adolescent kid looking sad in bed

When School Anxiety Becomes School Avoidance

March 27, 2024

Almost every parent has been there: Waking up each morning wondering if your child will readily prepare for and attend school, or begin protesting, and even worse, refuse to go. Now and then, kids can be anxious about going to school or may even dread it. Still, when it becomes so severe and stressful that the child experiences significant distress or struggles with chronic absence, it may be an emotional disorder.

School avoidance is not the same as truancy. Truancy refers to skipping school without a valid excuse. In contrast, school avoidance is when a student experiences intense anxiety or fear about attending school, which then can lead to chronic absenteeism. A variety of factors, including bullying, social anxiety, academic pressure, or a traumatic event, can be associated with school avoidance.

School avoidance often presents with withdrawal, as well as emotional distress or behavior dysregulation around school times. Many children display physical symptoms, including headaches and stomach aches. These symptoms tend to improve on weekends and holidays and are alleviated when a child is acutely removed from the school environment. Although symptoms are improved, distancing from school only exacerbates the underlying condition. As with most anxiety-related disorders, exposure is the most effective and necessary management strategy. Working with a health or education team to ensure this is done in the most sensitive and collaborative manner possible will help ensure success.

“Rates of various forms of anxiety as well as other mental health challenges have risen in the post-pandemic era, and school avoidance is no exception. Domestic and international data reveal that rates of school absenteeism have doubled to approximately 20% since the pandemic. This contributes to an already precarious situation for school-aged children who are also experiencing gaps in learning and social connectedness since the pandemic,” explains Evelyn Berger-Jenkins, MD, MPH, an Associate Professor of Child & Adolescent Health at Columbia.

School refusal is problematic for parents to navigate on their own. It usually takes a team of therapists and educators to help encourage a child to attend and stay in school. Identifying underlying fears and anxiety is an important first step, however.

Getting to the Root of the Problem

As stressful as school avoidance may be for parents and children alike, it is important to approach the situation with patience and curiosity, trying to understand why a child might be avoiding school rather than reacting with either harsh discipline or permissiveness. Consider and inquire, without judgment, about the multiple factors underlying school avoidance, including:

  • Anxiety: Children with episodes of anxiety or anxiety disorders, including social anxiety, may find school to be overwhelming and stressful and may avoid going as a way to cope with their discomfort. Try to identify any specific triggers or stressors that may be contributing to their anxiety. Have they always been a courageous kid and suddenly became withdrawn after something occurred at home or school? Have they been timid all their lives and started refusing school as academic demands increased or social circles changed?
  • Bullying: Children who feel unsafe and uncomfortable may refuse school to avoid their bullies. Bullying can be particularly damaging to a child’s self-esteem and mental health and may require intervention from parents or school staff. Children may be reluctant to disclose bullying for fear of retaliation or embarrassment; therefore, instilling a sense of safety and assurance that this is not their fault is important.
  • Academic Issues: Children who struggle with reading, writing, or math may feel embarrassed or ashamed and may refuse school to avoid the challenges they face in the classroom. A neuropsychological or educational evaluation may help uncover some of these challenges. Extra academic support and resources, such as tutoring or specialized educational programs, can help and, if indicated, are mandatory services provided free of charge by public schools as part of the Individuals with Disabilities Education Act.
  • Family Issues: Children who have experienced adverse experiences in the past or present, including conflict or dysfunction in their home or community, may find it difficult to concentrate in school and may avoid going altogether as a way to cope with the stress. Acknowledging and validating the effect of trauma on a child’s mental health and cognitive functioning is important. Family therapy or other support services can help address the underlying issues contributing to school avoidance.
  • Physical Health Issues: Children may become school-avoidant due to physical health issues, including asthma, frequent infections, and chronic orthopedic issues, for example. Accommodations and support services or specialized transportation can help a child who is experiencing physical health issues continue to attend school despite these challenges.

Dr. Berger-Jenkins says, “It is often the case that multiple factors contribute to a child’s refusal to attend school, and there is no one test or treatment that will quickly resolve the issue. Therefore, patience and curiosity are key to uncovering contributing factors and managing them one by one, in collaboration with the child, and their school supports. Maintaining a sense of positivity and hopefulness is a helpful counterbalance to the child’s distress.”

What You Can Do 

Whatever the underlying reasons, parents and educators can work together to help the child overcome school avoidance by providing reassurance, general and academic support, resources, therapy, or special accommodations. A supportive and welcoming school environment where safety is the expectation and children are encouraged to seek help when needed can also be achieved through anti-bullying programs and initiatives, mental health resources for students, and academic support services.

Although it is essential to seek professional help for significant concerns, including anxiety, depression, and academic failure, for example, there are a few coping strategies for parents and children that may be helpful:

Develop a plan: Once you have identified the underlying cause, work with the student to develop a concrete plan for addressing it. The plan should be co-designed with the child and not overly complex to maximize success. For example, making changes to the student’s academic schedule, assuring adequate sleep and other generally healthy lifestyles, and incorporating scheduled exercises in mindfulness or anxiety-lowering strategies may help. Support from a school counselor to follow through on the plan may be helpful.

Encourage communication: Encourage students to communicate their feelings and concerns with you or a trusted adult. Let them know that it is okay to feel anxious or overwhelmed and that some amount of anxiety is, in fact, adaptive and helpful – ex., to avoid danger such as a fire. However, explain that excessive anxiety can also be harmful to one’s health and that taming excessive anxiety is possible with a little work. Assure them that there are people who can help.

Build a support network: Help the student build a network of supportive friends, family members, or professionals who can offer encouragement and guidance. Teachers and school staff may help connect the child with other students who have experienced school avoidance or pair them with a supportive peer. Seeking support from a mental health professional in the child’s school or through their pediatrician is also possible.

Celebrate successes: Recognize and celebrate the students’ successes, no matter how small they may seem, to help build confidence and encourage continued progress. Focus on the fact that the child was able to remain in school for a few hours rather than stressing the fact that they had to come home early, for example. Let them know that you empathize with their emotions but are confident they will accomplish the expected goal of attending school.

Create a routine and structure: This can help your child feel more comfortable and secure and make attending school regularly easier. Establish a consistent morning routine, and ensure your child knows what to expect when they arrive at school.

Try to make school more enjoyable for your child: If they’re struggling with a particular subject, you might want to find a tutor or extra support to help them catch up. Please encourage them to pursue extracurricular activities that they enjoy, such as sports or music, to help the child feel more engaged with school overall.

It Can Get Better

Finally, it’s essential to be patient and supportive throughout the process. School avoidance can be a challenging issue to deal with, and it’s important to remember that the child is not doing this on purpose. Try to remain calm and positive, and let the child know there is support. With the right interventions and strategies, overcoming school avoidance and thriving personally and in the classroom is achievable.


Evelyn Berger-Jenkins, MD, MPH, is an Associate Professor of Child & Adolescent Health at the Vagelos College of Physicians and Surgeons at Columbia University