A child seeking to avoid school may be motivated by potential negative and/or positive effects of doing so. Kearney and Silverman8 identified 4 primary functions of school refusal behaviors:
- avoiding stimuli at school that lend to negative affect (depression, anxiety)
- escaping the social interactions and/or situations for evaluation that occur at school
- gaining more attention from caregivers, and
- obtaining tangible rewards or benefits outside the school environment.
How school avoidance manifests
School avoidance has attributes of internalizing (depression, anxiety, somatic complaints) and externalizing (aggression, tantrums, running away, clinginess) behaviors. It can cause distress for the student, parents and caregivers, and school personnel.
The avoidance may manifest with behaviors such as crying, hiding, emotional outbursts, and refusing to move prior to the start of the school day. Additionally, the child may beg their parents not to make them go to school or, when at school, they may leave the classroom to go to a safe place such as the nurse’s or counselor’s office.
The avoidance may occur abruptly, such as after a break in the school schedule or a change of school. Or it may be the final result of the student’s gradual inability to cope with the underlying issue.
How to assess for school avoidance
Due to the multifactorial nature of this presenting concern, a comprehensive evaluation is recommended when school avoidance is reported.4 Often the child will present with physical symptoms, such as abdominal pain, nausea, vomiting, diarrhea, headaches, shortness of breath, dizziness, chest pain, and palpitations. A thorough medical examination should be performed to rule out a physiological cause. The medical visit should include clinical interviews with the patient and family members or guardians.
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