School Avoidance
Avoiding school occurs in about 5% of all school-aged children and affects girls and boys equally. It is most likely to occur between ages 5 and 6 and between ages 10 and 11.
The cause is often unclear, but psychologic factors (such as anxiety and depression) and social factors (such as having no friends, feeling rejected by peers, or being bullied) may contribute. A sensitive child may be overreacting with fear to a teacher's strictness or rebukes. Younger children tend to fake illness or make other excuses to avoid school. The child may complain of a stomachache, nausea, or other symptoms that justify staying home. Some children directly refuse to go to school. Alternatively, the child may go to school without difficulty but become anxious or develop various symptoms during the school day, often going regularly to the nurse's office. This behavior is unlike that of adolescents, who may decide not to attend school (truancy, playing "hooky" (see Section 23, Chapter 271)).
School avoidance tends to result in poor academic performance, family difficulties, and difficulties with the child's peers. Most children recover from school avoidance, although some develop it again after a real illness or a vacation.
Home tutoring is generally not a solution. A child with school avoidance should return to school immediately, so that he does not fall behind in his schoolwork. If school avoidance is so intense that it interferes with the child's activity and if the child does not respond to simple reassurance by parents or teachers, referral to a psychologist or psychiatrist may be warranted.
Treatment should include communication between parents and school personnel, regular attendance at school, and sometimes therapy involving the family and child with a psychologist. Therapy includes treatment of underlying causes as well as behavioral techniques to cope with the stresses at school.
 See the sidebar What Are Stress-Related Behaviors?
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