illness, some children can develop school refusal.

What should you do if you think your child has school refusal?

1. Seek help early: Anxiety disorders such as school refusal can turn into a vicious cycle where avoiding the very thing that makes the child scared, reinforces the fear itself.  A child and adolescent psychiatrist will be able to diagnose the condition and refer your son or daughter for therapy and treatment.
2. Talk to your child: Your child may find it difficult to talk to you about their feelings as often they are not fully aware of the causes of their anxiety.  It’s important not to belittle their feelings, for instance dismissing their fears that something might happen to you whilst they are at school.  For them, this could be a very real anxiety.  Instead, try and listen to them, show them that you care, are concerned and are taking their anxieties seriously.
3. Returning from a break from school: If you think your child is likely to struggle returning to school after the long holidays or following an illness, consider slowing integrating school back into their life.  Buying new uniform or a pencil case a few weeks before their return, taking a few walks that pass the school gates, inviting school friends around or looking at school pictures can all help.  Be led by your child and try not to force the issue.
4. Talk to the school. Hopefully your school will have had prior experience of this and will be able to help you manage the situation and offer support.  You may want to consider a gradual return to school or part time hours to ease your child back into the routine.
5. Seek parenting support or family therapy – many parents who have school refusers say how deeply frustrating and upsetting it is for them, as they simply don’t know what to do.  A parenting advisor will be able to give you advice on how to manage the morning routine and family therapy can be invaluable at working through the difficulties your child is experiencing.

Research has shown that cognitive and behavioural therapies can be incredibly effective at helping school refusers, with some studies showing that the majority of children will be back in full time education after a year of treatment.  Seeking help early and getting support for your child is the most important step to getting things back on track for your family.

Clinical Partners is the UK’s largest private mental health partnership and have child and adolescent psychiatrists, psychologists and psychotherapists helping families across the UK.  If you are worried about your child please call one of our team on 0203 326 9160.