Child Anxiety Tales - School Refusal

What school refusal is

School refusal is an anxiety-based problem where a child struggles to go to school or to stay there for the whole day. It can look like morning stomachaches, tears at drop-off, calls home to be picked up, or flat refusal to get out of bed. It is different from skipping school to hang out with friends: kids with school refusal usually want to do well but feel unable to face school.

Psychologists Dr. Christopher A. Kearney and Dr. Anne Marie Albano developed a functional framework to address school refusal. It focuses on why a child avoids school rather than just the behavior itself. Using the School Refusal Assessment Scale, Revised (SRAS-R), professionals look at four core reasons behind school avoidance and build a plan that targets the reason that fits.

Four reasons kids avoid school

Many kids have more than one reason, and the reasons can change over time.

1Avoiding negative feelings or overwhelmed feeling that comes with demand

What it looks like: The child is overwhelmed by sensory issues, tests, or general distress.
What helps: Use gradual exposure to school and teach somatic relaxation skills.

2Escaping negative judgement or social situations

What it looks like: The child fears peer judgment, public speaking, or social interaction.
What helps: Focus on social skills training and cognitive reframing techniques.

3Separation anxiety, seeking comfort and/or connection

What it looks like: The child wants to stay near parents or caregivers for comfort and connection.
What helps: Train parents to set firm morning boundaries and routines.

4Seeking relief

What it looks like: The child stays home to play video games, watch TV, or sleep.
What helps: Remove daytime home privileges so staying home loses its appeal.

Key takeaway for families

Successful help starts with identifying the exact reason first. Treating a child who wants more time with a parent the same way as a child with severe social anxiety can backfire.

How the cycle keeps going

Each reason has its own cycle. Choose one to see how staying home keeps it going:

Leaving school or staying home brings quick relief from the distress, but it makes school feel harder to face:

How it is treated

Kearney and Albano’s cognitive-behavioral approach matches treatment to the child’s specific reasons for avoiding school, rather than using a one-size-fits-all plan. It has four core parts:

1Functional assessmentUsing tools such as the School Refusal Assessment Scale to pinpoint why the child is avoiding school.

2Coping and relaxation skillsTeaching deep breathing, relaxation exercises, and new ways of thinking (cognitive restructuring) to manage panic and physical complaints.

3Gradual return to schoolStep-by-step return-to-school plans, morning routine training, and attendance contracts, so the child practices facing school a little at a time.

4Parent and school teamworkParents, teachers, and school counselors work together to remove the rewards of staying home (like video games during school hours) and to support a smooth classroom drop-off.

What you can do today

Act early. The longer a child is out of school, the harder going back feels. Even a partial day is better than a full day at home.
Talk with the school. Ask the school counselor to help plan a calm drop-off, a safe person to check in with, and a step-by-step return.
Keep mornings predictable. Same wake-up time, same routine, and a short, warm goodbye.
Make home days boring. If your child stays home, keep screens, games, and treats for after school hours, so home does not compete with school.
Praise every step. Notice getting dressed, getting in the car, or staying through one more class.
Rule out medical causes with your pediatrician if physical complaints are frequent, then treat the anxiety alongside them.

Instead of"Fine, you can stay home today if you feel that bad."

Try"I know your stomach feels awful when you're worried. Let's get you to school, and you can check in with Ms. Lee at 10."

Free tools

Practice Ladder BuilderPlan a step-by-step return to school, from getting dressed to staying the full day.

Symptom CheckerA few questions to help you decide on next steps.

Tips from ExpertsPractical advice from child anxiety specialists.

Finding help

Get treatment with our team

The OCD & Anxiety Institute, founded by Dr. Muniya Khanna, offers evaluation and CBT with exposure for kids, teens, and young adults with anxiety and OCD, in person in Berwyn, PA and by video across Pennsylvania.

Book a free 15-minute call Visit The OCD & Anxiety Institute

Find a provider

Looking for care in person or outside of Pennsylvania? Start with a directory below.

International OCD FoundationProvider Directory Association for Behavioral & Cognitive TherapiesFind a CBT Therapist Anxiety & Depression Association of AmericaFind Your Therapist American Academy of Child & Adolescent PsychiatryFind a Psychiatrist American Psychological AssociationFind a Psychologist Substance Abuse and Mental Health Services Administration (SAMHSA)National Helpline1-800-662-4357

World map with pins for Coping Cat trained clinicians

Referral NetworkCoping Cat trained clinicians worldwideSearch by location or specialtyFind a clinician →

If you are unable to find a treatment provider through these or other websites, you can:

Contact the psychiatry department at a local medical school or a university psychology department.
Contact your county mental health department, a local hospital, or a community mental health center and ask about mental health clinics or staff psychiatrists.
Search through your insurance company for local behavioral health or psychiatry providers.
Search the American Psychological Association provider database.

Disclaimer: We do not endorse the references or providers listed. We list available resources as a service.

Where can I get immediate help? If your child is suicidal or in emotional distress, the 988 Suicide & Crisis Lifeline provides 24-hour, confidential support. In life-threatening situations, call 911 or go to the nearest emergency room. Call or text 988 Call 911

Books

School refusal

When Children Refuse School: A Cognitive-Behavioral Therapy Approach

by Christopher A. Kearney and Anne Marie Albano. The treatment approach described on this page.

