School Refusal 91herself feel happier and more secure when she has her child around
during the day. The child or adolescent may always have been perceived
as particularly precious or vulnerable, for example, having survived a
very premature birth, contrary to the doctors’ expectations.
3 Difficulty negotiating with outside agencies. For example, the family may find
it hard to liaise with the school to address bullying or academic stress,
or getting help for emotional difficulties.
Intelligence and attainments
As a group, school refusers are of average intelligence and academic ability.
Problems with schoolwork may be present but are not usually the main
factors leading to school refusal. Objective measures of attainment level
(from school tests or psychometric tests) are frequently useful, if only to
reassure the individual and the family.
Personality
The school refuser may have been a rather quiet conformist who had
relatively few friends and was easily ‘thrown’ by minor mishaps. On the
other hand, the previous personality may have been unremarkable or even
outgoing. There is commonly a history of previous separation difficulties
when first attending nursery or school.
Family composition
Family size is irrelevant, that is, there is no over-representation of only
children or children from large families. Youngest (rather than middle or
eldest) children are probably at greatest risk.
Differential diagnosis
1 Truantsstay away from school to engage in other activities without
parental permission. In many schools, this is the commonest cause of
non-attendance in the last year or so before adolescents are officially
allowed to leave school. In most cases truants spend the day in groups,
and their parents are unaware of their whereabouts. Whereas school re-
fusal is often secondary to an emotional disorder, truancy is often linked
to disruptive behavioural disorders. Unlike school refusal, therefore,
truancy is associated with the predictors of a conduct disorder: male sex,
social disadvantage, large family, parental criminality, marital discord,
poor school attainment, inconsistent discipline and lax supervision.
2 Some children are deliberatelywithheld from school by their parents,either
because the parents think school is useless or because they need their
child’s help. An ill mother, for example, may choose to keep one of her
children at home for company or to do the housework. The distinction
between withholding and school refusal is not always clear since the
parents of school refusers are often anxious themselves and may collude
with their child’s decision to stay at home.