Most children and adolescents go to school, even if they complain about it. But 10 percent to 15 percent of students are estimated to miss 10 percent or more school days each year, making them “chronically absent.” It’s a major challenge facing our schools today—and a big problem for the families of the children, too.

There are many reasons why students are chronically absent. Some have medical problems that keep them home. Some have parents who don’t make an effort to get their children to school in the morning. And a third group of children doesn’t go to school school because it’s too hard, academically, socially and/or emotionally. Those children fall into a category called “school avoidant.” 

At the Yale Medicine Child Study Center, we are experienced at treating the underlying issues that contribute to children avoiding school. 

“School avoidance is a more prevalent problem than many people realize,” says Eli Lebowitz, PhD, a Child Study Center psychologist. 

Lebowitz says that the school-avoidant category includes children who simply don’t attend school at all, some who rarely attend, and many who are under-attenders, skipping 10 percent to 20 percent of school days, which amounts to one or two days a week.

“One of the painful aspects of this problem,” Lebowitz says, “is the makeup of the group. School avoidance is linked to other factors, including coming from a disadvantaged background, having low socioeconomic status, and being a member of an ethnic minority.” If these students are missing school, it means that they’re not getting an education. They are at high risk of dropping out of high school, Lebowitz says, which makes it more unlikely that they’ll break the cycle of poverty into which many were born.

To understand why students stop going to school, it helps to examine the factors that make school a positive experience for others, Lebowitz says. 

“There are three main ‘hooks’ that keep kids going to school,” he says. “School gives kids the opportunity to do well in academics or at sports (or other extracurricular activities), or they may enjoy the social experiences. If you are a kid who doesn’t do particularly well in any of these areas—and that’s not so rare—the question is: "Why would you want to go to school?” 

For such children, attending school feels like being trapped in a job that they hate but aren’t allowed to quit, Lebowitz says.

Several factors can convert unhappiness at school into nonattendance, including a lack of structure and supervision at home or challenging family circumstances. But anxiety is often at the root of the problem.

Some school-avoidant children are anxious because they don’t do well in school, Lebowitz says. “Nobody wants to feel frustrated daily,” he says. “It’s painful for such students to be constantly graded and told their whole future depends on doing well—when they aren’t.”

Continuing the workforce analogy, Lebowitz says: “Nobody thinks that all people who are 30-years-old should have the same job. But, essentially, all 10-year-olds do have the same job. Human differences don’t suddenly emerge at 19, when you are done with school. They are there from day one. Whether the reason is ADHD or anxiety or learning differences, sometimes school just isn’t a good fit and in these situations, it’s easy to understand why a child would look for reasons not to go.”

A child’s anxiety can lead to school avoidance in other ways as well, says Lebowitz. Some children have severe separation anxiety and can’t tolerate being apart from their parents. Other anxiety-related problems that motivate children and teens to avoid going to school include social anxiety, phobias (such as of illness or germs) and obsessive-compulsive disorder, along with depression.

While middle school is often the time when children tend to become bold about missing school by claiming to be sick or playing hooky, Lebowitz says, there’s usually a clear pattern of poor attendance in earlier grades too. “For a lot of these kids, the first day that they are able to make a decision to be absent is an important day,” he says. “It’s when they suddenly learn that it’s possible to not go.”

Missing days becomes a self-perpetuating cycle, he adds. “It becomes more difficult when you do go back,” he says. “People start to ask questions. You fall further behind. So being absent is likely to promote more absence and now you have a real problem.”

It’s frustrating to be a parent in such a situation because the options are limited. As Lebowitz says, “You can pick up a 4-year-old and take him to school but not a 14-year-old.” Being insistent or confrontational doesn’t usually help either. “It then becomes a fight between two people—one that can escalate quickly, because the kid is the one who is willing to push harder,” Lebowitz says.

At the Child Study Center, we work with teachers, schools and families to help get school-avoiders past the problem and back to the classroom. The first step is to figure out what’s upsetting the student, because it’s rarely a simple matter of preferring a life without school. “That may be true with hard-core truancy,” Lebowitz says. “But most of the time, we find the child is worried, anxious, depressed and frustrated—all of which adds up to being terrified of going to school.”

Treatment is multidimensional and individualized. After identifying the root causes of a child’s anxiety, which might include family problems, learning disabilities, mental-health challenges (such as OCD or depression), or social issues such as bullying, a plan is developed to address the problems. “We tailor the intervention to the situation,” Lebowitz says. Examples of treatment include tutoring to help a teen catch up on classwork or counseling for students who struggle socially.

The resistant student takes part in psychotherapy, including cognitive behavioral therapy and, if needed, coaching to help him learn to handle difficult situations. An innovative computer program (like a computer game) may also be used to train the student’s brain to be less responsive to anxiety triggers. The parents are involved too. A psychotherapeutic approach, called SPACE (Supportive Parenting for Anxious Childhood Emotions), helps them to learn productive ways to handle a child’s anxiety.

We are widely known for expert diagnosis and treatment of all issues related to childhood anxiety. At the core of research and clinical care is an emphasis on treating the whole child, within the context of his or her environment. That’s of particular value to the treatment of school avoidance, because family dynamics and what’s happening at school fuel the problem.

Additionally, with longstanding expertise in treating the full spectrum of mental-health problems in children and teens, the Child Study Center is able to connect patients and their families to resources to address other related issues, such as anger, trauma and learning disabilities.

The Child Study Center works extensively with public and private schools throughout the state to address chronic absenteeism and also contributes to national research on this challenging issue. School avoidance is a symptom, not a diagnosis. Effective treatment must address the underlying issues and also motivate students to become interested and once again invested in building a productive future.