Last reviewed 01/2018
These are multifactorial. - separation anxiety - the true problem may be a fear of leaving home rather than attendance at school. - specific fears - realistic or unrealistic; these can be fears of travel to school, social element at school like bullying, or particular features of school life like school assemblies, certain classes. - family dynamics - the child will not want to return to school unless he sees that both parents want this and are acting together to bring it about. Mothers with their own anxieties of separation may unconsciously keep a child at home as a companion. Fathers are often relatively absent from these families - Others - depression may be a cause of school refusal in older children/young adolescents. Early onset/young psychiatric disease should be considered eg schizophrenia. This is very rare.
Several factors may coexist. Different factors are more important at different ages. There are three ages when presentation is more likely. - 5 years - onset often acute, separation anxiety common - 11 years - precipitated especially by stresses of transfer to secondary school. - 14 to 15 years - consider depression and schizophrenia at this age although still rare.
Other precipitating factors are often found in the history and seem to have triggered off the problem, eg changes of address or school or class, illness in the family or the child, loss of a family friend etc.