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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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Refusal to go to school may happen at any age but most typically occurs in children 5-7 years of age and in those 11-14 years of age. During these years, children are dealing with the changes of starting school or making the transition from elementary or middle school to high school. Preschoolers may also develop school refusal without any experience of school attendance.

Generally, the child or adolescent refuses to attend school and experiences significant distress about the idea of attending school. Truancy (absent from school without permission) may be due to delinquency or conduct disorder and can be differentiated from school refusal. The truant student generally brags to others (peers) about not attending school, whereas the student with school refusal, because of anxiety or fear, tends to be embarrassed or ashamed at his or her inability to attend school.

Signs of school refusal can include significant school absence (generally one week or more) and/or significant distress even with school attendance. Distress with school attendance may include the following:

• A child who cries or protests every morning before school
• An adolescent who misses the bus every day
• A child who regularly develops some type of physical symptom when it is time to go to school

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