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Child and adolescent mental health

School anxiety or refusal

What is school anxiety or refusal?

Although not included in DSM-5 or ICD-10 (the manuals that are used to diagnose mental health conditions), school anxiety/refusal/phobia is very real. Children of any age can find going to school difficult or even impossible. They may refuse to get up in the morning or get dressed; they may feel or be sick; have a headache or stomach ache, a racing heart or feel dizzy; they may get angry, upset or even distraught. As time goes on, the more worrying it becomes for the child or young person and their parents/carers. Equal numbers of boys and girls are affected.

What do children with school anxiety or refusal worry about?

  • sensory issues such as noisy classes or the size of the school which can be overwhelming, especially for pupils on the autistic spectrum

  • unsupervised playgrounds

  • problems with friends or teachers

  • bullying

  • peer pressure to be naughty

  • fear of failure - sometimes, but by no means always, they may have learning disabilities, or learning difficulties such as dyslexia

  • some school refusal may be linked to specificsubjects such as PE which may be because of the sport or changing/showering in front of their peers

Other children worry about things that are not to do with school but mean that they do not want to leave their home to attend school, such as having a sick parent or having been burgled and afraid the burglars will return when they are not at home.

Case studies

Max is a bright, sporty 13 year old boy with plenty of friends. He was perhaps the last person you would expect to start avoiding school. chool refusal had started as frequent stomach aches and headaches that had kept him from school. His doctor couldn’t find anything physical that was causing Max’s symptoms and his school were worried about Max’s attendance as he was only attending two or three times a week. Talking therapy revealed that Max had set himself very high standards at secondary school and was worried that he couldn’t keep his high grades up. That’s when the anxiety had started to make him avoid school. Treatment involved teaching him to be more self-confident and resilient, and helping him to tackle those thoughts about perfectionism. It also meant doing some work with Max’s mum about not transmitting her own, understandable, anxieties to him.

Craig is a Year 7 pupil whose school attendance started falling in the second term of his first year in secondary school. It began with reluctance to attend school and odd complaints of tummy pains and feeling sick in the mornings at the time of going to school. Over the next few weeks, his distress in the mornings worsened and he was missing two to three days of school each week. He usually started worrying about attending school the previous night and by the morning he was shaking, sweating and close to panic. On weekends, he was his usual happy and carefree self.

Three families of young boys - 14-year-old Kai, 14-year-old Harry and 10-year-old Charlie - tell the BBC what life is like living with school refusal. Kai and his mum talk on video about how he is affected by his severe anxiety and the negative way in which he has been treated by the school system. Harry, who has been diagnosed with ADHD and is on the autistic spectrum, has also been badly affected by the school system because of his school refusal. Charlie hasn't been to school for a year because of his extreme anxiety which has led to his parents splitting up. 60-year-old Jon also talks about his school anxiety in the 60s and 70s, a time when mental health issues in children were not recognised, being so bad that he attempted suicide.

Websites and web pages

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Not fine in school (NFIS) is a website by and for parents with children who have experienced school attendance difficulties. The team's experiences cover a wide range of influences and causes, so there is a useful mix of knowledge and interests. Many members of the team are also employed in related professional roles including teaching, mental health support, advocacy, therapy and academic research. They are passionate about helping and empowering other parents. They know how it feels to experience the high levels of stress and anxiety created by the catalogue of issues that relate to school attendance difficulties. There is also a wealth of information for young people themselves and professionals. is an Australian website providing free, reliable, up-to-date and independent information for parents and carers to help their families grow and thrive together. 


There is comprehensive information on school refusal in children aged five to eight, including signs and symptoms; causes; practical strategies to use at home; working with the school; and getting professional help. There is also a page of information on truancy and school refusal in young people aged nine to 15.


Information and advice for parents and carers whose child might be anxious about school, how to support therm, and  where they can get help. Scroll to the bottom - or click here - for a link to a page of information and advice on what they can do if a child refuses to go to school. 

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