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Understanding and Dealing with Children Who Refuse or Avoid Going to School: A Cognitive-Behavioral Approach

Presenter: Meir Flancbaum, Psy.D.

View the webinar’s corresponding slides here        Download the Webinar

Almost every child puts up a fuss about going to school at one point or another. But for some youth, refusing to go to school or attending with intense discomfort, collectively referred to as school refusal behavior, happens with great frequency. School refusal causes significant interference in a child’s ability to learn and generates stress for parents and school personnel trying to help. This workshop will present an overview of school refusal behavior, including a discussion about why children avoid school and research-supported strategies to increase attendance. Topics such as treatment using cognitive behavior therapy, developing school-based accommodations, and the importance of collaboration between parents and school staff will also be reviewed. This workshop is designed for parents and professionals interested in learning more about children who avoid going to school and how they can be more effective in providing proper supports.

Meir Flancbaum, Psy.D., is a clinical psychologist and director of the Center for Cognitive Behavior Therapy in East Brunswick, NJ, where he provides therapy, school-based consultation services, and professional development workshops focusing on the evaluation and treatment of children and adolescents with a variety of social, emotional, and behavioral difficulties. Dr. Flancbaum has a specialization in the assessment and treatment of Tourette syndrome, trichotillomania (hair pulling), skin picking, and related conditions such as OCD, ADHD, and the range of anxiety disorders. He also has a specific interest in school phobia/refusal and behavioral parent training. He has consulted to several schools and organizations in New Jersey and New York, where he has conducted functional behavioral assessments (FBAs), developed behavior intervention plans, and provided ongoing teacher consultation and training in classroom management techniques and social emotional skills training.

Comments(30)

  1. HGreen says

    I would appreciate your thoughts on home schooling and at what age would you recommend beginning it?

    • Dr. Flancbaum says

      Though there can be are exceptions, I do not often recommend home schooling and therefore don’t have a specific age to start it. I typically utilize home schooling or home instruction as temporary interventions while children are in CBT treatment, with a goal of returning to school.

  2. GYegevnia says

    Our son is in 2nd grade. He seemed excited about going back to school, but after a couple of weeks we are struggling to get him on the bus. Should the school be addressing these concerns themselves or should I be seeking an outside psychologist? If so, what does treatment/therapy look like?

    • Dr. Flancbaum says

      The context and details certainly play a role in determining the best approach here. Children sometimes begin school with a “honeymoon period” for the first few weeks before the challenges begin. Other times, there may be an event that occurred which is prompting your child’s resistance. My recommendation would be to check in with the school to gather your experience and gather information. If they have clear strategies to help your child return to school and the plan makes sense, you’re good to go! Otherwise, or if your child appears to be really struggling, I would move on an outside expert who can quickly and thoroughly understand the situation and develop a plan. Typically, the less time a child is out from school, the easier it would be to get him back.

  3. GLevy says

    My 12 yo son has been struggling on and off with school attendance – being late, saying he doesn’t want to go, etc. Should I be seeking treatment or starting my collaboration with the school now and see how it goes for a little bit?

    • Dr. Flancebaum says

      It’s never too early to start your collaborative relationship with the school! Send an email requesting information or request to have a short phone call with your child’s primary teacher or guidance counselor. You can learn valuable information from this interaction, or perhaps provide school personnel with insight which they can then look into on their end. At the same time, be careful to describe the behaviors you are seeing while reserving judgement on the reason he is not wanting to go to school.

  4. PSanjeet says

    What is the likelihood of a younger child copying the older child experiencing school refusal> should we be doing something to avoid this with the 2nd kid?

    • Dr. Flancbaum says

      Child behavior is learned. If a child is observing an older sibling refuse school, he or she certainly may follow. At the same time, just because one child does, doesn’t mean the next week. It would be prudent to have a look at the controllable reasons the first child is engaging in school refusal – especially the parent variables – to be sure that they are not repeated. Be particularly careful that the message is clear and consistent that school attendance is required.

