When Anxiety Leads to School Refusal

Behavioral Health Behavioral Health

Chronic school refusal can impact quality of life and participation in normal activities.

Princeton House Behavioral Health Addresses When Anxiety Leads to School Refusal

When children or teens exhibit school refusal, it can be associated with significant anxiety about going to or staying at school, rather than a desire to stay home. Because so many factors can contribute to school refusal, it may require various points of intervention to identify and address underlying issues and a team approach to help the child or teen reintegrate.

“These children are typically compliant, often well behaved, and usually above average academically,” says Jody Kashden, PhD, Clinical Director of Child and Adolescent Programs at Princeton House Behavioral Health. “Sometimes major life changes—such as going to a new school, parental separation, or the birth of a sibling—can lead to school refusal. Other contributing factors range from peer bullying and difficulty coping with academic demands to family dysfunction or the presence of a true anxiety disorder.”

Preventing Longer-Term Issues

Early intervention is critical in preventing a child from becoming more entrenched in avoidance behaviors and to interrupt any negative impact on academic achievement. When young children miss too much school, it is often linked with long-term reading problems and weaker social/emotional skills, according to Advocates for Children of New Jersey. Likewise, chronic absenteeism can impact graduation and success rates for older children. 

The first step in successful treatment is to conduct a comprehensive assessment and rule out any medical issues, according to Dr. Kashden. In addition, when therapists and health care providers work with the child, parents, teachers, and school administrators, reintegration is most effective.

An effective treatment modality is to use an anxiety-based model, working on exposure and response prevention. Dr. Kashden suggests a combination of:

  • Building hierarchies with graduated exposure to sources of stress or anxiety-provoking situations 
  • Cognitive behavioral therapy
  • Mindfulness skills
  • Relaxation training
  • Social skills training
  • Contingency management
  • Reentry planning

“When school refusal has a significant impact on functioning at school or behaviors are generalized to other activities of daily life, Princeton House can provide a more intensive level of treatment and family therapy to help get children and teens back on track,” adds Dr. Kashden.

For more information, visit princetonhouse.org or call 800.242.2550/inpatient or 888.437.1610/outpatient.

According to Dr. Kashden, personality attributes that can be linked to school refusal include:

  • Being introverted, socially isolated, or behaviorally inhibited
  • Having low self-esteem
  • Being immature or dependent on others
  • Falling on the autism spectrum
  • Being a high achiever
Article as seen in the Fall 2017 issue of Princeton House Behavioral Health.