School Refusal

Excerpt

School refusal is not a Diagnostic and Statistical Manual of Mental Disorders (DSM–5) diagnosis. It is described as a symptom that can be associated with several other diagnoses, for example, social anxiety disorder, generalized anxiety disorder, specific phobia, major depression, oppositional defiant disorder, post-traumatic stress disorder, adjustment disorder, among others. School refusal describes the disorder of a child who refuses to go to school on a regular basis or has problems staying in school. Children may avoid school to cope with stress or fear for a vast number of reasons. Management options include cognitive behavior therapy, educational-support therapy, pharmacotherapy, and parent-teacher interventions. Providers may also consider psychoeducational support for the child and parents. Monitoring medications, referral for a consultation to more intensive psychotherapy are important as well.

School refusal is a challenge for children, families, and school personnel. Failing to attend school has significant short and long-term effects on children's social, emotional, and educational development. It is important to identify problems early and provide interventions to prevent further difficulties. A collaborative approach is required for the assessment and management of school refusal which includes the provider, parents, school staff, and other mental health professionals. Many children often present with physical symptoms, evaluation by a physician is important to rule out any underlying medical problems. Children with school refusal are often scared to go to school, scared enough that they will not leave the house.