School Phobia: A Complete Guide

Learn about school phobia in children: its causes, symptoms, and treatments

June 1, 2024

There’s little doubt about how important school is to a child’s development. Children with good educational backgrounds have more career opportunities available for them in the future.

However, some children experience intense fear when it comes to attending school. This phenomenon is known as school phobia or school refusal. It’s the responsibility of caregivers, educators, and physicians to come together and develop strategies to combat school phobia.

Keep Reading To Learn

  • How to recognize the signs of school phobia
  • The difference between school avoidance and other conditions
  • How you can help your child overcome school phobia

What Is School Phobia?

School phobia occurs when a student experiences distress about going to school. It is a type of situational anxiety that appears in children between the ages of 5 and 17.

Situational anxiety is a psychological response that occurs in stressful or unfamiliar settings. School refusal is not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Instead, the issue is considered a symptom associated with other mental health disorders, including:

  • Social anxiety disorder
  • Generalized anxiety
  • Depression
  • Oppositional defiant disorder
  • Post-traumatic stress disorder

School phobia can occur in different situations. The situation in question typically dictates the severity of the phobia.

For instance, it’s normal for young children to feel anxious about going to school for the first time. In the majority of cases, children feel scared about leaving their parents and experience some age-appropriate separation anxiety.

Going to school for the first time is also a new experience, and children can feel uncertain about what to expect. In many cases, children recover quickly from their fears and eventually feel confident heading into school.

If reluctance doesn’t resolve independently, children may feel significant distress each time they leave their parents. They may even enjoy school but still not want to be separated from their caregivers for an extended period. Age and maturity typically determine how long the reluctance to attend school will last.

In older children, school avoidance tends to come from fear of something negative happening to them while attending school. The fear could stem from an ongoing bullying situation, news of a school shooting, or could be related to grades and academic responsibilities.

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How Common Is School Phobia?

According to the American Family Physician, school refusal occurs in approximately 5% of all school-age children. Children affected by this issue may end up chronically absent from school and fall behind on assignments and tests.

School refusal can occur at any age, but children in certain age groups are more likely to resist going to school. For instance, children aged 5 to 6 starting school for the first time have higher rates of school reluctance.

Pre-teens often tend to have a higher susceptibility to school avoidance as well. School phobia in this age group is often due to concerns about fitting in. Students in this age group may find interests away from school (such as video games) more appealing than the pressures of school.

School refusal occurs equally among boys and girls. However, sexuality can affect school phobia and chronic absenteeism. A study published in the Journal of School Psychology found that students who identify as LGBTQ+ reported more unexcused absences than their heterosexual classmates.

School refusal can lead to multiple absences during the academic year. In severe cases, students may miss weeks or months due to their fears. Often, when a child misses school for an extended period, they’ll feel more reluctant to return.

Causes of School Phobia

Various factors can trigger school avoidance. Most children with the condition have an underlying issue behind their fear of going to school. Although each child is different, some of the most common causes of school refusal include the following.

Distress in School Settings

Children may feel stressed by certain situations while in a school setting. They may report feeling bad at school and can’t clearly identify what’s bothering them.

Young children may not like how other classmates interact with them or feel stressed by a teacher who raises their voice in the classroom. They may also be reluctant due to issues with transitions. For example, the child may feel stressed when traveling from the bus to school or changing classes.

Separation Anxiety

Some children experience intense separation anxiety. The strength of their feelings can make it hard to leave home every morning and attend school.

Children with separation anxiety find it challenging to be away from their parents for extended periods of time. They may even fear something terrible may happen to their caregivers when they are away from home. Some children naturally outgrow separation anxiety the longer they attend school.

Stressful Life Events

Any external stress could affect whether a child wants to go to school or not.

For instance, children can experience stress when starting at a new school after a family move. Also, children may act out and stop going to school when there’s violence at home or if parents are going through a divorce.

