School can’t (refusal)

School Can’t (refusal) for Parents/Carers – What do you need to know?

Trigger warning: this page mentions self harm and suicide. If you need support head over to the Australian Government’s Mental health and suicide prevention contact page.

And disclaimer – I am not an expert in school can’t be any means! School refusal is something I experienced as a child and something two of my children are also experiencing now, so I’m sharing my experiences and some of the information and research that I have looked into as well as information regarding the senate inquiry into the ‘National Trend of School Refusal and Related Matters‘ . If you are requiring support for school can’t – please chat to your GP, Paediatrician, Psychiatrist or psychologist and school staff and check out some of the resources listed HERE.

Summary of main points (if you don’t want to read the whole post!)

School can’t (which is my preferred terminology, so will be using this throughout this post) is another way of saying “school refusal,” “school avoidance,” “school phobia,” “attendance anxiety,” “anxiety-based school refusal” and/or “emotionally based school avoidance”.

School can’t comes under an umbrella term of “school attendance difficulties” is an “inability to attend school due to a severe negative physiological reaction to school.” It is a stress response. It is different to truancy (which is where children stay out of school and attempt to conceal this fact from their parents) and school withdrawal (where parents actively encourage non-attendance). In school can’t, the parents are aware and actively encouraging attendance at school.

The most prevalent populations of children and adolescents who experience school can’t are neurodivergent individuals, particularly Autistic and ADHD individuals and/or individuals with learning differences, such as dyslexia or dysgraphia. School can’t is also over represented in individuals with mental health challenges (including anxiety and depression) which often co-occur in the neurodivergent population.

Children aren’t pretending to have school can’t. Most children with school can’t, would like to go to school and they want to learn. However, they do not yet have the skills, supports or strategies in place that allow them to go to school without significant distress.

The most common factors that contribute to school can’t fall under 4 categories. These include a) Individual factors (such as anxiety or sensory challenges) b) Family factors (such as a recent divorce or a new baby) c) School factors (relational – such as teacher, staff and peer challenges & environmental – such as noisy classrooms, changes in routines) d) Policy/Procedural/Regulation factors (such as uniform policies, non-neuro-affirming policies/procedures) However, It is also important to know that the cumulative impact of all these experiences add up over time.

School refusal impacts the child or adolescent, their family, including parents/carers and other family members in multiple ways. This can include psychosocial challenges, financial challenges and more.

Parents, teachers, health professionals and schools need to work together to support our children and adolescents experiencing school can’t. The senate inquiry found that there needs to be a multi-tiered system of supports that include the individual, parent/carers, teachers and school community.

Research tells us we shouldn’t FORCE our children to attend school if they are having significant distress, however there should always be an expectation of learning and education.

There are ways of supporting our children with school can’t and resources that are available! I have also shared a little bit of my experiences that hopefully help.

My Story of school can’t

I hated the first 9 years of school.

From the outside there was no reason I should have. I went to a small and supportive school for K-2, then another even smaller school from years 3 – 12. I had lots of friends, was never bullied, got good grades and was a perfect little angel – so teachers liked me.

In primary school, I was also really good runner, always coming first or second in the 200m, 400m and 800m (not the 1500m cause that’s just too much running for my short little legs!!) And even in years 5 and 6, I was also our school debating captain. We never lost a debate.

But under all that achievement, I was a mess. I would constantly pretend to be sick (but actually felt really sick!) whenever my dad was home so I could stay home with him (he was a shift worker so often home during the day.)  My anxiety about going to school, looking back now through the lens of neurodiversity, makes perfect sense.

I was terrified of making a mistake and people not thinking I was “perfect.” (Interestingly performance anxiety and perfectionism are both linked to reasons why children can’t attend school). Above all though, I just wanted to be at home, cuddling my cat (Bambi was his name – named after Disney’s fawn Bambi, because he was a fawn colour) and feeling safe with my dad.

My absenteeism became so significant that in the end of year awards in year 6, I was “awarded” the ‘most sick days in the class’ certificate. (For real… don’t even get me started on how that made me feel, when I was presented that in front of my entire class at the end of year ‘pool party’.)

Due to never being at school, I didn’t complete a lot of assignments and the principal at the time told my parents they should repeat me. Oh as well as that I obviously just wasn’t “trying” and “I’ll probably never amount to anything”. I’m happy to say he was very wrong.

