School Refusal: Anxiety, Bullying, and Long-Term Psychological Consequences

It’s common enough for kids to become shy or nervous about starting the new school year. But for some students, the anxiety is overwhelming enough that they try to avoid school at any cost. They may feign headaches and nausea, complain that their teacher hates them, or beg parents not to send them to school. Known as school-refusal behavior, this type of anxiety can keep kids out of school for weeks or months worth of school in a single year. The Wall Street Journal recently profiled school refusal, what’s behind it, and how it’s best addressed by parents.

Letting kids stay home or attending school with them (e.g. as a volunteer classroom aide) may seem helpful and supportive, but ultimately it just affirms their fear and their perceived inability to handle school alone. Antidepressant medications are sometimes prescribed for children with anxiety, but this is a controversial response. Cognitive behavioral therapy is the most effective response to school-refusal behavior, with success rates ranging 50-70% (and higher in refusal-specialized clinics).  Therapists work with kids on identifying their fears and gradually facing them, often by attending one class, then two, then three until the child is back in school full-time.  Students also learn relaxation techniques and breathing exercises to help them calm down when they start feeling anxious in school

There is no single cause of school refusal that applies to all students, but for many the behavior stems from an overall sense of anxiety about the experience. Being called on in class, judged by peers, and separated from their home and parents can be stressful. School refusal often surfaces when kids start at a new school, whether after a move or as a transition from elementary to middle school. Bullying and social dynamics can also trigger or exacerbate school-related childhood anxieties. If not addressed with therapy, school refusal and the anxiety behind it all too often lead to poor academic performance, depression, and self-medication through drugs and alcohol later in life.

© Copyright 2010 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Arnold


    September 26th, 2010 at 11:19 AM

    I liked going to school when I was little but all this changed when I started to be bullied by a huge kid in school. I started to refuse going to school and my parents guessed the reason right. They came to my school and one talk between the teachers and the bully fixed it all. I even became friends with my former bully and school was never a problem again. I thank my parents for having recognized the problem and doing something about it rather than pressurizing me to attend school.

  • bren


    September 26th, 2010 at 12:41 PM

    All of this is good information but nothing is going to do the trock unless everyone is on the same page. That means the student making the commitment to have a good year and ignore the junk from other people at school; parents have to give them the support that they need; and lastly the teachers have to stop turning a blind eye to this sort of thing in the classroom and ask for help for the student when that is needed!

  • bren


    September 26th, 2010 at 12:42 PM

    sorry… that very first line should have said nothing is going to do the TRICK… fingers get too fast for me sometimes

  • NATE


    September 27th, 2010 at 3:46 AM

    It can be really hard for a child-all the bullying and other stuff,other kids mocking or insulting.

    The biggest problem is that most children are scared to open up their parents regarding this,simply because they think they are at fault.They are too little to understand that its just not their fault!So a good parent should make the child aware of this-that it is not his fault and that they will support and stand by him and also get rid of the problem for him.

  • Hollis


    September 27th, 2010 at 4:58 AM

    I have a friend who would let her child stay home any time there was any kind of little problem at school. Needless to say this only made things worse when she decided home schooling made no sense for her and the child had to go back to the real classroom instead. We need to give our kids the tools that they need to deal with these kinds of issues instead of only trying the ways that will shield them from the problems. These are the realities of life and they have to learn how to handle them.

  • Ross Taylor

    Ross Taylor

    September 27th, 2010 at 10:30 AM

    Hollis:Yes, running away from the problem is not going to help, ever!

    taking up the problem and coming up with a solution for it is the way that it should be and also the child will learn this kind of negative behavior from his parents. So beware, parents…

  • Georgia


    September 28th, 2010 at 4:25 PM

    When are the schools going to take a stand and get more involved?

    I do not necessarily think that kicking out the bullies is the best idea and you can never get rid of them all but they need to come up with some sort of program that shows that that this kind of behavior is not going to be tolerated in school or outside of school.

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Title   Content   Author is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on