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School Refusal (cont.)

What Symptoms and Signs Are Associated With School Refusal?

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

When to Seek Medical Care for School Refusal

If any of the signs or symptoms of school refusal occur, contact a health-care professional.

What Exams or Tests Diagnose and Assess School Refusal?

Helpful tools to confirm the diagnosis of an anxiety disorder and the level of impairment include the following:

  • The Child Behavior Checklist (CBCL)
  • The SCARED (The Screen for Child Anxiety Related Emotional Disorders)
  • The Children's Manifest Anxiety Scale
  • Children's Global Rating Scale
Medically Reviewed by a Doctor on 1/11/2016

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Patient Comments & Reviews

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School Refusal - Treatment

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School Refusal - Experience

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Read What Your Physician is Reading on Medscape

Anxiety Disorder: Separation Anxiety and School Refusal »

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), separation anxiety is a fairly common anxiety disorder that consists of excessive anxiety beyond that expected for the child's developmental level related to separation or impending separation from the attachment figure (eg, primary caretaker, close family member) occurring in children younger than 18 years and lasting for at least 4 weeks.

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