Sept. 12, 2024 – Stephanie Edenburgh’s daughter was developing health problems – or so she first thought.
It started with her child complaining each morning of what Edenburgh described as “vague ailments,” like stomachaches and headaches. But she soon noticed that these symptoms only seemed to appear on school days. Edenburgh’s daughter was 11 at the time, and was transitioning from elementary to middle school.
“I also saw a sudden drop in enthusiasm for things my child used to love, like interacting with friends or going on school trips, said Edenburgh, who lives in San Diego. She quickly realized her child was actively trying to avoid going to school.
Scolionophobia, or fear of school, affects about 1 in 20 children at different points of childhood, according to the Cleveland Clinic. The condition, which is also referred to as school avoidance or school refusal, often happens at times of stressful change, such as when a child enters first grade, middle school, or high school.
Difficult experiences or mental health conditions can also contribute to school avoidance.
“If a child struggles to stay in school, either by not showing up or by not staying through the day, this could be related to anxiety, depression, OCD, or bullying,” said Jacqueline Sperling, PhD, director of the Anxiety Mastery Program at McLean Hospital in Cambridge, MA, and an assistant professor of psychology in the Department of Psychiatry at Harvard Medical School.
In younger children, dependency on a parent may make going to school frightening. “Anxiety-based school absenteeism in younger kids may be related to separation anxiety from caregivers,” says Christopher Kearney, PhD, chair of psychology at the University of Nevada, Las Vegas, and a clinical child psychologist who studies school absenteeism.
A recent study from Spanish and Italian researchers found that the COVID-19 pandemic has increased adolescents’ school anxiety due to stress, academic struggles, and lack of social interaction. Like the pandemic, other circumstances beyond a child’s control may spur scolionophobia.
“Oftentimes, school avoidance starts with a triggering event that serves as a last straw,” said Felicia Wolf, PsyD, a staff psychologist at the Menninger Clinic in Houston and an assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine. Causes can include the stress of returning to school after a prolonged illness, living in an unsafe neighborhood, or having a learning disability. School avoidance can also start after the death of a loved one, or if a child has to change schools, or even has a change of teacher, she said.
The Impact of School Avoidance
The results can be very serious. Canadian researchers found that in the short term, a child who refuses to go to school can have social isolation, lower academic performance, and may even be at risk of suicide, depending on the root of the issue. In the long term, children who avoid school are more likely to drop out and are more likely to develop major depression.
The sooner the problem is addressed, the better the outcome.
“You don’t want to reinforce the behavior,” Wolf said. “Don’t let your child avoid school – avoidance will increase anxiety.”
Signs of School Avoidance
Signs a child trying to avoid school can include:
- Complaints of feeling sick before school in the morning. The child may say they have stomach pain, a headache, nausea, diarrhea, fatigue, and dizziness. These symptoms may or may not be real and may disappear once the child is allowed to stay home.
- Panic
- Crying
- Screaming
- Threats of self-harm
- Physically refusing to go to school (lying on the ground, for example)
Signs of avoidance often begin after a break from school. “You may find that after a vacation or long weekend, your child suddenly starts begging not to go to school, or plants their feet and refuses to walk out the door, or hides in their bedroom,” Wolf said.
The problem can also result in behavior changes while the child is at school, like their grades dropping. But clues about school avoidance can also be more subtle, like eating lunch in the school bathroom rather than with their peers in the cafeteria. Teachers may also notice that the child is withdrawn, Kearney said.
Is Bullying Related to School Avoidance?
In short, it can be a significant factor. A new study review found that verbal bullying and cyberbullying by a child’s peers creates social anxiety. Children who are bullied are more likely to go through school refusal than other children.
“If bullying is the problem, you want to be your child’s advocate,” said Sperling. “You can talk with the school staff about keeping an eye on your child with other children who may be bullying them. This way, your child will not look like a tattletale, but an adult can still flag bullying behavior. Your child’s teachers can also make sure not to pair your child with another child who may be bullying them on school projects.”
A parent may discover that their child needs to develop new relationships as well. Friendships among children can change as a new school year begins, for example. “Keep in mind that your child’s bully may have once been their best friend,” said Sperling. If this is the case, a parent can encourage a child to get excited about trying new things to bond with new peers. “Help your child increase their social capital by encouraging them to participate in school activities they like,” said Wolf.
How Should Parents Respond to School Avoidance?
Start with a gentle approach. “A parent can say, ‘I notice that it’s been harder for you to get out of bed,’” said Sperling. “‘I want to know why, so I can support you.’ This is how you can learn why your child’s anxiety level is going up. Ask open-ended questions so a child can explain as fully as possible what they are dealing with.”
Edenburgh found this strategy to be helpful. “I didn’t want to come off as confrontational, so I just started by saying, ‘I’ve noticed you seem upset about going to school. Can you tell me why?’” she said. “I tried to be as non-judgmental as possible, because I wanted my child to feel safe talking to me. It turned out that my child was anxious about some social dynamics and academic pressure.”
If a child won’t open up, or flat-out won’t go to school, it’s important to remain compassionate, but to set boundaries.
“If a child ends up staying home, one solution can be to make the home environment less comfortable,” said Sperling. “The child shouldn’t be allowed to watch Netflix all day. Instead, they should sit at the kitchen table and do schoolwork the same way they would in class, with a set lunch break and bathroom breaks the same way they would have them in school. This can be a lot less fun than learning among other kids and may help solve the problem.”
When Is Professional Help Needed?
Wolf said if the symptoms last more than a week, it might be worth seeking more help.
“Start with your child’s pediatrician to rule out any medical conditions. The pediatrician can also talk to your child and make a referral to a therapist if necessary.”
Edenburgh also sought professional help for her child. “We were given practical tools to manage the anxiety,” she said.
A new study found that children with school avoidance can greatly benefit from problem-solving and skill set training, a fresh treatment strategy that gives a child a sense of control and confidence. Talk therapy, exposure therapy, and medication can also make a difference.
Also, know that school staff is experienced in helping with issues like school avoidance. Involve your child’s teachers and guidance counselor.
“One thing that really helps a child is increasing predictability,” said Wolf. “Find out your child’s schedule from the school staff so they know what to expect during the day.”
A parent can also encourage their child without unreasonable expectations. Avoid pressure about getting perfect grades – reducing stress can lower anxiety, raise a child’s self-esteem, and help them look forward to school again.
“My child and I developed a routine together that included relaxation time before and after school, and I encouraged participation in activities they enjoyed,” Edenburgh said. “I found that these changes helped build their confidence and reduce their anxiety. I’ve seen a big improvement, and now my child is more comfortable with school. It’s a work in progress, but I feel like we’re on the right path.”
