Another Look at School Avoidance

by Lucille Carr-Kaffashan, Ph.D.

As students begin their 4th academic year impacted by the Covid-19 pandemic, educators are continuing to adjust their understanding about what types of support are needed to address children’s educational and emotional challenges. Teachers and administrators all over the country are reporting record levels of anxiety and depression, and when asked about their number one concern, they frequently mention school avoidance.

Life has changed in numerous ways since the start of the pandemic, and many would agree that the world feels scarier and less stable than we remember it to be in early 2020. Some students who struggled with school avoidance prior to pandemic-related school closures have found it even harder to face the stress of being at school. Others who previously had little or no difficulty getting themselves to school each day may be finding it too anxiety provoking to leave the perceived safety of home no matter how reassuring parents and teachers try to be.

School avoidance is a pattern of refusing or avoiding school altogether or difficulty remaining in school for the entire day. It is not the same as truancy, and it is not an avoidance of schoolwork per se. It is a complex syndrome influenced by temperament, genetics, cognitive factors, and family environment, and often occurs after a stressful event (e.g., a parent’s illness, a bullying incident, a move to a new home or school, a prolonged absence from school). In general, it is best understood as an anxiety disorder related to separation anxiety.

Effective School Solutions (ESS) has a long history of treating school avoidance within the various Multi- Tiered Level of Supports (MTSS) programs that it offers to districts throughout the country. Staff draw from research-based standards of care and the collective experience of ESS’s own clinical experts to design individually tailored clinical interventions.

We recently caught up with one of ESS’s own clinical experts, Jordan A. Katz, MSW, LSW, a Licensed Social Worker, to get her take on our current understanding of school avoidance. Ms. Katz’s clinical interests include obsessive compulsive disorder (OCD), anxiety disorders, emetophobia, mental health stigma, and access to mental health care. In addition to her role as Professional Development Trainer and Coach for ESS, she currently maintains an active clinical practice, working as a psychotherapist with children, teens, and adults who struggle with OCD and other anxiety disorders.

How common is school avoidance and when should a parent or teacher become concerned?

As reported by The School Avoidance Alliance the refusal to attend school or remain in class an entire day is not uncommon, affecting 5% to 28% of students at some time in their lives. If the behavior persists for 1.5–2 weeks, it’s time for parents and school professionals to confer about the causes and what can be done to help.

What are the signs of school avoidance?

School avoidance will look different depending on the age of the child. With younger children, for example, we might see tantrums or threats to run away when it’s time to go to school and they may say things like “No, I’m not going to go to school. I’d rather run away from you.” They may even run down the street when the bus comes. We might see tearfulness in the morning before going to school, or even the night before. It is also very common to see somatic complaints, including stomach aches or headaches. These may be so persistent that a parent pursues medical intervention, e.g., bringing the child to see a gastroenterologist because of chronic stomach aches associated with going to school or being in school.

Other things to look out for include seeing a student hesitate about going to school or exhibit persistent negative thoughts or statements about school that didn’t otherwise exist. A student might suddenly declare “I hate school” or “I’m not good at school” or make statements that suggest worry: “What if something bad happens when I’m at school?” “What if I get bullied?” “What if I fail this exam?” Another common behavior is reassurance seeking from parents or teachers, such as continually asking, “Is everything going to be okay?”

Exposure to bullying is another factor that contributes to school avoidance. Recently, there’s been an increase in bullying online, so it’s not just face-to-face bullying that adults must consider. For example, perhaps a student who has had no problem going to school in the past becomes aware of something negative said about him or her on social media. This contributes to apprehension about going into school and about being present among peers.

What are the causes of school avoidance?

There are social, educational, and mental health factors that contribute to school avoidance.

Social factors include bullying, the impact of social media, and substance use. As I mentioned earlier, if a child is exposed to bullying at school it will create an undesirable situation that the child will want to avoid. The explosion of social media has ensured that our students’ social contact doesn’t end when they leave school and go home. Whether it is bullying or competition or social pressure of any kind, students can no longer get away from it: it now follows them home. For example, there may be tweets or social media posts that could be the prompting event for a student to avoid the next day. As for substance use, if a student is using substances for any reason — to fit in, to feel “cool”, to self-medicate, to party and/or experiment — it may contribute to that student being unable or unwilling to rouse from sleep or to feel motivated to go to school the next day.

