When a Child Says “I Can’t Go to School” – Understanding the Reality

In India, studies suggest that 2–5% of school-going children experience significant school refusal at some stage, with higher rates observed in urban settings and during key transition periods such as starting school or moving to higher grades. Dr. Rajeshwari Ganesh, a Developmental and Behavioral Pediatrician, frequently meets families who describe mornings filled with tears, physical complaints such as stomach aches or headaches, and intense distress—while the same child appears relaxed and symptom-free on weekends or holidays.

It is important to understand that school refusal is not misbehaviour. It is a signal. A signal that a child is experiencing emotional overwhelm and has not yet developed the skills to recognise, express, or regulate that distress. Identifying the underlying emotional, developmental, or environmental factors early allows families and schools to respond with empathy, structure, and appropriate support rather than pressure or punishment.

What Is School Refusal?

School refusal refers to a child-motivated refusal to attend school or remain in school, often driven by emotional distress. Unlike truancy, these children usually want to do well academically and often feel guilty about missing school.

School refusal is commonly associated with anxiety and emotional regulation difficulties rather than defiance or lack of discipline. Children may express their distress through physical symptoms such as stomachaches, nausea, headaches, dizziness, or fatigue—symptoms that typically resolve once school is avoided.

How School Refusal Presents in Daily Life

Children with school refusal may:

• - Cry, panic, or cling excessively during school mornings
• - Report physical complaints only on school days
• - Frequently visit the school infirmary
• - Struggle to separate from parents
• - Appear calm and symptom-free on weekends

In adolescents, school refusal may look more subtle—withdrawal, irritability, sleep disturbance, or refusal masked as “lack of motivation.”

Why Does School Refusal Happen?

School refusal rarely has a single cause. In my clinical experience, it usually results from a combination of emotional vulnerability and environmental stressors.

Common contributing factors include:

• - Separation anxiety or social anxiety
• - Fear of failure or academic pressure
• - Bullying or peer difficulties
• - Sensory sensitivities or learning challenges
• Sudden changes such as relocation or school transition

These children are not avoiding school—they are avoiding overwhelming feelings.

Anxiety: The Most Common Underlying Factor

Anxiety is the most frequent driver of school refusal. This may include:

• - Separation anxiety in younger children
• - Social anxiety in middle school years
• - Performance anxiety or fear of evaluation
• - Generalized anxiety with excessive worrying

Anxiety often expresses itself through the body before it becomes visible as emotional distress, which is why children genuinely feel “unwell” on school mornings.

Triggering Events and Transition Periods

School refusal may begin suddenly after:

• - A long illness or hospitalization
• - A holiday break
• - A family death or separation
• - Changing schools or teachers
• - Academic or social setbacks

Transitions temporarily reduce a child’s coping capacity, making previously manageable stress feel unmanageable.

Why Early Action Is Critical

The longer a child stays away from school, the harder it becomes to return. Avoidance reinforces anxiety, creating a cycle where staying home brings relief—but increases fear of return.

Early recognition and intervention significantly improve outcomes. When addressed promptly, most children return to school successfully with confidence restored.

How School Refusal Is Evaluated

A thorough evaluation focuses on understanding why the child is refusing school—not forcing attendance blindly.

Assessment typically includes:

• - Detailed developmental and emotional history
• - Identification of anxiety, learning, or sensory issues
• - Screening for neurodevelopmental conditions
• - Understanding family and school dynamics

I use internationally standardized developmental and behavioral assessment tools to ensure accurate diagnosis and individualized planning.

Effective Management and Treatment Approaches

School refusal responds best to collaborative, structured intervention.

Key strategies include:

• - Cognitive Behavioral Therapy (CBT) to address anxiety
• - Gradual school reintegration plans
• - Parent counseling and empowerment
• - Close coordination with school authorities
• - Addressing learning or developmental challenges

Medication is not always required and is considered only when anxiety is severe and persistent.

The Role of Parents and Schools

Parents play a vital role—not by forcing attendance, but by providing calm consistency. Schools, too, are essential partners. Temporary accommodations, emotional support, and gradual exposure plans can make a meaningful difference.

When needed, involving school counselors or education welfare authorities helps ensure continuity and safety.

FAQs – Questions Parents Commonly Ask

Q. Is school refusal just bad behavior?

Anwer: No. It is an emotional response, not defiance.

Q. Do children with school refusal dislike school?

Anwer: Most want to attend school but feel emotionally unable to cope.

Q. Will my child outgrow school refusal?

Anwer: Without intervention, it often persists or worsens.

Q. Is therapy effective for school refusal?

Anwer: Yes. CBT and family-based interventions are highly effective.

Q. Should parents allow the child to stay home?

Anwer: Short-term flexibility may be needed, but prolonged avoidance reinforces anxiety.