Children's Hospital Colorado

How to Handle School Refusal

A young girl in pajamas yawning and rubbing her eye.

The bus comes in ten minutes, and your kid is still not dressed and ready for school. You find her in bed.

She rolls over. "I'm not going."

This scenario unfolds more often, and in more families, than parents might think. "It's actually a really common problem for families," says Jessica Malmberg, PhD, psychologist and Clinical Director of Outpatient Services at Children's Hospital Colorado's Pediatric Mental Health Institute. "Upwards of 25% of children are going to have some type of school refusal behavior at some point during their lives."

That's true of pretty much all kids, regardless of age, sex, race or socioeconomic status. It can be outright refusal or a subtler tactic, such as pretending to be sick or leaving school without permission. It happens most commonly during times of transition: academic transitions, like the jump from grade to middle school, or middle to high school; as well as life transitions, like deaths, moves or divorces.

The school refusal reinforcement dynamic

Kids generally refuse to go to school for one of two reasons (or sometimes both). Parents can harness those reasons to create incentives that drive the behavior the other way.

Positive reinforcers for school refusal behavior

Sometimes kids get unintended rewards when they miss school — like attention from a parent or fun activities like movies or video games — that they wouldn't get if they went.

What to do: "We often set up rewards and contingencies," says Dr. Malmberg. For example, a parent might set up special attention — like dinner or a one-on-one "date" — as a reward for good attendance. The key is to make the reward contingent upon going to school, rather than the other way around.

Negative reinforcers for school refusal behavior

Kids avoid situations that provoke negative emotions or physical feelings (like stomachaches). These difficulties might be social — like social anxiety, bullying or feeling excluded — or academic, such as pressure from presentations or tests.

What to do: When there's a specific issue — such as bullying or academic stress — work with the school to address the situation and develop supports. Here, too, rewards and contingencies apply: "For example," says Dr. Malmberg, "'If you go to school today, when you get home you get to play video games for an hour.'"

The most important factor for dealing with school refusal

Whatever the cause, "The single most important factor in getting kids back to school is clear, consistent expectations," says Dr. Malmberg. "You are going to school. Unless you're vomiting or you have a fever, you are going."

In some cases, it can help to see a mental health professional, who can work with kids and parents individually to develop strategies for dealing with the issues underlying the behavior. Your child's pediatrician may be able to help or refer to a doctor who can.

The good news: "With the right support, the prognosis is excellent," says Dr. Malmberg. "Kids will get themselves back to school, and they'll be able to grow into happy, successful adults."

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