School avoidance occurs wben children and teens repeatedly stay home from school or are repeatedly sent home from school, due to emotional problems or because of aches and pains that are caused by emotions or stress and not by medical illness.

Ben's Story

Ben missed a lot of school because of his stomachaches. His stomach felt especially bad on Monday mornings. Often, while he was getting dressed for school, he felt as if he might throw up. His mother did not want him to go to school if he was sick. On days he stayed home, Ben got back into bed, and by lunchtime he felt much better. But by the next morning, he felt miserable all over again. He managed to get himself to school sometimes, but it was getting harder and harder. He would be embarrassed if he threw up on the bus. Ben's doctor had examined him and found him to be in excellent health despite his stomach pains. Still his stomachaches continued, and Ben's mother had started to worry about how many school days he was missing.

What Is School Avoidance?

School avoidance is a condition that occurs in up to 5 percent of schoolchildren and adolescents, with boys and girls equally affected. Sometimes school avoidance is called school "phobia" (FO-bee-a) or school refusal. School avoidance is a pattern of missing school for symptoms that are caused by emotions or stress, rather than physical illness. School avoidance is different from truancy (TROO-an-see), which is a pattern of repeated unexcused absences from school. The student who is truant, or skips school, is neither at home nor at school. In school avoidance, the student stays home.

What Causes School Avoidance?

There are two main reasons students have school avoidance. One reason is that the student feels anxiety (ang-ZY-eh-tee), fear, or worry about some aspect of going to school or about leaving home. The other reason is that there is some benefit, or a secondary gain, to staying home from school.

Anxiety-related school avoidance: 

Most children have some anxiety about attending, school for the first time, which is known as "separation anxiety." It is not surprising when separation anxiety occurs when a child is about to enter kindergarten or first grade. For many children this is the first time they are away from home or separated from their parents.

But some children have separation anxiety that lasts beyond the expected age. Children who have recently been through other difficult separations, such as divorce or the death of a parent or the illness of a family member, may have an especially difficult time leaving home to go to school.

Children with school avoidance may have headaches, stomachaches, chest pain, or other symptoms brought on by the stress of separation. These pains are real, but they are caused by the body's response to stress and not by an illness. Usually, a checkup by the doctor finds the child or teen to be in good physical health. Srudents with anxiety-related school avoidance are often good students and like school, but because of their stress-related symptoms, they feel that they need to stay home.

Some students with school avoidance may have anxiety about school itself. They may worry about grades, about being bullied, about being called on in class by the teacher, or about having to undress for gym.

Some schools have rules about when students may use the bathroom, and this may be a worry to children who may need to go more often. Dirty school bathrooms without enough privacy or issues about safety may be real concerns for some children.

In many cases, anxiety-related school avoidance begins with an upsetting event that happens at school, for example, being teased or experiencing something disturbing in class. Students who are shy and sensitive by nature and those who have an overprotective parent may be more likely to have anxiety-related school avoidance.