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How we support young people struggling to attend school

School refusal is rarely about simply not wanting to go. A young person may become distressed before school, feel physically unwell, attend inconsistently or stop going altogether. We help them understand what’s making school difficult and what support may help them feel safer, more confident and better able to move forward.

At a glance

School refusal, sometimes called ‘emotionally based school avoidance’, describes the difficulties some young people experience around going to school.

It can develop gradually or happen quite suddenly, and usually involves significant distress around attending school.

Difficulties may be linked to anxiety, bullying, low mood, relationships, academic pressure, unmet SEND needs, sensory overwhelm or other experiences.

Physical symptoms such as headaches, stomach aches or nausea can also be part of the picture.

Understanding what’s making school difficult is often more helpful than focusing on attendance alone.

Questions parents and carers often ask

My child used to go to school happily. What’s changed?

Why do they feel ill every morning before school?

Could anxiety, bullying or unmet support needs be behind this?

Should I make them go even when they’re distressed?

Will missing school make things worse?

Can therapy help them return to school?

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A closer look at school refusal

Young people who experience school refusal have difficulty attending school because being there, or the prospect of going, has become extremely hard to manage emotionally. It can look very different from one young person to another:

Emotional signs | Dread, anxiety, panic, low mood, tearfulness, fear of particular situations or becoming very distressed the night before school.
Physical signs | Headaches, stomach aches, nausea, feeling sick or other symptoms that regularly arise in connection with school.
Changes in attendance | Struggling to leave home, arriving late, attending only certain lessons or days, frequently asking to come home or stopping school altogether.

There’s rarely one simple explanation. School may have become difficult because of bullying, friendships, academic pressure, fear of failure, separation, a difficult experience or changes taking place elsewhere in a young person’s life.

SEND can also play an important part. Autism, ADHD, sensory differences, learning needs or communication difficulties can make parts of the school day increasingly overwhelming, particularly if those needs haven’t yet been recognised or properly supported.

Sometimes school itself isn’t the whole problem. It may simply be the place where wider anxiety, low mood or emotional distress becomes most difficult to manage

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How Teenage Mental Health approaches school refusal

Young people can struggle to attend school for very different reasons. Rather than simply asking, “How do we get them back into school?”, we ask, “What has school come to represent for this young person?”

Therapy gives them a safe, independent place to talk about their experiences without feeling that the therapist is there simply to persuade them back into school. The focus remains on understanding what they’re going through and helping them to:

understand the situations, relationships or experiences that are making school difficult
recognise patterns in their anxiety or distress
put difficult feelings into words
find ways to manage overwhelming emotions or physical symptoms
rebuild their confidence around situations they have started to avoid
think about what changes or support might make school feel more manageable

How we work depends on the young person. But broadly, our therapists draw on psychodynamic psychotherapy, integrative therapy, play therapy and CBT-informed approaches.

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There isn’t one right outcome for every young person. Progress might involve gradually returning to school, putting additional support in place, recognising previously unidentified needs or exploring different educational settings.

Where appropriate, and with the young person and family’s agreement, we can also work with schools or other professionals to help build a fuller picture of what’s happening and what support may be useful.

School refusal can also place enormous pressure on parents and carers. Mornings can become upsetting and exhausting. We can help parents and carers understand what their child may be experiencing and think about how best to respond, while keeping therapy as a safe space for the young person.

Ultimately, the aim is to understand what’s made school so difficult and help the young person move towards an education and everyday life they can manage more confidently.

When extra support may be needed

Get help with support

It may be helpful to seek professional support if difficulties around school attendance are becoming more frequent, intense or difficult to manage, particularly if you notice your child:

becoming increasingly distressed or anxious about school
regularly getting headaches, stomach aches, nausea or other physical symptoms before school
attending less often or stopping school altogether
becoming increasingly isolated from friends or activities
experiencing significant anxiety, panic, low mood or hopelessness around school
appearing overwhelmed by sensory, social or academic demands
showing signs of needs that haven’t yet been recognised or supported
self-harming or having suicidal thoughts

If you’re concerned about suicidal thoughts or believe a young person may be at immediate risk of harm, seek urgent medical or emergency support.

Get help with support

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