It’s common for children and teens to not want to go to school every once in a while.  But for some, the anxiety, fear, or distress about school becomes so strong that it leads to ongoing struggles with attendance.  This is called school avoidance.

Also known as school refusal, school avoidance is when a child has persistent difficulty going to or staying in school.  It can look like missing whole days, showing up late, leaving early, or trying to avoid certain classes or situations.

The good news is that by learning the signs and how to respond, you can help your child start getting back to school.

Recognizing School Avoidance

Early on, it can sometimes be hard to tell the difference between everyday reluctance and true school avoidance.  While every child is different, there are some common early warning signs to watch out for:

• Consistently arriving late, asking to leave early, or missing certain classes, which may start occasionally but become a repeated pattern over time
• Frequently complaining of feeling sick, such as headaches, stomachaches, or other physical complaints, especially on Sunday nights or weekday mornings
• Difficulty getting out of bed or getting ready for school, such as taking much longer than usual in the morning or showing a lot of hesitation about leaving
• Frequent arguments or emotional outbursts when it’s time to go to school
• Repeated visits to the school nurse for physical symptoms that don’t have a clear medical cause

Why School Avoidance Happens

School avoidance can happen for a number of different reasons, including anxiety, depression, learning challenges, trauma, or environmental stressors.  At InStride Health, we specialize in addressing school avoidance that occurs because of anxiety and OCD.  Common anxiety-related triggers include:

• Social Anxiety: Fear of embarrassment or negative judgment from peers or teachers, leading to avoidance of class participation, hallways, or social settings like lunch.
• Generalized Anxiety: Excessive worry about grades, performance, or the future.
• Panic Disorder: Fear of experiencing a panic attack at school and being unable to leave or access support.
• Separation Anxiety: Fear that something bad will happen to the child or their caregiver while they are at school.
• Emetophobia: Fear of vomiting, getting sick, or seeing others vomit at school.
• Obsessive-Compulsive Disorder (OCD): Fear of contamination or distress about not being able to complete rituals in the school environment.

What Maintains School Avoidance

School avoidance often starts in understandable ways. A child may begin missing school due to illness, a family event, social stress, or learning challenges. However, once school avoidance begins, it can escalate quickly – and the longer the child is out of school, the harder it becomes to return.

There are two key factors that tend to keep school avoidance going once it starts: the relief a child feels by avoiding school, and the comfort they gain from staying home.

• Relief from Anxiety:  The first factor is that something about school is uncomfortable or anxiety-provoking. This may include academic demands, social fears, or past negative experiences. These stressors elicit anxiety, fear, or worry, leading the child to avoid school.  And, when a child stays home, the short-term relief they get makes it even harder for them to approach school the next time.

• Comforts at Home:  The second, often less recognized, factor is that staying home feels safe, enjoyable, and comfortable. Young people may have access to electronics, preferred activities, caregiver attention, and other comforts that are not available at school.  When home feels rewarding in these ways, it can unintentionally make avoiding school more appealing than attending.

Addressing School Avoidance

At InStride, we believe that breaking the cycle of school avoidance requires a team approach.  This includes the child, their parents, and the school.

Support for the Child

The gold-standard treatment for anxiety- or OCD-related school avoidance is cognitive behavioral therapy (CBT), with a strong emphasis on exposure therapy. The primary goal is gradual school re-entry, starting with small, manageable steps and building up over time.  These steps might include:

• Waking up early and following a morning routine
• Practicing a structured school day at home
• Driving to school without going inside
• Meeting with a school counselor in the building
• Attending 1-2 preferred classes
• Working up to a full school day

Throughout this process, we teach coping skills to help children and teens manage their anxiety and/or OCD symptoms while taking brave steps towards returning to school.

Support for Parents

We support parents and caregivers by focusing on two key goals: reinforcing brave steps toward school and making home less comfortable during the school day.

This might include:

• Limiting access to electronics or other preferred activities during school hours
• Making rewards (like screen time) contingent on taking steps toward school
• Reducing parent check-ins or attention during the day
• Limiting access to the bedroom during school hours

In addition to these changes, parents can shift their attention to their child’s positive effort through validation and praise. They can also set up a reward system to reinforce the steps their child takes towards returning to school.

Collaboration with the School

Supporting a student with school avoidance requires close collaboration with their school. This includes working with school staff to identify school-based triggers, hold a school re-entry meeting, and align on a gradual plan for returning to school. Temporary accommodations and support can also reduce initial barriers to re-entry and set the stage for success.

Examples of school supports might include:

• Flexible start times
• Modified schedules
• Supportive staff check-ins
• Access to a quiet or private workspace
• A plan for managing or making up missed work

In addition, having a clear plan for ongoing communication and tracking progress helps everyone stay aligned and adjust support as needed.

InStride Can Help Your Child with School Avoidance

At InStride, we use CBT with a focus on exposure therapy to help young people with school avoidance and their families gain skills to manage their anxiety and gradually return to school.

We understand the importance of family during treatment. That’s why we also provide support for parents and caregivers.   We have a parent/caregiver skills group to teach you skills to most effectively support your child during and beyond their anxiety treatment. That’s followed up with our parent practice group, which is a space for discussion and problem-solving for incorporating the strategies learned in the skills group.

We provide specialty outpatient care for pediatric anxiety disorders, OCD, and related conditions, like school avoidance, for ages 7-22. Every individual receives a three-person care team:

• Therapist
• Exposure coach
• Psychiatrist

With no waitlist and a response to your inquiry in 24 hours, young people can quickly start their journey with us toward the life they want.

Reach out to us today for more information or to start getting our help with the school avoidance your child is experiencing.