Fear of Something Bad Happening

Although children should feel protected at school, that’s not always the case. Kids may fear that something negative may happen to them on school grounds. Fear can stem from a previous incident, such as bullying or threats made by peers.

Fears related to academic performance can spark school phobia. Children may worry about getting bad grades or failing an upcoming test. Students may have an aversion to public speaking and wish to refrain from giving presentations in front of the class.

Children may also worry about their safety at school. Over 300,000 children have been exposed to gun-based violence while at school. After news about a mass shooting at a school, it’s not unusual for children to feel fear about returning.

Traumatic Experiences

Children who have experienced traumatic events, such as abuse, bullying, injuries, or a school shooting, may develop school phobia if any of these incidents occur on school grounds.

Due to such trauma, children may have a negative association with the environment and wish to avoid going. Children may also not want to go to school if they don’t feel protected by staff members.

For instance, if a child is physically assaulted on school grounds and the administration doesn’t adequately punish the offender, the student may feel like the school isn’t safe.

If a student isn’t feeling secure, the school needs to be notified. Staff and caregivers must collaborate to ensure a child feels protected while in school.

Symptoms of School Phobia

The symptoms of school phobia can vary depending on the individual child. Any underlying factors will also impact symptom severity. The most common sign of school avoidance is when children express their reluctance to attend school. However, caregivers may also notice the following symptoms.

Physical Symptoms

Children with school phobia may complain of physical symptoms, especially before the school day begins. Symptoms can include stomach pain, headache, nausea, diarrhea, fatigue, and dizziness.

The physical complaints may be real or exaggerated by the child. Since the child is “sick,” caregivers may feel obligated to allow the student to miss school. If the child is permitted to stay home, the symptoms may subside.

Emotional Symptoms

Children with school phobia often experience intense feelings over school. Students may demonstrate signs of anxiety, depression, or panic. The stress of school may lead to acting out and bouts of crying or screaming. Children may throw tantrums and make threats of self-harm.

Avoidance Behaviors

Children with chronic absenteeism will actively try to avoid going to school. They may express willful behaviors to escape attending school since it causes them anxiety.

They may flat-out refuse to leave the house or fall to the ground in protest. Despite such behavior, if children do end up at school, they may ask to go to the nurse often to get out of class.

Children with school phobia may not always experience the same intensity of feelings. For example, symptoms may worsen if they are stressed about an upcoming test.

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Disorders Related to School Phobia

School refusal is often associated with other mental health conditions, with underlying issues affecting how a child deals with attending school. Children may experience a combination of disorders that impact their treatment plan. During mental health assessments, professionals can determine a diagnosis for the child.

The following mental health disorders are frequently associated with school refusal.

Separation Anxiety

Separation anxiety disorder is characterized by excessive anxiety or fear when children face separation from attachment figures. The most common attachment figures are parents and grandparents.

When the time of separation is about to occur, such as the start of the school day, the child may respond by crying, yelling, or begging to stay with the attachment figure.

Social Anxiety

Social anxiety disorder involves a fear of social situations. Children with this condition may fear being called upon in class or having to interact with peers in the lunchroom or on the playground. They may shy away from activities that require them to work alongside classmates, such as group projects.

People with social anxiety disorder feel stress over any performance activity, such as giving a speech to a class or presenting a science fair project. They may have an underlying fear of embarrassment or failing to meet expectations.

Read more about anxiety in kids

Specific Phobia

Specific phobia is an intense and irrational fear of a particular object or situation. For example, a person may have a phobia of being in crowded rooms or using public restrooms.

For school phobia, the child may have a phobia of any school-related stimuli, such as taking a test or having to stand in a single file line. Phobias may initiate the child’s fight or flight response.

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Depression

Depression symptoms often include persistent feelings of sadness, loss of interest in activities, poor eating habits, and changes in sleep patterns. A child with depression may appear unmotivated to complete schoolwork and may complain of frequent tiredness.

