School refusal

Abstract

Background: School refusal occurs in 1-5% of all school children and has major social, emotional and educational implications for the child.

Objective: This article outlines the assessment and management of school refusal in general practice.

Discussion: Initial assessment includes consideration of predisposing, precipitating and perpetuating factors in the child, family and school; a thorough examination to reassure the child and parents about physical symptoms; judicious use of investigations relevant to the presenting physical symptoms; and information from the school about the child's behaviour, social functioning, academic progress, and records of attendance. Management requires collaboration between parents, school and the child to plan a school return strategy. Acknowledge the reality of the child's feelings. Provide appropriate strategies for the child to manage anxiety. Encourage parents to reduce potentially undermining doubts about successful re-entry to school and plan calm morning routines and escort to school. School strategies may include special supports such as modified curriculum, reduced homework or remedial tuition, and positively reinforcing attendance. With established longer term school refusal, referral to a multidisciplinary mental health team may be required.