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Medical Author:

Bettina E Bernstein, DO

Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Although young children usually find going to school fun and exciting, one in four children may occasionally refuse to attend school. Such behavior becomes a routine problem in about 2% of children. Many children with school refusal have an earlier history of separation anxiety, social anxiety, or depression. Undiagnosed learning disabilities or reading disorders may also play a significant role in the development of school refusal.

Signs of a psychiatric disorder called separation anxiety disorder can include the following:

• School refusal
• Excessive worry about losing a parent; excessive worry that a parent might be harmed
• Excessive reluctance to be alone at any time
• Persistent refusal to go to sleep without a parent or other caretaker present
• Repeated complaints of physical symptoms whenever the child is about to leave a significant parental figure

These behaviors must begin before the child is aged 18 years, must last for four weeks or longer, and must cause serious problems with academic, social, or other functioning in order to be called a disorder.

Some commonly cited reasons for refusal to attend school include the following:

• A parent being ill (Surprisingly, school refusal can begin after the parent recovers.)
• Parents separating, having marital problems, or having frequent arguments
• A death in the family of a friend of the child
• Moving from one house to another during the first years of elementary school
• Jealousy over a new brother or sister at home
• Parents worrying about the child in some way (for example, poor health)
• Bullying can also be a cause of school refusal. Bullying is unwanted aggressive behavior among school-aged children involving a real or perceived power imbalance that is repeated or has the potential to be repeated over time. Bullying can include threats and attacking someone physically or verbally.
• Signs that a child may be a victim of bullying include the following:
• Unexplained injuries
• Lost or damaged clothes, books, electronic items, jewelry
• Decline in grades especially in math and reading -- not interested in school work
• Avoids school complaining of headaches, stomachache, feels sick
• Skips meals or binge eating -- may not eat lunch at school
• Nightmares and trouble sleeping
• Sudden loss of friends or avoids social situations
• Decline in self-esteem or feels helpless
• New onset of self-destructive behaviors: runs away, hurts self, suicide threats
• Effects of being bullied for the victim include the following:
• Increased risk of depression
• Increased risk of anxiety
• Drop in grades and academic achievement
• Child who is bullied retaliates with violence toward others

Other problems at school that can cause school refusal include feeling lost (especially in a new school), not having friends, or not getting along with a teacher or classmates.

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