Learn more →

Books for kids

A reading list for children and teens, organized by age.

Reading level 4 to 8 10 books

First Day Jittersby Julie Danneberg. Whispering Coyote Press, 2000.
Wemberly Worriedby Kevin Henkes. Greenwillow Books, 2010.
Scary Night Visitors: A Story for Children with Bedtime Fearsby Irene Wineman Marcus, Paul Marcus, & Susan Jesche. Magination Press, 1990.
I Don’t Know Why…I Guess I’m Shy: A Story About Taming Imaginary Fearsby Barbara Cain & J. J. Smith-Moore. Magination Press, 2000.
Into the Great Forest: A Story for Children Away from Parents for the First Timeby Irene Wineman Marcus. Magination Press, 1992.
Night Light: A Story for Children Afraid of the Darkby Jack Dutro & Kenneth Boyle. Magination Press, 1991.
Cat’s Got Your Tongue? A Story for Children Afraid to Speakby Charles E. Schaefer & Judith Friedman. Magination Press, 1992.
Outsmart Your Worry Tool Kit for Kids, Ages 5-11by Tool Kits for Kids, LLC, 2008.
Lions Aren’t Scared of Shots: A Story for Children About Visiting the Doctorby Howard J. Bennett. Magination Press, 2007.
Sometimes I’m Scaredby Jane Annunziata & Marc Nemiroff. Magination Press, 2009.

Reading level 9 to 12 8 books

Nobody’s Perfect: A Story for Children about Perfectionismby Ellen Flanagan Burns. Magination Press, 2009.
What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxietyby Dawn Huebner. Magination Press, 2006.
What to Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCDby Dawn Huebner. Magination Press, 2007.
Up and Down the Worry Hill: A Children’s Book about Obsessive-Compulsive Disorder and its Treatmentby Aureen Pinto Wagner & Paul A. Jutton. Lighthouse Press, Inc., 2004.
I Bet I Won’t Fret: A Workbook to Help Children With Generalized Anxiety Disorderby T.A. Sisemore. New Harbinger, 2008.
Outsmart Your Worry Tool Kit for Kids, Ages 11-18by Tool Kits for Kids, LLC, 2009.
Kissing Doorknobsby Terry Spencer Hesser. Laurel Leaf, 1999.
Blink, Blink, Clop, Clop: Why We Do Things We Can’t Stopby E. Katia Moritz. Weston Press, 2011.

For teens 5 books

My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panicby Michael A. Tompkins, Katherine A. Martinez, & Michael Sloan. Magination Press, 2009.
Outsmart Your Worry Tool Kit for Kids, Ages 11-18by Tool Kits for Kids, LLC, 2009.
Free From OCD: A Workbook for Teens With Obsessive Compulsive Disorderby T.A. Sisemore, 2010.
Perfectionism: What’s Bad About Being Too Goodby Miram Adderholdt & Jan Goldberg. Free Spirit Publishing, 1999.
Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way", and Parents Say "Way to Go"by John March, 2006.

Books for parents & caregivers

Books to empower those who support children and teens.

Anxiety 11 books

The Resilience Recipeby Muniya Khanna & Philip Kendall (2021). New Harbinger Press.
You and Your Anxious Child: Free Your Child from Fears and Worries and Create a Joyful Family Lifeby Anne Marie Albano, with Leslie Pepper. A Lynn Sonberg Book with Avery/Penguin Press, 2013.
The Coping Cat: Parent Companionby Philip C. Kendall, Jennifer Podell, & Erika Gosch. Workbook Publishing, 2010.
The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Themby Elaine Aron. Three Rivers Press, 2002.
Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries and Phobiaby Tamar Chansky. Broadway Books, 2004.
Freeing Your Child from Negative Thinking: Powerful, Practical Strategies to Build a Lifetime of Resilience, Flexibility and Happinessby Tamar Chansky. Da Capo Lifelong Books, 2008.
Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Childrenby John Dacey & Lisa Fiore. Jossey-Bass, 2001.
Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parentsby Andrew R. Eisen, Linda B. Engler, & Joan Sparrow. New Harbinger Publications, 2006.
The Worried Child: Recognizing Anxiety in Children and Helping Them Healby Paul Foxman. Hunter House, 2004.
Help for Worried Kids: How Your Child Can Conquer Anxiety & Fearby Cynthia Last. Guilford Press, 2006.
Helping Your Anxious Child: A Step-by-Step Guide for Parentsby Ronald Rapee, Susan Spence, Vanessa Cobham, & Ann Wignall. New Harbinger Publications, 2008.

OCD 3 books

Freeing Your Child from Obsessive Compulsive Disorder: A Powerful, Practical Program for Parents of Children and Adolescentsby Tamar Chansky. Three Rivers Press, 2001.
OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manualby John S. March & Karen Mulle. Guilford Press, 1998.
What to Do When Your Child Has Obsessive-Compulsive Disorder: Strategies and Solutionsby Aureen Pinto Wagner. Lighthouse Press, 2002.

Other guides

Last updated October 2026. This guide is for education and is not a substitute for an evaluation by a qualified professional. If your child is in crisis, call or text 988 or go to the nearest emergency room.

School Refusal: A Guide for Parents