Depression symptoms do not typically subside when a child stays home from school. Symptoms may worsen as children miss more days of school.

Read more about depression

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) can appear in children who have experienced trauma. PTSD symptoms can occur as flashbacks of the event, difficulty sleeping, and having nightmares.

If the trauma happened at school, being on the grounds can act as a trigger for the student. For instance, the child may have PTSD due to being assaulted at school or from a traumatic event like a school shooting.

Read more about trauma disorders and PTSD

Additional Health Conditions

Children with school phobia can have additional psychiatric conditions that affect their ability to attend school willingly. Persistent depressive disorder, oppositional defiant disorder, and adjustment disorder have also been found in children with chronic absenteeism. Students with these conditions may find it challenging to participate in school on a regular basis.

Children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) can also struggle with school avoidance. Children with ASD may struggle with sensory issues while in school and find the change in routine demanding.

Students with ADHD may have problems focusing on work, managing tasks, and regulating emotions. Managing these underlying conditions may help alleviate school refusal.

Girl looks down with arms crossed

Identifying School Phobia in Children and Teens

Assessing school phobia requires a professional evaluation. The assessment should involve collaboration among caregivers, teachers, and mental health professionals. Caregivers and teachers should not ignore chronic absenteeism.

According to the American Academy of Family Physicians, students who miss more than 5% of school days are at risk for academic and social issues.

By missing school often, grades are likely to drop, and the child may need extra help understanding the material covered during class time. Kids who miss a lot of school can also struggle with friendships.

To identify school avoidance and take action, caregivers, educators, and professionals will likely engage in a plan that includes the following steps.

Review of Medical and School Records

A thorough review of medical records should occur before any other assessments are made. Health records can help rule out any medical conditions contributing to chronic absenteeism.

For instance, children with learning disabilities may feel stress about school because of their inability to focus and complete their assignments.

A review of school records can show patterns in a child’s academic history. For instance, the child may miss a lot of school around the period when standardized testing is typically done.

Observation and Interviews

Observing a child’s behavior in school will add valuable insights into the reasons behind their phobia. Professionals can watch the child and monitor interactions with peers and staff. Such observations may help identify any potential triggers at school.

Mental health professionals should interview the child, parents, and teachers. During these interviews, professionals aim to find out the stressors contributing to school avoidance.

Questionnaires and Assessments

Questionnaires and standardized assessments can be helpful tools for gathering information about the child’s mental state. They may reveal if a child has expressed any feelings about school.

The assessments may use a numbered scale to assess a child’s emotions. The parents, child, and teacher often fill out the questionnaires. Sample questions may include:

  • How frequently do you stay home from school because talking to other kids is hard?
  • How often would you rather be home with your parents than at school?
  • How much would you rather be taught by your parents than go to school?

Collaboration With School Staff

Collaboration between school staff, including teachers, counselors, and administrators, can lead to a better understanding of the current school environment.

Staff may know firsthand any challenges the child may face during the school day. Teachers witness social interactions and may have noticed issues with peers. Educators can also give feedback on academic performance. A student’s struggles in a particular class may cause school reluctance.

How Is School Refusal Different From Truancy?

One key thing to remember is that school avoidance is different from truancy. Truancy refers to deliberately skipping school. Truancy has often been linked to antisocial behaviors. However, it’s easier to confirm the reasons behind frequent absences if they are evaluated by a professional.

Students with school phobia tend to have serious emotional distress about going to school. They don’t attempt to conceal their emotions and instead try to convince their parents to allow them to miss school. They usually stay home for the day if they don’t attend school.

In comparison, some students deliberately skip school and won’t show signs of anxiety and stress about attending. In these cases, students don’t usually let parents know about plans to skip school.

Instead, they pretend to attend. In order to avoid detection, they will likely not stay home during the school day. Their avoidance doesn’t stem from a phobia.

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Tips for Parents

Supporting children with school phobia will always require a team effort between school staff, caregivers, and mental health professionals. The following suggestions can help parents encourage their children to overcome school refusal.

