Raising a child is hard, and it gets harder when they reach their teenage years. So, what do you do when you talk to your child's school, only to find that they haven't been attending? Or, what if they refuse to go to school in the first place? They don't go catch the bus, they refuse to get in the car, and you can't spend all day trying to coerce them into it or risk losing your job.

It can feel hopeless, and it feels no better for your teenager. School is vital, a critical component of academic development, but also an essential element of social and emotional health. Watching your child refuse to engage with what, to you, is their very future, is devastating.

Broadly, this is called school refusal. What is it specifically, what causes it, and how can you help your teen work through their problems and get them back on track?

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

Understanding School Refusal

School refusal is not a specific mental health diagnosis. Rather, it's a symptom of other underlying disorders, such as social anxiety, generalized anxiety, depression, PTSD, or even some kind of risk that school represents to them.

This is the first step: recognizing that school refusal is not a lack of ambition, laziness, defiance of parental control or authority, or a willful disregard of the future. It stems from a very real and very disruptive source in mental health.

School refusal isn't always an outright refusal to attend, either. It can also include difficulties in attendance or participation, centered around intense emotional and mental distress. Teens experiencing these emotions may exhibit symptoms such as:

• Physiological symptoms like headaches, stomach aches, or illness on school days, especially around important events.
• Symptoms of panic, meltdowns, tearfulness, and other examples of anxiety.
• Difficulty separating from caregivers (more common in younger children).
• Avoidance of school, either in general or centered around specific classes, settings, or even peers.
• Attendance difficulties; even if they get on the bus, they skip classes.

This goes beyond the understandable anxiety around big tests, the first day of classes, or major presentations. School refusal is a broader, more generalized form of anxiety centered around school and the specific triggers or causes within the school environment.

Most of the time, school refusal is obvious. Your teen doesn't want to leave their room, let alone the house. The thought of attending school causes immediate, impactful resistance. This isn't a case of going to school and skipping a few classes.

Only sometimes, where they know they have an avenue, will a teen pretend to attend school but never actually go. Even then, they're more likely to just come home, or go somewhere they consider safe; school refusal isn't about wanting to do something different or wanting to engage in risky behavior. It's about feeling miserable at the thought and seeking comfort instead.

What Causes School Refusal in Teens?

In teens, school refusal is most often related to generalized anxiety, but can also relate to trauma and PTSD, depression, or something more specific.

These days, a distressingly common source of school refusal is the news of a school shooting. Especially if it happens somewhere close, this kind of traumatic event can induce anxiety and PTSD in teens who fear it can happen at their school too.

Another somewhat common source is bullying. If your teen is having consistent negative experiences at school, and they have anxiety about more of those experiences happening if they attend, of course they aren't going to want to go. No one wants to put themselves in a situation where they know bad things are going to happen to them.

In rare cases, there can be more severe triggers centered around the school. Abusive teachers are a relatively uncommon cause, but it can still happen.

Other times, mental health disorders like anxiety and depression can make even relatively minor stressors from school much more affecting, such that your teen associates school with extreme negative emotions for seemingly unreasonable reasons.

High levels of social pressure, from peers, parents, educators, and others, can also lead to a dramatic fear of failure and underperformance, which spirals into anxiety and depression, leading to school refusal; if they can't face the prospect of failure and they are sure they're going to fail, it's better not to attend, in their mind.

This is also an area where undiagnosed or underdiagnosed issues can lead to school refusal. If your teen is neurodivergent in a way that they don't quite understand, but which causes friction in school, it can lead to school refusal. So, too, can sensory processing issues that make school inordinately difficult.

The teenage years are also a time of social upheaval, and your teen is likely exploring their boundaries and trying different experiences to better learn who they are. Some of those explorations can be viewed unfavorably by certain elements of their community ( gender and sexuality exploration is a big one in today's cultural climate, for example) and that can lead to additional stress.

As you can see, there are many, many possible causes, but they're all rooted in the same general source: anxiety, depression, PTSD, and similar mental health disorders.

How to Handle School Refusal in Teens

If you believe your teen is exhibiting the symptoms of school refusal, it's important to recognize that this isn't a passing feeling, laziness, or slacking off. It's a severe, near-debilitating form of anxiety.

Addressing the problem means understanding it, which is why we covered it extensively above. But understanding is only the first step. Here's what else you can do.

Hold a Close Discussion

The first thing you're going to want to do is talk to your teen. Sit them down and have a discussion with them about why they're refusing to go to school.

