School Refusal

Although young children usually find going to school fun and exciting, 1 in 4 children may occasionally refuse to attend school.

Treatment at Our Center.

What To Expect.

Cognitive-Behavioral Treatment (CBT)

Individuals will be engaged in our outpatient program using cognitive behavioral therapy which includes exposure and response prevention. Additionally, CBT will be combined with psychoeducation, goal setting, and motivation. Researchers and practitioners agree that the use of CBT in treatment for school refusal is recommended.


These behaviors must begin before the child is 18 years old, 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.

What Is School Refusal?

School refusal occurs when a student will not go to school or frequently experiences severe distress related to school attendance.

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 infant sibling
  • Excessive parental worrying about the child in some way (for example, poor health)
  • Bullying can also be a cause of school refusal.

Diagnostic Criteria

DSM-5 Diagnostic Criteria for School Refusal (individual must have at least 3)
  • Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures
  • Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death
  • Persistent and excessive worry about experiencing an untoward event (eg, getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure
  • Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
  • Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
  • Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms (eg, headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

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