Get Involved Immediately

Although you may assume a child’s unwillingness to attend school is a phase, don’t ignore the problem. Early intervention will help prevent school avoidance from getting more serious.

Identify Any Underlying Issues

Listen to your child and encourage them to talk about their specific concerns about attending school. Do they complain about a particular teacher? Did they recently lose a friend?

Attempt to identify any triggers that could cause them to feel anxious during the school day. Remember to share this information with your child’s doctors.

Validate Your Child’s Experiences

It’s important to validate your child without trying to minimize the challenge. When listening to your child, convey that you understand their anxiety while emphasizing the importance of working through it.

For example, you can say, “I hear how hard it is for you to give a presentation in front of the class. I know it’s scary, but I also know you’ll be able to do it.”

Communicate and Collaborate With School Staff

If you notice your child is anxious about going to school, contact the school’s guidance counselor and your child’s teacher. Share your concerns and ask for support.

The staff may suggest ways to make school less stressful for your child. Advocate for your child if you believe any mistreatment during school is the cause of their refusal to attend.

Be Firm About School Attendance

Although it can be difficult to witness your child’s distress, you must emphasize the importance of attending school.

Remember to validate your child’s feelings and tell them you understand why they’re nervous or scared. Explain that you will help them face their fears and that you will always listen to their feelings.

Help Your Child Find Meaningful Aspects of School

Is there a subject they find enjoyable? A particular teacher they connect with? Do they have a friend they could join on a sports team? It can be helpful for your child to find one aspect of school to look forward to.

Make Staying Home Dull

If your child has school phobia, you don’t want to make time at home fun. The child may look forward to lounging in bed or having extended screen time.

Instead, limit screen time and create a schedule for the day. You may even reach out to the school to ask for any assignments your child is missing and request they finish the assignments during the day.

Seek Professional Help if Needed

If your child’s school avoidance persists or symptoms affect their daily routine, you should make an appointment with your pediatrician. Explain the situation to the pediatrician and request a referral to a mental health professional specializing in school refusal.

Tips for Educators

In collaboration with caregivers and mental health professionals, educators also play an important role in supporting kids with school phobia. The following suggestions can provide educators with tips to help children overcome school refusal.

Recognize the Signs of School Avoidance

Teachers should pay close attention to any children who are frequently absent from school. Teachers may also notice recurrent requests to go to the nurse.

Children may complain of physical symptoms, such as stomach pain and headaches. If a teacher notices avoidance behavior, the first step is to reach out to parents to determine if the student is experiencing school phobia.

Create a Supportive Classroom Environment

Openly communicate with the child and try to alleviate fears about going to school. Give age-appropriate resources to help them overcome their fears.

Collaborate With Parents

Work closely with caregivers to understand their child’s specific challenges. You can recommend strategies to support a child’s return to school. Keep the caregivers updated on the child’s academic progress and classroom behaviors.

Implement Accommodations

Teachers and school personnel may need to put accommodations in place to help support any students struggling with school avoidance. For instance, the child may require extended time on assignments or flexible class scheduling.

The school should also permit the child access to any counseling resources available.

The school nurse should also receive guidance on how to help a child with school phobia. The child may feel ill due to anxiety about school, and the nurse should know what to do if the situation arises.

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How Is School Phobia Treated?

Effective treatment for school phobia involves a comprehensive approach, aiming to address the underlying cause of chronic absenteeism.

The plan should also give support to all involved, including parents and caregivers. Although a treatment plan for the child is essential, parents often need therapy as well.

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is a highly effective treatment approach for school phobia. The goal of CBT is for people to challenge negative thought patterns and find coping strategies when faced with stressful situations.

Therapists will ask children to talk about their fears associated with school and will come up with exercises to reduce stress levels.

CBT for school refusal also commonly uses exposure therapy techniques. This form of treatment allows mental health professionals to gradually expose patients to their fears in a controlled setting.

