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Back to school time can be a period fraught with mixed emotions.

For some kids, a new school year, a new classroom, a new teacher and even new classmates can be a source of excitement for weeks leading up to the first day of school. For other children, however, back to school time isn’t so easy.

Although a bit of trepidation and nerves about school can be completely normal, for some children, their anxiety surrounding attendance at school can be so bad they can’t attend at all. These children have school refusal.

Every school year it is estimated that two to five per cent of children refuse to come to school due to school refusal. This can be anything from mild cases, like a kindergarten student who misses school due to separation anxiety, to more severe cases that can see students go months or even years without stepping into a school building.

School refusal can manifest in many different ways and in some cases, can even impact children who manage to make it into the school building.

“It can be the kid who won’t get out of bed in the morning, barricades himself in the bathroom and refuses to leave the front door or it could include people who have made it into the building but who spend all or part of the day avoiding the classroom,” Dr. Jonathan Dalton, a licensed psychologist and the Director of the Center for Anxiety and Behavioral Change in Rockville, Maryland, told Theravive.

“Most kids don’t celebrate Monday morning, they would much rather continue the weekend and have a good time but that’s more a preference based reaction  whereas with school refusal and school avoidance, it’s anxiety based avoidance in the majority of cases. It’s kids who would otherwise likely want to be at school but the fear of something about school is making it difficult for them to attend school,” he said.

According to the Anxiety and Depression Association of America, a child with school refusal will either have problems staying in school, or refuse to go to school on a regular basis.

Children who experience school refusal can experience physical symptoms like diarrhea, head aches, stomach aches, dizziness, or feel very tired. These physical symptoms may occur in the period immediately before it is time to go to school. Often, if the child is allowed to stay home the physical symptoms will disappear, only to reoccur the following morning when it is once again time to go to school.  

For other children who make it into the school building, tell tales signs of school refusal may be regular trips to the school nurse’s office, or regular requests to phone home.

As well as the physical symptoms, some children will experience a change in mood with tantrums, separation anxiety, avoidance, defiance and inflexibility all being potential signs of the disorder.

“Classically, when school refusal begins it happens in one of two ways. One is the kid is feeling great and all of a sudden something happens at school; a panic attack or a bullying incident and they just refuse to go the next day. So there’s a very clear line when they stopped going to school. More often it’s an insidious onset so kids begin to miss an increasing numbers of days,” Dalton said.

“When you’re starting to see an escalated number of days absent from school, that’s a big warning sign,” he said.

Although the trigger for school refusal is different for every person, the disorder has been found to be more common at the beginning or end of the school year, after vacations and after weekends. Significant life events like the death of a family member, moving schools, a long period of illness, or transitioning from elementary to middle school can all be factors in the development of school refusal.

For some children, the condition can last for an extended period of time.

“We see kids all the time who haven’t stepped foot in a school building in three years, it can be a long standing entrenched behaviour,” Dalton said.

And in older children, the disorder can be more severe.

“The most number of kids that we see are high school kids. We see it often beginning in middle school, in 7^th grade and really getting pernicious in the high school years,” Dalton said.

School refusal can be treated with professional help, and Dalton says in the vast majority of cases kids are able to return to school. But allowing a student with school refusal to stay home may actually do more harm than good.

“If kids are out of school for a long time that becomes a petri dish for depression to grow on, because of the absence of social support and nothing in the rhythm of life in that way.  It doesn’t bode well for academic performance in the short term and the long term, there’s much higher rates of marital dissatisfaction down the road for these kids who aren’t really treated effectively, because avoidance really ruins lives,” he said.