School Refusal

School refusal describes the persistent difficulty in attending or remaining in school, which is a growing concern for families, educators, and mental health professionals. Although research on this topic spans nearly a century, recent decades have provided stronger frameworks and a clearer understanding of why students refuse school. According to a widely used model from Kearney and Silverman, school refusal is typically driven by one or more motivations: avoiding negative emotions triggered by school, escaping social or evaluative pressures, seeking attention from caregivers, attempting to gain control over a certain aspect of their life, or pursing more rewarding activities outside of school. Regardless of the cause, the consequences can be serious, including academic decline, social isolation, family conflict and increased risk for drop out and mental health issues.

To determine which interventions best address the issue, studies have examined psychosocial treatments across both single-case and group design experiments. An extensive review over fifteen studies shows consistent findings; behavioural and cognitive-behavioural interventions improve school attendance and reduce emotional symptoms such as anxiety, depression and anger. Strategies commonly include gradual exposure, positive reinforcement for attendance, relaxation training, social skills development and cognitive restructuring to challenge anxious or distorted thinking.

Some treatments include teacher or parent training, some compared cognitive-behavioural therapy with supportive counselling. Behavioural components consistently played a central role in successful outcomes. The most effective intervention is those that are tailored to the function of a child’s refusal behaviour, working with each individual to unpack their behaviours and their drivers.

Some children benefit more than others from intervention, and this may be due to social skills, family dynamics or the specific reason behind their refusal. Whilst mental health issues are the main factor, there are many other drivers for these behaviours that must not be overlooked. Each individual is different and must be treated with respect throughout the process, with anxieties addressed in a meaningful way.