Key Issues in School Avoidance

Primary care physicians are often the first professionals to become aware that school avoidance is an issue for a child or adolescent. Many school avoidant children will complain that they fell ill, and parents will schedule them to see their physician. Assessing why a child is avoiding school can be a complex and difficult issue.

In the absence of an underlying physical cause, children avoid school for many reasons, ranging from a social phobia to truancy. Children may also avoid school because they are struggling academically, being bullied, or having conflict with teachers. Some children avoid school in order to obtain attention from parents, or spend more time in activities they prefer, such as video games. School avoidance has a negative impact on academic performance, and as the child or adolescent falls behind, the desire to avoid school can often intensify.

School avoidance should be treated as a symptom. The first step in addressing school avoidance is to understand the motivation behind the avoidant behavior. Is the child avoiding school to engage in more pleasurable activities, to avoid emotional distress, or manage some sort of unpleasantness such as a learning problem or bullying? In all cases the child should return to school as soon as possible while the underlying reasons for the school refusal are being evaluated. Support should be obtained from school administrators and counselors to facilitate the child’s or adolescent’s return to school. Temporary relief can sometimes be obtained by not having the child return directly to their classroom. Instead they may spend the day with a different teacher or in the counselors’

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