What Is School Refusal?

School refusal happens when anxiety or distress makes it hard for a child to attend school. It’s rarely about defiance—it’s about feeling unsafe, unprepared, or unable to cope with the demands of the school day.

Research shows that school refusal affects 1%–5% of school-aged children and often appears during times of transition—starting kindergarten, entering middle school, or returning after a break or illness (Kearney & Albano, 2007). In teens, it is frequently linked to social anxiety, depression, and academic stress, with older adolescents at greater risk of prolonged absences and lower graduation rates if it is not addressed early (Egger et al., 2003; Heyne et al., 2015).

You may also hear it called school avoidance or EBSA in educational settings—terms that highlight the role of emotional distress rather than willful truancy.

Some common reasons include:

• Separation anxiety – trouble leaving a parent or caregiver

• Social anxiety – worries about peers, speaking in class, or fitting in

• Panic disorder or generalized anxiety – fears about panic attacks or “something bad” happening

• Perfectionism or academic pressure – fear of making mistakes or not meeting expectations

• OCD-related fears – contamination concerns, harm worries, or “just right” feelings

• Adjustment stress – after illness, a move, or major life change

You might notice:

• Frequent complaints of headaches, stomachaches, or nausea before school

• Meltdowns or panic symptoms in the morning

• Refusing to get in the car or walk into the building

• Patterns of partial days or complete absences

Empowering Children Through Understanding and Choice

Treatment works best when children feel involved and in control of their progress. Depending on the child’s age, we prioritize helping them:

• Understand their anxiety and how it affects their communication.

• Feel a sense of choice and control over their treatment steps.

• Celebrate successes, no matter how small, to build confidence.

How We Help Kids & Teens Return to School

Our approach is part science, part collaboration, and part cheerleading. We work to understand the “why” behind your child’s school avoidance, then build a gradual return plan that balances empathy with clear expectations.

The most effective treatment for school refusal—whether in children or teens—combines graded exposure to the school environment, parent involvement, and school collaboration. For adolescents, research supports pairing these strategies with targeted skill-building in emotional regulation, problem-solving, and academic coping to help them manage the pressures of high school and beyond (Heyne et al., 2015).

This might include:

• CBT for school refusal – Helping your child identify unhelpful thoughts, practice coping skills, and see themselves as capable.

• ERP (Exposure and Response Prevention) – Breaking the school day into smaller, manageable steps and practicing them in ways that reduce avoidance.

• Parent coaching – Giving you clear tools to set boundaries, remove unintentional rewards for staying home, and keep mornings calmer.

• School collaboration – Partnering with teachers and counselors to set up accommodations, check-ins, and classroom supports that make re-entry more successful.

What Gradual Exposure Might Look Like

Every plan is different, but a return-to-school ladder could start with:

1. Driving to school and staying in the parking lot.

2. Walking into the building with a trusted adult.

3. Attending one favorite class or activity.

4. Increasing time at school until full days are consistent.

For teens, we may also include exposure to socially or academically challenging situations—like giving a short presentation or attending a difficult subject—to address underlying fears directly.

Supporting the Whole Child

We know that no two kids are alike, and school refusal often shows up alongside other challenges. That’s why our work is:

• Neurodiversity-affirming: We adapt strategies for kids with ADHD, autism, sensory sensitivities, or other learning differences.

• Holistic: We address emotional regulation, social skills, and self-esteem alongside anxiety treatment.

• Family-centered: You’re part of the team. We help you stay consistent and confident in supporting your child’s progress.

Why Acting Early Matters

Avoidance can quickly become a habit, and the longer a student is out of school, the harder it can be to return. Early intervention is especially important for teens, as prolonged absence is linked to lower graduation rates, reduced college attendance, and ongoing mental health challenges (Egger et al., 2003).

One study found that when targeted support begins within the first few weeks of school refusal, children and teens are more likely to return to full attendance and less likely to experience ongoing emotional struggles (King & Bernstein, 2001).

Take the First Step Toward Freedom from School Refusal

Whether your child is missing the occasional day or has been out for weeks, we can help you create a plan that feels doable for your child and sustainable for your family.

We offer specialized child and teen therapy in-person at our Portland, OR office and online for families across Oregon and California. Whether you’re looking for specialized child therapy or practical parent support our team is here to help.

Contact us today or schedule a free 15 min consultation

Sources

• Egger, H.L., Costello, E.J., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child & Adolescent Psychiatry, 42(7), 797–807.

• Kearney, C.A., & Albano, A.M. (2007). When Children Refuse School: A Cognitive-Behavioral Therapy Approach. Oxford University Press.

• Heyne, D., et al. (2015). School refusal: Epidemiology and management. Pediatrics and Child Health, 25(9), 513–517.

• King, N.J., & Bernstein, G.A. (2001). School refusal in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 197–205.