School refusal behavior

About four percent of all school-age children and adolescents have difficulty attending school or simply refuse to go. Finding a solution to this problem has been difficult in part because these children exhibit a wide variety of behaviors and symptoms. Christopher A. Kearney, University of Nevada/Las Vegas, reviewed existing studies of school refusal behavior. Although these children were a mixed group, he found that a large proportion of them exhibited symptoms of depression.

Children identified as depressed were found to have higher levels of dysphoric mood, tearfulness, a sense of being unloved or unwanted, a sense of emptiness or isolation, self-denigration, suicidal preoccupation, loss of interest and energy, insomnia and exaggerated illness behavior. There appear to be two distinct subgroups: those with separation anxiety (often young children) and children and adolescent who fear failure or rejection in school. Recent research with adolescents who refuse to go to school indicates that approximately eight percent meet the criteria for major depression, while more than one-fourth of the sample score above normal for symptoms of depression.

Though the connection between refusing to attend school and depression may not be surprising, Kearney warns that current evaluation methods in schools often fail to identify the depressive symptoms of these children. He believes that educators need to be more alert to the possibility of depression in children who have difficulty attending school.

Kearney also found that almost 25 percent of the children in the study avoid school to pursue positive reinforcement at home. However, even children who receive positive reinforcement at home experience a buildup of tension and depression at the prospect of having to return to school and face classes, peers and teachers. To develop more effective treatment strategies, Kearney recommends that students who have difficulty attending school be evaluated for depression.


“Depression and School Refusal Behavior: A Review With Comments on Classification and Treatment”, Journal of School Psychology, Volume 31, pp. 267-279.

Published in ERN September/October 1993 Volume 6, Number 4.

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