The therapist will start by exposing the student to less stressful school-related situations. Gradually, the student may face more challenging school situations with a therapist’s help.

Educational-Support Therapy

Educational-support therapy is a type of treatment that combines informational presentations and psychotherapy sessions to help children overcome their fears about attending school.

With this approach, professionals provide information to parents and caregivers to help them learn more about the importance of school attendance. Students and caregivers also learn about coping strategies for stressful situations.

Children are encouraged to freely discuss their fears and feelings about attending school. For this type of treatment, professionals don’t practice exposure therapy techniques—the goal is to provide support and information to children and caregivers.

However, for some children, treatment without any exposure therapy can make it challenging for them to complete the return to school.

Medications

Depending on the age and diagnosis of the student, psychiatrists may recommend medication along with talk therapy. Medications can help address underlying disorders, such as anxiety and depression.

Selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication used for students who are refusing to attend school. SSRIs, like sertraline, are intended to help reduce anxiety symptoms. When prescribing medication, providers start patients on an introductory dose and eventually increase it to a therapeutic level.

Benzodiazepines may be used in conjunction with SSRIs to address school refusal, but these types of medications are typically only given on a short-term basis.

Parent and Teacher Interventions

Getting parents on board is crucial to successfully treating school phobia. Although parental involvement is vital for all ages, it’s especially needed to address school refusal for children in elementary school. Parents should attend and participate in all therapy sessions with their children.

During therapy, parents are likely to receive behavior management tools. For instance, therapists may ask caregivers to focus on positive reinforcement for school attendance. Parents can undermine progress if they unknowingly provide positive reinforcement when a child stays home from school.

Parents may get recommended individual therapy sessions to help reduce their own anxieties. During the sessions, they can start understanding how to support their child as their child returns to school.

Caregivers should inform the child’s teachers about the child’s school phobia as well as any treatment the child receives to address the issue. The school may also provide resources to help the child, such as counseling sessions. The school has a responsibility to provide a supportive environment to help the child feel comfortable and safe.

Help Your Child Feel More Like a Kid

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Whatever mental health difficulties your child may be dealing with, McLean is here to help. Contact us today at 617.855.2820 to learn more about treatment options for children, teens, and young adults.

Girl on tire swing laughing

With Help, There Is Hope

The bottom line is that addressing school phobia requires a collaborative effort involving parents, educators, and mental health professionals. By working together, a plan of action can help the child avoid unnecessary absences.

School refusal is complex and requires a multifaceted treatment approach. A child’s refusal to attend school may not get resolved overnight. Instead, it may take time to alleviate a child’s fears and anxieties about school.

Early intervention is important. Professionals can devise an individualized plan with appropriate interventions. Fortunately, the prognosis for school avoidance is good. Many cases of school phobia resolve with age and without any lasting detrimental effects.

Want More Info?

Looking for even more information about school phobia? You may find these resources helpful.

Interesting Articles and Videos and More

Learn more about youth mental health and what you can do if your child is displaying signs of school avoidance.

Helpful Links

These organizations may also have useful information:

Anxiety and Depression Association of America
ADAA is dedicated to increasing awareness and improving the diagnosis and treatment of anxiety disorders in children and adults.

American Academy of Child and Adolescent Psychiatry
This organization works to promote the healthy development of children, adolescents, and families through advocacy, education, and research, and provides professional support and resources to child and adolescent psychiatrists throughout their careers.

Parent/Professional Advocacy League
A statewide, grassroots family organization in Massachusetts dedicated to improving the mental health and well-being of children, teens, and families through education, outreach, support, advocacy, and partnership. They aim to support families, nurture parent leaders, work for systems change, and improve access to mental health services for children and families.

The Child Anxiety Network
This organization aims to provide thorough, user-friendly information about child anxiety. They also offer direction for those who are not sure where to turn when they think their child or a child they know may need professional help to cope with anxiety.