School Anxiety and Refusal: How to Support Your Child or Teenager

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Our blog articles are written and reviewed by experienced clinicians at London Psychiatry Clinic, including consultant psychiatrists, psychologists, and therapists. Every post is grounded in current research and clinical expertise to ensure that the information you read is accurate, relevant, and trustworthy.

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Have you noticed a change in your child’s behaviour around going to school? Perhaps they are showing signs of anxiety or complaining of unexplained aches and pains in the morning. When your child suddenly becomes anxious about going to school, not knowing how to help can leave you feeling confused, lost and even frustrated. 

Back-to-school anxiety is much more common than you might think. This guide will help you gain a deeper insight into the difference between school nerves and more serious issues. We’ll explore:

• School refusal and emotional-based school refusal (EBSA)
• How to recognise the signs and symptoms of school refusal
• Practical strategies to support your child when they feel anxious
• Looking beyond surface behaviours to discover underlying causes
• Learn when professional help might be the best route to take

Most importantly, we want to discuss how effective strategies can help your child overcome their school anxiety. We want all children to make the most of their time at school by engaging in their education and enjoying social interactions with their peers.

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What Is School Anxiety?

School anxiety is more than typical nervousness. It's a persistent, overwhelming fear about attending school. It can significantly impact your child's daily life, creating intense physical and emotional responses.

It manifests differently by age. Younger children might complain of tummy aches, become clingy, or have emotional outbursts. Teenagers may experience panic attacks, refuse to get ready for school, or develop headaches and nausea.

Whatever symptoms your child shows, know that school anxiety is very real. It's nobody's fault and doesn't reflect your parenting.  We understand that it can feel easy to blame yourself as a parent and try to do everything alone, believing that you should be able to cope. But you don’t have to go through this all by yourself. Early intervention can be incredibly effective. It may help prevent school anxiety from becoming progressively worse or affecting your child’s future. The first step is understanding what's happening so you can respond with compassion and take practical steps to support your child’s confidence and well-being.

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School Refusal and Emotionally-Based School Avoidance (EBSA)

What Is School Refusal?

While school anxiety is the feeling of worry or fear about school, school refusal is when those anxious feelings become so overwhelming that a child can't bring themselves to attend. It’s different from behaviours like truancy, where a child will skip school without parental knowledge. School refusal typically occurs with parents' awareness. And it can often lead to significant family conflict over school attendance.

School refusal can look like your child attending school but often leaving early. They might be consistently late or stop wanting to go altogether. It’s not simply a case of trying to avoid homework or other school responsibilities. It's a real inability to manage school life caused by anxiety or other emotional struggles. And it deserves to be treated with compassionate understanding and a willingness to look at what’s going on for your child on a deeper level.

What Is EBSA?

Emotionally-Based School Avoidance (EBSA) is the term used by many professionals. It describes school attendance difficulties that are rooted in a child’s emotional distress. It offers a broader understanding of school refusal. Recognising it as a symptom of underlying emotional needs rather than a behavioural choice.

There are many genuine reasons your child might feel negatively about going to school. These might include:

• Anxiety
• Depression
• Trauma
• Bullying
• Body dysmorphia
• Low self-esteem
• Perfectionism
• Overstimulation (due to ADHD or Autism)
• Learning difficulties
• Other mental health challenges

Using the term ESBA helps us to reduce stigma around school refusal. It encourages a more understanding rather than blaming or punishing anyone for what’s happening.

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EBSA vs School Refusal: Understanding the Difference

These terms are often used interchangeably. But understanding their differences can help parents, professionals, and children approach the situation with the care it deserves.

• School refusal:  traditionally focused on the behaviour of not attending school
• Emotionally-Based School Avoidance (EBSA): emphasises the emotions behind a child’s avoidance

EBSA takes a more holistic view of why children refuse school. It recognises that school avoidance comes from complex emotional, psychological, and environmental factors. Not from children being deliberately difficult. Both terms describe the same issue: children who can't attend school due to emotional distress. But EBSA encourages us to respond with compassion and understanding rather than frustration and punishment.

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Signs Your Child May Be Refusing to Go to School Due to Anxiety

Recognising the signs of school anxiety early can help you support your child most effectively.

 Physical symptoms often appear first and may include:

• Complaints of stomach aches
• Frequent headaches
• Feeling unwell on schooldays in particular

Emotional and behavioural signs may include:

• Excessive worry about school-related activities
• Crying when it's time to get ready for school
• Difficulty getting ready for school
• Frequent requests to leave school early
• Complete refusal to discuss school-related topics
• Hypervigilance around  time - constantly asking when they have to leave for school

It can be useful to observe whether your child’s symptoms significantly reduce or disappear during weekends or holidays. If they are calmer and less anxious when going to school isn’t on the cards, it might reveal a connection to school anxiety.

