The Anxiety and Agoraphobia Treatment Center
There is Hope. There is Help.
Call: 610-667-6490
112 Bala Avenue
Bala Cynwyd, PA 19004

School Refusal


Although not a psychological condition itself, school refusal is a specific challenge facing many families that frequently relates to anxiety.  While many refer to school refusal as a “phobia” of school, in reality there are many factors that might cause a child or adolescent to avoid school.  These may include learning difficulties, fear of academic failure, perfectionism and fear of making mistakes, social anxiety, bullying, a general avoidance of discomfort, separation anxiety and/or a preference for the environment outside of school. 

A child exhibiting school refusal behavior may struggle to leave the house in the mornings, may engage in engaging in tantrums or “melt downs” and actively resist school. At times the child may leave the house easily, but consistently beg to stay home and experience much anxiety throughout the school day. He or she may also frequently miss school, leave early or spend large quantities of time outside of the classroom, either skipping classes or remaining in the nurse’s office or guidance office. At its most extreme, school refusal behavior results in complete absence from school. 

School refusal behavior can impact the child and family in several ways. It can cause increased conflict at home, generating stress for the family. It can interfere with the child’s social life, limiting interactions with peers and social opportunities. It can also impact academics, as decreased time in the classroom typically results in a loss of opportunities for learning. If left untreated, chronic absenteeism can result in failure or eventual school dropout.

Treatment of School Refusal:

At AATC, treatment for clients with school refusal is individualized. First, a thorough assessment determines the particular factors that are causing that child or adolescent to refuse school.  Then, a cognitive behavioral approach is specifically-tailored to that child’s unique needs.  This may include teaching a child new skills to reduce anxiety prior to and while attending school.  Children and adolescents are educated about anxiety and learn how to identify unhelpful ways of thinking related to their anxiety about school. They are taught cognitive and behavioral strategies to replace anxious thoughts with more helpful, accurate and rational ways of thinking.  Coping tools to manage feelings of anxiety and associated physical symptoms are also part of treatment. In addition, the therapist will work with the family to incorporate strategies to reinforce adaptive coping and eliminate inadvertent rewards for staying home. Treatment also includes gradual exposure, in which the child or adolescent gradually reengages in previously-avoided school activities, ultimately learning to overcome their fear or aversion to school.

There is also a supportive component to therapy that allows the child to discuss life stressors and concerns.  Parents are educated on the tools their child is learning so they can support a child’s progress outside of treatment.  With parent permission, our therapists will work with your child’s school, pediatrician, psychiatrist and other community providers as needed.  

Our focus is on treating the “whole child,” so issues other than anxiety may also be addressed in treatment. 

For more information regarding treatment for children and adolescents, or to schedule an initial evaluation for your child, please contact Dr. Lori Kasmen at (610) 667-6490 ext 21 or lkasmen@aatcphila.com