Educational factors include things like a learning disability or some other neuro-cognitive difference. A child might say, for example, “If I struggle in school, I may have a hard time being there. I don’t really enjoy it. It’s hard for me. I don’t really understand what I am learning anyway, and I don’t learn at the same rate as my classmates. It’s going to be hard for me to be there.” Students who have ADHD may have a hard time sitting in classes in districts that use block scheduling, which can require students to sit and pay attention for 90-minute classes.

Mental health factors could include anxiety or depression. Generalized Anxiety Disorder or Social Anxiety Disorder might manifest in comments like “I am anxious about being in school and worried about how I am doing in my classes” or “Other kids will be mean to me and won’t want to talk to me”. Depression might be reflected in comments like “I don’t get much sleep, it’s difficult for me to get going in the morning” or “I don’t really care about school because I just feel sad a lot of the time”.

What can parents do?

Well-meaning parents can inadvertently maintain or reinforce school avoidance. For example, if a student has a tantrum or says to a parent, “I don’t want to go to school” or “it’s scary” or “I don’t like it” it is understandably hard for a parent to force a child to do something that is causing them emotional distress. It is important, however, to urge parents to encourage their children to face their fears and continue to go to school even though it’s hard or doesn’t feel comfortable. Parents need to assure their kids that they can tolerate uncomfortable feelings, and these feelings are temporary and will pass. Over time, as parents withdraw these protective behaviors and accommodations, it can help the student be more functional in the school setting. By decreasing parental accommodations, students can become more independent in confronting their fears and develop a greater sense of self-efficacy, confident in their ability to remain at school. It can also be important for parents to get their own mental health support if they find it difficult to withdraw those accommodations and to tolerate the child’s discomfort.

How can schools help?

The most important goal is for educators to identify and understand when a student might be struggling with an anxiety or depressive disorder. There are a variety of different symptoms to look out for in the school setting. For example, a student who persists in checking for mistakes, who often turns in incomplete assignments, who seeks lots of reassurance, who isolates more than in the past, who seems unwilling or unable to be involved in class discussions, who is chronically late, might be struggling with anxiety or depression. These are all symptoms that an educator might notice and then begin to question what might be going on with this student.

From there, the teacher or school counselor should talk with the parents to share what they’re observing and see how these symptoms might be showing up outside of the school setting. In some instances, when there are mild issues related to something like social anxiety, the teacher or school counselor might feel comfortable coming up with goals or exposure opportunities so that the student might practice new behaviors while tolerating discomfort during school activities. In other cases, if the child is refusing school frequently, it may be something that’s more significant that requires professional help. In that case, the educator can make a referral to school based mental health counselors, or help parents identify outside resources, such as a program or a practitioner who specializes in the treatment of anxiety or mood disorders.

We are grateful to Ms. Katz for taking the time to share her perspectives on this pervasive problem.

Some Final Thoughts

Educators are analytical by nature and by training and strive to understand their students’ struggles.

As Ms. Katz pointed out, there are many factors that contribute to the development and maintenance of school avoidance, and once a student’s pattern of avoidance persists beyond two weeks it is critical to have a mental health professional conduct a comprehensive assessment before creating an intervention strategy. The School Refusal Assessment Screening (SRAS) tool, developed by Kearney and Albano, helps us understand what factors are most relevant for any given student.

The four primary reasons that students avoid school:

• To avoid school-related stimuli or situations that cause discomfort or anxiety (e.g., noisy cafeterias, bus rides, fire drills, crowded hallways, other children that make them uncomfortable such as bullies, not being able to do schoolwork because of learning differences, etc.)
• To avoid evaluative or social situations related to school performance (e.g., tests, public speaking, athletic performance in the gym or on sports teams, etc.)
• To receive attention from parents or caregivers (e.g., separation anxiety or the feeling that one or both parents need them at home, etc.)
• To seek tangible rewards that make staying home more comfortable or enjoyable than going to school (e.g., access to video games, ability to sleep in, to work at a job, to socialize with friends outside of school, etc.)

And remember, make sure to engage school-based mental health professionals as soon as possible in the conversation about any student’s pattern of school avoidance!