Why Children and Teenagers Avoid School

Common Triggers

School avoidance can stem from many triggers. These triggers can make the school environment feel threatening or overwhelming for your child. It’s important to remember that these feelings are deeply unpleasant. Particularly if your child doesn’t fully understand what’s happening to them.

Academic Pressure

Academic pressure is a major trigger for many children. Especially those with learning difficulties or perfectionist tendencies. Fear of failure, public embarrassment, or disappointing peers, teachers and parents can create overwhelming anxiety. These fears can grow so large that your child begins to link school with feeling terrified.

Social Issues

Social difficulties represent another major trigger. Navigating friendship problems, feeling socially awkward or isolated, and bullying can make school feel like a very hostile environment for your child. 

Environment

The school environment itself can also be hugely overwhelming. Children might feel bombarded with sensory stimulation from noise and crowds. They might have a fear of specific teachers or experience anxiety around using the bathrooms. 

Underlying Conditions

As well as social and environmental triggers, there might be underlying conditions and anxiety contributing to your child’s fear around school.

• Separation anxiety - when your child expresses fear and anxiety around being apart from you or their primary caregiver. 
• Social anxiety - when your child is deeply fearful about social situations. For example, they might experience high levels of stress working in groups or when called to speak in class.
• Phobias - when your child has an intense fear of a particular object or situation. For school-related phobias, this could involve attending a specific class, taking a test, or even standing in line.
• Depression - when your child displays symptoms like sadness, changes in sleeping and eating habits, or loss of motivation. If your child is experiencing depression, these symptoms will likely persist beyond school hours.
• Post-traumatic stress disorder - when your child has been through a traumatic event. They may experience symptoms like flashbacks, difficulty sleeping, anxiety and nightmares. If the traumatic event happened on the school grounds, just being there can become a trigger.

Additional health conditions

Conditions like autism spectrum conditions (ASC) and attention-deficit/hyperactivity disorder (ADHD) can also make the unpredictable nature of the school environment overwhelming. ASC and ADHD can exacerbate sensory issues, challenges with focus and concentration and difficulties regulating emotions. 

For parents, caregivers, and professionals, it’s deeply important to identify the root causes of Emotionally-Based School Avoidance. Knowing why your child is struggling helps us to develop strategies that will help them feel safe, seen and heard. And managing underlying conditions with supportive treatment may help alleviate school refusal.

Back to School Anxiety

Why It’s Harder After a Break

Anxiety about going back to school after break is incredibly common. It can also feel much more intense and unpleasant than daily school anxiety. An extended break from school allows your child to adjust to the comfort and safety of being at home. This can make the transition back to school, with its more rigid structure and social and academic demands, feel even more jarring and overwhelming. 

As a parent, you might notice your child's anxiety fades during school holidays. It's natural to hope the problem has resolved itself. Enjoying relaxed, easy time together feels wonderful. But watching their anxiety return as school approaches can be heartbreaking.

Often, the longer the break, the harder it is to go back. This can create a difficult cycle. Each holiday makes the next return to school even more challenging for your child.

How to Help Your Child Prepare

If signs of back-to-school anxiety increase as your break comes to an end, here are some preparation strategies that might help:

• Start conversations about returning to school early, acknowledging their nervousness
• Create a visual calendar showing the countdown to school return 
• Gradually reintroduce school-like routines during the final week of holidays 
• Practice the school routine, including getting dressed and the journey to school 
• Connect with school staff before their return to discuss concerns and ensure compassionate support is in place
• Consider a gradual return with shorter days if needed

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How to Help a Child with Anxiety About School

At Home

Remember that it isn’t anyone’s fault that your child is experiencing anxiety about school. It’s not a case of you being to blame, or them simply acting up. It’s a very real experience for your child, and it’s okay that it has an effect on you too. 

Creating a supportive home environment is incredibly helpful for both you and your child. The following strategies may help you and your child feel safer, more understood and relaxed about going to school.

