By: Natasha Binns, Clinical Psychology Registrar

If your child is struggling to attend school, you are not alone. School refusal affects around 1–5% of children in Australia and has only increased since the COVID-19 pandemic. But what exactly is school refusal, and what can help your child?

What is School Refusal/School Avoidance?

School refusal is difficulty attending school due to high emotional distress. It differs from truancy (skipping school without parents’ knowledge), school withdrawal (parents keeping a child home), and school exclusion (suspension/expulsion). Children often want to attend but feel unable to, and usually communicate this distress to caregivers.

It may present as physical complaints (e.g., headaches, nausea, pain), anxiety or tearfulness before school, delays or avoidance in getting ready, difficulty separating from parents/caregivers, or missing full or partial school days.

What Causes School Refusal?        

School refusal is best understood as a signal of underlying difficulties, rather than a problem in and of itself. When a child feels unsafe or distressed, avoiding school becomes a natural response. There is often no single cause, but a combination of factors unique to each child.

These may include anxiety (social, performance, separation, or general worry), peer difficulties (e.g., bullying, isolation, or conflict), conflict with teachers, learning challenges, trauma, transitions (e.g., new school or class), and unmet sensory or neurodivergent needs.

Supporting regular school attendance means understanding and addressing these underlying factors.

The Mental Health Factors of School Refusal

While school refusal is not a formal diagnosis, it is often linked to underlying mental health disorders. Identifying whether any of these are contributing to your child’s school avoidance is important so they can receive the right support and gradually return to school.

Common mental health disorders associated with school refusal include:

Anxiety Disorders (e.g., Generalised Anxiety, Social Anxiety, Separation Anxiety, Panic Disorder): School may feel scary or unsafe, leading to avoidance.

Depression: Low mood, fatigue, loss of interest, and feelings of hopelessness can make school feel overwhelming rather than frightening.

Obsessive-Compulsive Disorder (OCD): Intrusive thoughts and time-consuming compulsions can make attending and coping at school very difficult.

Neurodevelopmental Disorders (e.g., autism, ADHD): Sensory sensitivities, difficulties with transitions, social communication, and executive functioning can lead to overwhelm, burnout, and school avoidance.

Trauma-Related Disorders: Past trauma can lead to hypervigilance, avoidance, and strong emotional or physical reactions, with school sometimes acting as a trigger.

Collaborative Strategies for School Refusal

Addressing school refusal works best as a collaborative effort between your child, parents, school staff, and any healthcare providers. Everyone should understand and validate the underlying difficulties, while still reinforcing the importance of attending school—even if that begins with arriving late.

Helpful strategies include working with the school on a gradual re-entry plan, ensuring access to support people and safe spaces, and putting accommodations in place for challenges like bullying or sensory overload.

If mental health factors are contributing factors, support from a mental health professional is important to prevent these difficulties from worsening. Clinicians at Spencer Health can assist by developing a tailored reintegration plan and helping your child build coping skills for ongoing challenges.