CHAPTER 8
School Refusal
Roughly 5% of referrals to child and adolescent mental health services
present with refusal to attend school associated with anxiety or misery.
This presentation is labelled ‘school refusal’. The term ‘school phobia’ is
probably best avoided since refusal to go to school is not a diagnosis: it is
a presenting complaint that can reflect a variety of problems in the child
or adolescent – or indeed in the family or school system as a whole. It is
also worth noting that school refusal is salient because we live in a society
that particularly values schooling and makes it compulsory. There is no
administrative or psychiatric category for ‘shopping refusal’ or ‘weeding
refusal’, though there probably would be if children were expected and
obliged to spend much of their time shopping or weeding the garden.
Epidemiology
School refusal peaks at three ages: on starting school; after school transfer;
and in the early teens. Though many young children are reluctant to
go to school, their parents are generally able to get them there anyway.
‘Successful’ school refusal is commoner among older schoolchildren, partly
because it is harder to compel them to attend school against their will. In
the Isle of Wight survey, no cases of school refusal were found among
over 2,000 children aged 10 and 11 (in their last two years of primary
school). When the same children were assessed at 14 and 15 years of age,
there were 15 cases of school refusal (representing a prevalence of 0.7%).
School refusal is equally common in boys and girls. No one socio-economic
group is particularly vulnerable.
Characteristic features
The child or adolescent either refuses to go to school or sets out for
school but returns home before or shortly after arriving at school. In some
cases, the child or adolescent explicit says that he or she is frightened
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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