What is 'SCHOOL REFUSAL'?

‘School refusal’ is a term commonly used to describe the reaction of children who experience severe anxiety and distress in relation to attending school, often resulting in prolonged absences. Children experience a range of psychological and physical symptoms, and in severe cases suffer with depression, self-harm and sometimes attempt suicide. School refusal is acknowledged as a multi-dimensional, dynamic and diverse emotional reaction, meaning each case is individual and complex to resolve.


Differing terminology has been used over time, since ‘absence from school due to excessive anxiety’ was first noted by Broadwin in 1932. Then in 1941 the term 'school phobia' was used by Johnson, et al to refer to: 'a type of emotional disturbance in children associated with great anxiety, that leads to serious absence from school'. Since then a variety of labels have reflected developments in thinking about underlying influences, including 'home-bound school absence' (Waller and Eisenberg, 1980); 'school refusal' (Berg, et al., 1969), 'extended non-attendance' (Pellegrini, 2007) and ‘emotionally based school avoidance' (West Sussex Educational Psychology Service, 2018). 


‘School refusal behaviour’ was defined by Kearney and Silverman (1999) as child motivated refusal to attend school and / or difficulties remaining in school for the whole day. This definition related to children who want to attend school, but stay at home due to fear or anxiety and in addition, their parents know they have remained at home. There are also children who do not attend because of defiant behaviour or disinterest in school, and their parents are usually unaware of this absence, this is referred to as ‘truancy’ (Berg, 1997). However, Kearney (2018) acknowledged that the concept of truancy is problematic, as many ‘truants’ avoid school for reasons other than delinquency or disinterest.


The high level of confusion concerning the terms ‘school phobia’, ‘school refusal’ and 'truancy’ highlights tensions that exist in defining the problem and appapportioningol athanathance;ortioningortioning cause or blame. For instance, Fortune-Wood discussed professionals’ reluctance to use the term ‘school phobia’ because;


It would admit that the problem is in the school rather than in the family. Instead ‘experts’ will tend to opt for the label ‘school refusal’, which denies that school is the problem, denies a medical label and instead puts the onus on faulty behaviour. 


Pellegrini (2007) suggests this variation happens because the problem has been 'conceptualised by different agencies' and so has tended to reflect the related clinical, medical or educational focus. In response, he suggests the term 'extended school non-attendance' would be preferable as a more neutral and less judgmental option to describe the problem.

 

The lack of an agreed standard term or definition can be said to restrict the identification of children requiring support, and cause misunderstandings about the reasons for school absence that effect approaches used to resolve the situation. The range of terminology creates obstacles for families in getting the correct support because the focus on 'within-child' explanations deflects attention from alternative factors. This is significant as Kearney and Silverman (1990) highlighted, the crucial issue in resolving school refusal is to identify the function and need behind the behaviour.  

TRIGGERS INCLUDE:

  • Academic pressures
  • Testing & assessment
  • Bullying (by child or adult)
  • Friendship issues or Social anxiety
  • Learning difficulties
  • Ineffective SEND support
  • Ineffective support for physical ill health (chronic and/or acute medical conditions)
  • Undiagnosed SEND or Physical Illness
  • Home related worries
  • Sensorial difficulties
  • Mobility difficulties
  • Navigating around school
  • Unstructured break times
  • Separation anxiety
  • Emotional development delay
  • Not feeling difficulties are understood or believed
  • Adolescent brain or hormone 
  • Trauma
  • Sexual Assaultdevelopment
  • Classroom disruption
  • Changes to routines or staffing

SOME RECENT RELEVANT RESEARCH

PROSECUTING PARENTS OF CHILDREN WHO HAVE MISSED SCHOOL


Epstein, R., Brown, G. & O’Flynn, S. (2019)

Epstein, Brown and O’Flynn carried out a study of parents, and in particular, mothers, who are fined or threatened with fines for their child’s non-attendance at school. Many of the children and young people who do not attend school regularly are on the autism spectrum, or have SEND and/or moderate or severe mental health problems.  Many have been bullied and have then become afraid of school and too fearful to attend.

There are parents, often of children on the autism spectrum or with anxiety disorders, who, try as they might, simply cannot get their children in to school.  Many have received repeated fines and threats of prison. The authors call for a change in the law, so that parents are supported, not punished, if their children cannot attend school.

This report contains moving testimony from parents affected by this cruel law. There is at the end a useful section ‘Sources of help’ with some addresses, especially about legal advice, that many may find helpful.

