School avoidance occurs in about 5% of all school-aged children and affects girls and boys equally. It usually occurs between the ages of 5 and 11.
The cause of school avoidance is often unclear, but psychologic factors (eg, anxiety, depression) and social factors (eg, having no friends, feeling rejected by peers, being bullied) may contribute. If school avoidance behaviors escalate to the point at which a child is missing a lot of school, the behaviors may be an indication of more serious problems such as a childhood depressive disorder or one or more of the anxiety disorders, particularly social anxiety disorder, separation anxiety disorder, and/or panic disorder. A differentiating factor is that children with school avoidance manifest difficulties only in relation to school, whereas with other disorders, children also have symptoms that involve other areas of their life. A sensitive child may be overreacting with fear to a teacher's strictness or rebukes. Changes in classroom staffing or curriculum can precipitate school resistance in children with special education needs.
Younger children tend to manifest somatic complaints (eg, stomachache, nausea) or make excuses to avoid school. Some children directly refuse to go to school. Alternatively, children may go to school without difficulty but become anxious or develop physical symptoms during the school day, often going regularly to the nurse’s office. This behavior is unlike that of adolescents, who may decide not to attend school (truancy—see School Problems in Adolescents); chronic truancy is often present in children with a conduct disorder.
In the absence of a significant underlying disorder, school avoidance tends to result from
Poor academic performance
Family difficulties
Difficulties with peers
Most children recover from school avoidance, although some develop it again after a real illness or a vacation.
Home tutoring generally is not a solution. Children with school avoidance should return to school immediately so that they do not fall behind in their schoolwork. If school avoidance is so intense that it interferes with the child's activity and if the child does not respond to simple reassurance by parents or teachers, referral to a mental health practitioner may be warranted.
Treatment of school avoidance should include communication between parents and school personnel, regular attendance at school with in-school counseling (if available), and sometimes therapy involving the family and child with a psychologist. Therapy includes treatment of underlying disorders, adaptation of the school curriculum for children who have learning disability or other special education needs, and behavioral techniques to cope with the stresses at school.
(See also Overview of Behavioral Problems in Children.)