  5. LMajors says

    Do you see more school refusal issues with boys rather than girls?

    • Dr. Flancbaum says

      I may, yes, but the issue can happen among boys and girls.

  6. TMartin says

    At what age is school refusal most likely to start?

    • Dr. Flancbaum says

      It can start at any age, but I see it mostly commonly around 5-7 or in early adolescence.

  7. PPursell says

    Is it possible school refusal could be a rejection of the teacher? Could changing the teacher make a difference?

    • Dr. Flancbaum says

      It is possible that changing a teacher can make a difference. Some children and teachers are not a good fit. A careful assessment needs to be conducted to determine if this is the real cause of the avoidant behavior; it may be, or it may not be. If there is a legitimate concern, a switch should be considered. Remember, that children aren’t going to love every teacher they have and sometimes will just need to learn to cope with their current situation. This is a situation where the details are important.

  8. STrevino says

    Do you encounter bullying as a factor in school refusal?

    • Dr. Flancbaum says

      Bullying can trigger school refusal. When this is the case, it is important for the bulling situation to be swiftly addressed so the child can safely return to school.

  9. MHarker says

    Are you aware of a link between school refusal and agpraphobia?

    • Dr. Flancbaum says

      Youth who are concerned about having panic attacks in certain public places, i.e. those with agorophobia, may be less likely to go to school due to fear of having a panic attack there.

  10. FWarner says

    It would seem that you can’t treat school refusal in a vacuum. What would be the issues with not handling the co-occurring disorders?

    • Dr. Flancbaum says

      I’m sure this can be of great concern to you. Unfortunately, this is not a question I can comment on without more information, which would be beyond the scope of this forum.

  11. BCline says

    What if a private doctor/therapist is recommending a student to not attend school?

    • Dr. Flancbaum says

      I’m sure this can be of great concern to you. Unfortunately, this is not a question I can comment on without more information, which would be beyond the scope of this forum.

  12. Rfeingold says

    What if a student is engaging in self-injurious behavior (SIB) and the trigger is anxiety over school? What if doing SIB in school?

    • Dr. Flancbaum says

      This is a very good question and the details are important to provide a proper answer. On the one hand, we want children in school and on the other hand we need them to be safe. It would be important that this behavior is carefully understood and properly addressed. I would encourage you to promptly set up an appointment with a CBT/DBT therapist you trust so that you can have a consultation.

  13. KSmith says

    How do you handle a child that goes into panic attacks and throwing up when trying to get them to school?

    • Dr. Flancbaum says

      I would take a step back and try to understand the core fears or concerns. Based on that, one possibility may be a carefully crafted plan can be created using some skill building to face fears (e.g., some thinking strategies and positive self-talk) and then gradually helping the child to face his fears (i.e. exposure therapy).

  14. SBartell says

    I don’t think our situation with our 5th grade son is really school refusal but more of an attention thing. He’s the middle of 2 boys and we think its more of an attention thing. He goes to school then sees the nurse about a stomach or head ache so he can come home. How would you suggest we handle this.

    • Dr. Flancbaum says

      Nurses are often familiar with school avoidant behavior but may need to be given the memo from you that this is the situation. Ideally, the nurse can greet the child in a supportive manner, validate his discomfort, stress the importance of school, and send your son back to class. This is, of course, assuming there isn’t a medical reason why he should be going home. If this is unsuccessful, then an outside consult should be sought with a CBT psychologist with experience in this area. When anxious children have headaches or other somatic symptoms, they are real; they are just driven by anxiety and need to be properly treated based on that issue.

  15. FGamme says

    My 12 yo son sometimes goes to school and sometimes stays home, (3 days in and 2 days out) but when he goes back in, feels over whelmed with work and the cycle starts again.

    • Dr. Flancbaum says

      You are pointing out an important challenge with school avoidance, namely, the fear of being overwhelmed only results in avoidance and being even more behind. If this is a cycle, it would be important to involve a professional skilled in school refusal to assist with stopping this negative cycle and setting your child up for success.

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