During this discussion:

• Validate their feelings. If all you're doing is downplaying what they feel or being dismissive of their feelings, you'll leave your teen feeling like they can't open up to you, and they won't be able to have a productive discussion with you about their feelings.
• Listen without judgment. Judgment simply doesn't help, regardless of what you may feel about how your teen is acting.
• Ask and listen. Ask your child what causes them stress at school, and why they're feeling bad about it. Is it social? Bullying, from a peer or teacher? Anxiety over academic performance? There can be many different reasons.

Depending on your past behavior and interactions with your teen over this issue, it may not be a productive conversation the first time you attempt it. It's important not to let your emotions get heated or to be dismissive of their feelings.

The results of this discussion will guide the direction you should take with addressing the issue. Most of the time, the issue can't be solved by addressing specific people or triggers within the school system. Though cases of targeted abuse do happen, it's a rarity and outside the scope of our discussion today. It's more of a matter for the legal system.

Seek Professional Assistance

Regardless of the source of the problem, school refusal has one thing in common: it's an outsized reaction to the stimulus. It's vanishingly unlikely that the cause of your teen's anxiety is something truly bad enough that they need to avoid school for their safety.

That means the best next step you can take is bringing your teen to a specialist. What you want is a psychotherapist who can provide treatment to teenagers with school refusal.

The two "gold standard" treatment options are cognitive behavioral therapy and exposure-response prevention therapy. Cognitive behavioral therapy is a form of talk therapy that helps identify and challenge unhelpful thought patterns, and develop healthier coping mechanisms and ways of handling those thoughts. Trauma release exercises are specific physical movements that, alongside elements of therapy, provide a sort of reset to the central nervous system.

Depending on the specific case, you may also work with a therapist for other kinds of treatment. For example, if the root cause of your teen's issues comes from a form of PTSD, then something like EMDR might be appropriate to help. Different people respond to different kinds of therapy in different ways, so it's important to work with a trained therapist to identify what is going to be most effective for your teen.

At BMC-Troy, we are fully equipped to provide all of these treatment options and more. Our staff specialize in a variety of different kinds of treatment and are more than happy to work with your teen to find the avenue to success they should follow. Feel free to reach out to schedule an assessment to help your teen get the assistance they need.

If your teen has more severe issues, another potential option is called the CAPHP; the Child & Adolescent Partial Hospitalization Program. This program, provided by the University of Michigan Health Center in Ypsilanti, is a short-term, intensive, outpatient mental health program. Your teen would attend daily sessions, where they undergo tailored therapy aimed at helping them progress and build skills, before returning home in the evenings to reset in a comfortable and familiar environment.

Work With the School to Address the Problem

Working with your child's school is also a good step to take. There are many different avenues you can take, with different goals and outcomes.

If the root cause of your child's issues relates to bullying, being singled out by a teacher, or another kind of targeted abuse, working with the school can bring it to the attention of administrators who can take action and help make the school environment better.

You can also work with the school to develop a specific treatment and accommodation plan.

504 plans are a common option. 504 plans are accommodation sets that you and the school agree on, which help address the specific needs of your child. This is the lowest level of the binding agreements you can come up with to use with the school, and provides ways for your child's primary stress points to be alleviated and barriers removed.

IEPs are a step above 504 plans. They're usually aimed at younger children, but anyone between ages 3 and 25 can be eligible for an IEP. IEPs for teens over the age of 13 must also include an individualized transition plan, which helps map out plans and goals for after high school.

Depending on your specific school, there may be other resources available. Talk to your school's administrator about your teen's needs and what resources and options are available to them.

You can also reach out and contact the Student Advocacy Center of Michigan. This organization helps provide assistance with all kinds of school underperformance and can be reached at 1.855.688.1916.

If it comes down to it, severe issues can even warrant alternative schooling options. Hybrid schools, alternative academies, and other options may be available depending on where you live and what your child qualifies for.

Helping Detroit Families and Teens

At BMC-Troy, we strive to provide as much assistance as we can to anyone in need of mental health services in the Detroit area. If your teen is refusing to go to school, you can contact us for a confidential assessment and a roadmap with appropriate therapy. If medication is warranted, we can help manage that as well.

To get started, you can call our office at 248.528.9000, or you can fill out our new patient intake form directly from the website. From there, we can schedule an initial assessment and figure out what steps to take next.

Your teen's academic career is a key part of their future, and the way they develop in their teenage years is going to shape the way they grow over time. Sometimes, to give them the best foot forward in life, you need to call in the professionals. Mental health treatment, therapy, and accommodations are a key part of this ongoing success.