School Refusal in Teenagers: A Parent’s Guide to Understanding and Overcoming

High school is a time for social, emotional, and academic learning. For many young people, it’s also a chance to discover more about themselves, including their passions, values, and future goals. So what does it mean if your teen doesn’t want to attend school, and how can you help? 

When a young person refuses to go to school, it can be a sign of school refusal. School refusal in teenagers may be associated with anxiety, social struggles, and other challenges.

Without appropriate support and treatment, as many as half of teens with school refusal are at risk of not graduating from high school. 

While this is understandably concerning for parents, remember that there’s a reason why your teen is behaving this way. Learning more about the causes and symptoms of school refusal can help you connect your child with the right resources and support. 

What is school refusal in teenagers?

School refusal is when a child or teenager refuses to attend or stay in school. Also known as school avoidance and school phobia, it can be a way to cope with stress or other challenging situations. 

Research suggests that teens with school refusal behaviors have higher levels of anxiety and depression than teens without school refusal. It can also lead to concerns later in life, such as unemployment, lower income, marital problems, and reduced mental well-being.

According to the American Family Physician, approximately 5% of children experience school refusal. It can happen at any age, but it may be more likely to affect children who are going through a transition, such as entering middle school or high school.

School avoidance vs truancy

It's important to recognize that school refusal is not the same as truancy. With school refusal, parents are typically aware that their child is staying home to avoid the emotional distress of school. But with truancy, teens will skip school without a valid reason or telling their parents.

Teens with school refusal often stay home during school hours and even complete their assignments to avoid falling behind. Teens with truancy typically display a lack of interest in their schoolwork and are more likely to engage in antisocial behaviors like lying and stealing. 

Signs and symptoms to watch for 

Teens with school phobia will actively try to avoid going to school. They may plead with their parents to stay home or refuse to leave the house in the morning. Even when they do attend, they may hide out in the nurse’s office or leave before the school day ends. 

School refusal is associated with a range of physical, emotional, and behavioral symptoms. 

Physical symptoms

• Dizziness 
• Nausea and stomach aches
• Vomiting 
• Rapid heart rate

Emotional symptoms

• Anxiety
• Depression
• Panic attacks
• Suicidal thoughts

Behavioral symptoms

• Frequently asking to stay home from school
• Missing school on days with tests or presentations to the class 
• Drop in grades or performance at school 
• Avoiding school events, like games and dances

Underlying causes and risk factors

Understanding the root cause of school refusal is key to connecting your child with the right resources and support. Here are some psychological and environmental risk factors. 

Mental health challenges

School refusal is associated with multiple mental health conditions, including:

• Generalized anxiety disorder (GAD)
• Social anxiety disorder (SAD)
• Specific phobias
• Major depressive disorder (MDD)
• Oppositional defiant disorder (ODD)
• Post-traumatic stress disorder (PTSD)

Teens with neurodivergent disorders, like autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), may also experience school avoidance.

School-related triggers

Some teens may avoid going to school because of school-related stresses, like bullying and academic pressure. According to government data, nearly 20% of students aged 12-18 years report being bullied during school. 

School refusal can also be a way to cope with stressful situations, such as taking exams, giving presentations, or figuring out who to sit with in the cafeteria. 

Family and environmental factors

There are several other risk factors for school refusal in children and teens. These include:

• Conflict at home
• Having parents who are separated or divorced
• Having a parent with mental health challenges
• Changing schools or moving homes 
• Adverse childhood experiences, like child abuse or neglect

Action plan for parents dealing with school refusal 

Parents play an important role in helping their child understand what’s driving their school refusal and how to cope with it.

Here are six tips to help you approach the situation with patience, empathy, and compassion. 

1. Speak up

It’s normal for teens to occasionally complain about school. But if your child has been avoiding school on a regular basis, don’t hesitate to speak up to them about it. The sooner you address signs of school refusal, the sooner you can connect them with the support they need. 

2. Investigate triggers 

Teens who avoid going to school usually have a valid reason for their behavior. For example, it may be a symptom of an anxiety disorder, bullying, or social struggles.

If they find it difficult to open up, consider asking questions like “What part of the day feels the hardest?” or “Can you explain why the idea of going to school is so upsetting to you?”