AUTISM AND ANXIETY


Parents often report that diagnosed or suspected Special Educational Needs are often the underlying cause of severe anxiety that leads to school refusal. As an example, Autistic Spectrum Disorders (ASD) are often linked to school attendance difficulties, as Preece and Howley observe: ‘given the nature of ASD and social anxiety, it is perhaps not surprising that some individuals are absent from school for extended periods and thus become disengaged from formal education.’ (2018:3). Munkhaugen, et al (2017) confirm this by explaining that cases of school refusal behaviour are significantly higher in children with ASD than in typically-developing students.


The influence of special educational needs that are inadequately supported in school holds current significance as The Driver Youth Trust researched SEN provision reforms in schools since 2010 (when the current SEND Code of Practice was introduced). Their Joining the Dots report (2015) found SEN provision is: fragmented, leading to difficulties in sharing information and knowledge. As a result, many children and young people do not receive the support they deserve […] Ultimately students, parents, schools and sector organisations have been finding it difficult to navigate the new system and this is standing in the way of the reforms’ success. 


This also means that when a child is school refusing with a possible link to SEN it is increasingly difficult to arrange appropriate support or provision to be put in place at school. Returning to the link with ASD, the National Autistic Society published a report ‘Autism and Education in England 2017’ which illustrates the difficulties found in organising SEN provision, as they make the following observations based upon responses to their survey:

  • More than 50% of autistic children say they are not happy at school
  • Fewer than 50% of teachers say they are confident about supporting a child on the autistic spectrum
  • 50% of parents waited more than a year for the right support to be put in place at school for their child
  • 42% of children are refused an education, health and care assessment by their local council on first request

Some of the comments made in responses include:

  • “Autistic pupils are probably the SEN group I need the most guidance with and have received the least guidance on” (a teacher)
  • “We are stuck in a system that wants the child to fail before help is offered” (a parent)

The failure referred to in the second comment relates to failure to attend or cope at school, or failure to learn and make progress.


A number of recent research studies have considered autistic children’s experiences at school. Many parents within support groups struggle with school attendance and are in the process of trying to arrange assessments and/or support for children on the autism spectrum. Further research is needed to consider the link between autism and school refusal, and how children and young people should be best supported when they struggle in school.


PREECE & HOWLEY (2018) found that factors contributing to positive outcomes for young people with ASD and high anxiety when they re-engaged with formal education were

  • the development of an appropriate learning environment
  • a focus on the individual
  • an eclectic approach
  • consistency
  • effective communication
  • effective collaboration.


Examples of Relevant research

Elliott et al 2017 Practitioner Review of School Refusal Since 2000 (pdf)

Download

Finning et al 2019 Anxiety and Attendance (pdf)

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Preece and Howley 2018 Anxiety, ASD and Attendance (pdf)

Download

Pellegrini 2007 School Non Attendance (pdf)

Download

Maynard-2015-Treatment of School Refusal (pdf)

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Nuttall and Woods 2013 Effective Intervention for School Refusal (pdf)

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Gregory and Purcell 2014 Extended School Non-Attenders Views (pdf)

Download

Baker and Bishop 2015 Extended Non Attendance (pdf)

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Sheppard 2009 Raising School Attendance (pdf)

Download

Supporting Mental Health Case Study Report (pdf)

Download

Wise Up Prioritising Wellbeing in Schools (pdf)

Download

Young Minds Fighting For Report (pdf)

Download

Wellbeing and SEN in Secondary School (pdf)

Download

Children Missing Education - Family Experiences (pdf)

Download

CAMHS What Really Matters in Children and Young People's Mental Health (pdf)

Download

SITES OF INTEREST

MQ

Our vision is to create a world where mental illness is understood, effectively treated, and ultimately prevented. With the help of our supporters and a global network of leading scientists we can make this a reality. Together we are championing and funding research into mental health that will change millions of lives.

School Refusal PHD Research

My blog features aspects of my current PhD research into Parent's Experiences of School Anxiety and Refusal.

The Conversation

The Conversation is an independent source of news and views, sourced from the academic and research community and delivered direct to the public.


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AUTISTICA

The UK's leading autism research charity.

We harness the potential of cutting edge science to improve the lives of everyone affected by autism by

  • funding and promoting groundbreaking medical research
  • improving understanding of autism
  • advancing new therapies and interventions

NAS Research

Our understanding of autism has developed a great deal over recent years, but there is still much work to be done. Researching and studying autism and related issues is vital, not just to understand the causes and effects of autism, but to make sure that autistic people receive the best possible support.

If you're researching or studying autism, our autism library catalogue is a great resource.

National Children's Bureau

By establishing a firm evidence base, we can help build sector understanding and inform best practice and government policy.

We do this by using evaluation and research to evidence the impact of services and explore how practice can be improved to meet the needs of all children and young people. Our team of expert researchers have worked with academic institutions and practitioners across the UK to build an evidence base in areas such as literacy in the early years, the impact of poverty on health and the emotional well-being of children in care.