School refusal

Background
School refusal is a term originally used in Great Britain to describe refusal to attend school, due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. The term was coined as a more general alternative to school phobia, which can be used to describe school refusal caused by separation anxiety.

Approximately 1 to 5% of school-aged children have school refusal, though it is most common in children aged five, six, ten and eleven. The rate is similar within both genders, and there are no known socioeconomic differences.

Children and adolescents with school refusal sometimes suffer from other problems such as mood disorders, social phobia or clinical depression. The longer a child stays out of school the harder it is for them to go back, so some believe it is best to try to get the child back into school as quickly as possible. However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic symptoms and threats of self-harm. These problems quickly fade if the child is allowed to stay home.

Whereas some cases of school refusal can be resolved by gradual re-introduction to the school environment, some others may need to be treated with some form of psychodynamic or cognitive-behaviour therapy. Some families have sought alternative education for school refusers which has also proved to be effective. In extreme cases, some form of medication is sometimes prescribed but none of these methods have stood out prominently as solutions to the problem.

A medical condition often mistaken for school refusal is delayed sleep phase syndrome (DSPS). DSPS is a circadian rhythm sleep disorder, common in adolescents, which causes difficulty falling asleep at night and waking in the morning.