3. Validate their feelings

School refusal can be extremely distressing for teens, and that’s not something to be taken lightly. Validate their experience by letting them know they’re seen and supported. For example, you might use phrases like “I can see this feels really hard for you right now. How can I help?” 

4. Communicate with school staff

Missing school can affect your child’s grades and might even prevent them from graduating on time. If you’re concerned about your child’s academic performance, consider looping in their teachers and guidance counselor. 

5. Be mindful of your emotions

Parents who have difficulty regulating their emotions may struggle to effectively support a child with school refusal. It’s normal to feel upset when your child is struggling, but try to remain calm and grounded. 

6. Seek mental health support for your teen

If the idea of going to school causes your teen intense emotional distress, it may be time to seek professional advice. A therapist can assess what’s driving these behaviors and work with your child to find a solution. 

Assessment, treatment, and intervention strategies

If your child has been avoiding school for weeks or months, consider seeking professional support. Although school refusal is not a diagnosable mental health condition, it can be a symptom of anxiety and mood disorders in teens.

You can start by contacting your child’s pediatrician or school psychologist. Depending on their assessment, they might suggest meeting with additional mental health professionals for a more comprehensive evaluation to identify what’s causing your teen’s school refusal and how to help them cope.  

When treating school refusal, the goal is to help your child return to school without the emotional distress. Treatment will vary by person but may include some combination of therapy, medication management, and collaborative interventions.

Therapy

Therapy can help your child manage distressing symptoms like panic attacks, social withdrawal, and suicidal thoughts and behaviors. There are several types of therapy used to treat school refusal.

• Cognitive behavioral therapy (CBT): CBT helps teens identify the negative thought patterns associated with school refusal, then replace them with more empowering alternatives.
• Exposure-response therapy (ERP): With ERP, your child will learn to gradually confront their fears so they can feel more confident returning to school. 
• Dialectical behavior therapy (DBT): DBT can provide teens with the skills to manage intense emotions, like anger or shame. It can help your child tolerate uncomfortable situations without having a meltdown or skipping class.
• Family therapy: Family therapy is an opportunity for you and your teenager to learn how to improve communication, manage conflict, and create healthy behavior change.

Medication 

When school refusal is linked to underlying anxiety or depression, it may be worth exploring medication management. The exact medication and dosage depend on your child and their symptoms, so it’s best to discuss with their healthcare provider.

Interventions with your child's school

There are several ways that you can collaborate with your child's school to help them feel more comfortable returning to their classes. This might include having a peer buddy or a more flexible attendance plan. Your child might also qualify for an individual education plan, like an Individual Education Program (IEP) or 504 Accommodation Plan.

How to help once your teen returns to school

School phobia is a real challenge, so give your child some credit for deciding to return to school. Here are a few tips to make the process more manageable for you and your child.

Start small

You may find that it’s best to have your child ease into attending school again. For example, they can start by visiting their teacher after school. From there, they can attend school for a few half days before resuming full-time classes.

Encourage consistency

Help your teen keep the morning routine simple, such as eating breakfast, getting ready, and heading to school. Encouraging them to pack their lunch and choose their outfit the night before can also make the mornings more manageable and consistent.  

Promote self-care

Remind your teen to make time for activities that help them feel good. This might mean drawing, listening to music, or cooking dinner as a family.

Limit screen time

Teens with too much screen time may be more likely to experience adverse health concerns. This includes irregular sleep habits and symptoms of anxiety and depression. 

Model healthy coping skills

Healing can take time, so continue to show your teen healthy ways to cope with stressful situations. This can include exercises like deep breathing and positive self-talk.

Stay in touch with school

In addition to monitoring your teen’s attendance, remember to stay in touch with school staff. They can offer insight into how your teen is doing at school and provide additional resources and support. They might also make accommodations, like accepting written assignments versus oral presentations. 

How Emora Health can help with a school refusal teenager

School refusal is often a symptom of an underlying challenge, such as anxiety or experiencing bullying. When left untreated, it can affect a teenager’s academic performance, social relationships, and overall well-being. Recognizing signs of school avoidance is an important step in getting professional help.

Emora Health connects children and teens with licensed behavioral experts who specialize in depression, school anxiety, and navigating transitions. Our network of providers includes therapists, psychologists, and psychiatric clinicians who are trained in evidence-based treatments like CBT and DBT.

Learn more about Emora Health and get started on your healing journey today.