• Establish predictable routines that provide security and reduce uncertainty. This might look like going to bed and waking up at the same time each day. Having a breakfast prep routine together or packing a school bag together the night before
• Create calm, structured morning routines without rushing
• Listen to and validate your child's feelings. And agree on realistic expectations about school attendance
• Practice relaxation techniques together. These could be deep breathing or mindfulness exercises
• Encourage open communication about school experiences. Allow your child to speak about what’s happening for them without being interrupted or trying to fix everything right away
• Create regular check-in times where your child can share their worries without judgment

At School

For parents or caregivers, collaborating closely with school staff can ensure your child gets the support they need to feel safe at school. Some effective ways to do this are:

• Working with teachers to identify early warning signs of heightened anxiety and what to do when this happens
• Making sure your child has a designated safe person they can go to when they experience symptoms of school anxiety while on school grounds
• Arranging permission for supervised breaks when they feel overwhelmed or triggered
• Creating modifications around certain activities that appear to trigger anxiety
• Exploring additional support, such as time with a teaching assistant or school counsellor
• Establishing safe and quiet spaces that your child can retreat to when needed

Need assistance navigating your child’s school? Our specialist Greg Quee, a Cognitive Behavioural Psychotherapist and qualified teacher with 15 years of experience, is here to help. He understands how schools function and works with families to secure the right support. With his guidance, you’ll feel confident in advocating for your child's rights and needs.

When to Seek Professional Help For School Anxiety and Refusal

Here at the London Psychiatry Clinic, we recognise that while the strategies we’ve explored might be helpful, there are times when professional help is needed. For example, when school anxiety significantly impacts your child’s daily functioning. Or if their distress continues despite supportive interventions.

Psychological and therapeutic options

Our treatment pathways for school refusal involve a comprehensive, evidence-based approach. We understand the importance of uncovering the underlying causes and finding the right support to help you and your child. We believe that treatment plans should offer support not only to your child but to all involved, including parents and caregivers.

Treatment plans may include:

• Cognitive Behavioural Therapy (CBT) is often the first-line treatment for school anxiety. It helps children understand the connection between thoughts, feelings, and behaviours.
• Family therapy can address the broader impact on family dynamics. Play therapy may benefit younger children who struggle to express feelings verbally.
• Exposure therapy, conducted gradually and sensitively, can help children build tolerance for school-related anxiety triggers. This always occurs at the child's pace with extensive support and preparation.

Psychiatric care

Sometimes school anxiety warrants psychiatric evaluation. Particularly when other mental health conditions are present. 

A psychiatrist can assess whether medication may be helpful alongside talking-based therapies to help alleviate underlying causes such as anxiety or depression. However, it’s important to know that this is never the first or only intervention. We will always provide you with evidence-based information so you can make informed choices for you and your child.

Psychiatrists can also provide a compassionate and comprehensive assessment for underlying conditions that might be contributing to school avoidance. This ensures that all aspects of your child’s mental health are taken into account, helping alleviate their fears in the most effective way.

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FAQs About Back-to-School Anxiety

My teenager won't go to school because of anxiety - what can I do? 

Validate their feelings and avoid power struggles. Work with the school on gradual return plans and seek professional support. Focus on addressing underlying anxiety rather than forcing attendance.

What does the law say about school refusal in the UK?

Parents have a legal duty to ensure education. But, authorities increasingly recognise that prosecuting families with school refusal is counterproductive when mental health issues are involved.

Can a child be signed off from school with anxiety? 

Yes, healthcare professionals can provide medical evidence that a child cannot attend school due to anxiety. This should always be part of a broader support plan.

What is the best treatment for school anxiety in children? 

The most effective approach combines therapeutic intervention (particularly CBT) and family support. It also includes school collaboration, gradual exposure and is tailored to individual needs.

How long does school refusal last? 

Duration varies significantly. With appropriate help, many children return to school within weeks or months. Without support, it can persist much longer.

Is school refusal a mental health condition? 

School refusal is a symptom of underlying emotional difficulties. These include anxiety disorders, depression, autism, ADHD, or trauma responses requiring professional assessment.

What should I do if my child refuses to go to school every day?

Seek professional help as soon as possible. Contact your GP and school staff to let them know the situation. Focus on understanding why school feels impossible rather than forcing attendance.

Can a child be fined for missing school due to anxiety?

Local authorities shouldn't penalise families where mental health prevents attendance. Medical evidence and professional support documentation can help protect families from punitive measures.

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Conclusion

School anxiety and refusal can feel incredibly overwhelming for both children and parents. But with understanding, patience, and appropriate support, your child can overcome these challenges. Remember that school avoidance is a symptom of underlying distress. It's not simply your child being defiant or trying to cause trouble. It’s a very real condition that deserves validation, compassion and consistent support.

Key takeaways include:

• Recognising early warning signs and taking action before it reaches crisis level
• Working collaboratively with schools to create understanding and effective management strategies
• Seeking professional help when needed to support both you and your child on the path to recovery
• Maintaining hope that children can develop coping skills with the right support

If you're struggling to support your child with school anxiety or refusal, don't wait for the situation to worsen. Contact us today to discuss how we can support your family. And discover ways to help your child build a positive relationship with education. One where they feel safe, understood and engaged in school.