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School Refusal

School refusal (SR) can be a symptom of many different problems, including an anxiety disorder, depression, poor social skills, oppositionality, or academic difficulties. Anxiety disorders are the most common reason that elementary aged children refuse school. Many children who refuse school complain of feeling sick rather than of feeling anxious, and often feel sick every day. Parents may engage in fruitless medical testing for GI disorders or other maladies only to be told that there is no diagnosable or treatable condition. Children and teens who engage in school refusal often find it most difficult to return to school after long holidays, 3 day weekends, or legitimate absence due to illness.

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Successful treatment of SR includes four main components. These components include functional assessment of the school refusal, cognitive behavioral treatment, parent management training, and school consultation.

A functional assessment will be conducted to determine the nature of the avoidant behavior (the function), and to provide diagnostic clarification. The cognitive behavior therapy consists of psychoeducation, coping skills training, and gradual exposure (imaginal, virtual, and direct) to situations that the child fears. Parent management training is provided to educate care givers on evidence-based skills and techniques that can be utilized to help reduce the child’s experience of anxiety and to improve school attendance. Finally, the Anxiety Center team will be in close contact with the child's school team to provide consultation on accommodations and supports that can be readily implemented in the school setting to assist in rapid reintegration.

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