I will never forget the day my dad let me stay home again, after a morning of extreme internal anxiety, which showed itself with me feeling sick. My mum arrived home, made me get my uniform on, drove me to school and literally drag me into the primary area, into the classroom, sobbing and fighting. After my obvious distress and the fact that I had such significant school absence that year, I’m not sure how my teacher thought it was a good idea to give me an award for not being able to get to school – but that’s for another day!

By the time I was in high school I was severely depressed (again, I didn’t know this until I was in my 20s), severely anxious, masking constantly (i.e. pretending to be someone I was not to “fit in” or to “hide” my neurodivergent traits), and had so much difficulty with emotional regulation that I would self-harm often and was suicidal.

I don’t blame my mum for dragging me to school – parents, like children, I have learned as a mum (and am continuing to learn), do well if they can. I also don’t blame for my teachers being insensitive so-and-sos, they didn’t know better (I hope). Emotions and neurotypes weren’t discussed back then and weren’t honoured.

Thank goodness it’s 30 years on from that now, and schools are a much more inclusive, supportive and neurodiversity friendly place… or are they?

Well, apparently they are not. According to a senate inquiry conducted in 2022-2023 (and completed in August 2023) in Australia, into “The national trend of school refusal and related matters” school can’t is still a significant issue and actually it is only getting worse.

So here I find myself, again experiencing school can’t, but this time, from the parent perspective, not the child’s perspective. I have three incredible multiply neurodivergent children. I have a son, about to finish year 9, and two daughters, about to finish year 5 and year 4. My son doesn’t mind school – well he doesn’t mind the social part of school. He had school refusal as a pre-schooler, but he hasn’t since then.

My daughters on the other hand, have significant school can’t. They haven’t had a full day at school this term, and we are more than halfway through.

So let’s dive into a little learning about school can’t:

WHAT IS SCHOOL CAN’T?

School can’t is often most often called school refusal in the literature and research. However, school avoidance, school phobia, attendance anxiety of anxiety-based school refusal and/or emotionally based school avoidance are all describing the same thing. They are all ways of saying that a child or adolescent can’t go to school (or can’t remain at school for an entire day) due to the emotional distress it causes them.

My preferred terminology (and what I use throughout this post) is “school can’t”, as the child is not “refusing” to go to school, but showing that they “can’t” participate in school due to the emotional distress it brings. It is important to note that every child at some point will go through a period where school is challenging or difficult, and/or they may get emotional about going, but school can’t is much more significant.

The reality of school can’t, is that it’s an extremely challenging, multifaceted situation for everyone involved. It comes with a lot of emotional distress for the children and adolescent’s experiencing it as well as the parents/carers, siblings, extended family and at times, the school and teachers.

WHAT SCHOOL CAN’T IS NOT?

It is important to note that school can’t is NOT poor behaviour, manipulation, attention seeking or them trying to get out of learning. The child isn’t pretending to be distressed. This is a stress response to an overwhelming situation for the child.

I believe that “kids do well if they can.” (Thank you Dr. Ross Greene for this brilliant quote). Sometimes it can look like the child is “putting on” their emotional symptoms, but this is not the case. I truly believe that many of our neurodivergent children – two of mine included – aren’t able to do school well, because they don’t have the skills, support or strategies in place to do well – yet.

Both of my daughters become extremely distressed when we talk about attendance at school, to the point of having a panic attack, they have difficulty breathing, where they are literally shaking and vomiting. When the decision is made that we are not going to school that day, they will settle very quickly settle and be able to breathe again.

It honestly could look like they are putting this on, but I assure you they aren’t. Their body is in its fight/flight/freeze/fawn response because of the ‘perceived threat’ that school is ‘unsafe.’ Their response is because their brains are trying to keep them safe (from an actual or perceived threat) and when the decision not to go to school is made, their brain sends a signal that they are safe once again, and those emotional distress symptoms reduce or leave.

If we interpret our child or adolescent’s school avoidance as a cry for attention, we risk overlooking the genuine underlying issues that make school a challenging experience for them. More importantly, we may also fail to provide the crucial element of empathy, which is one of the most important elements of support our children required.

Who experiences school can’t?

The research tells us that neurodivergent individuals are significantly over-represented in the children and adolescents who experience (or have previously experienced) school can’t.

A study conducted by Connelly et al (2023) found 92.05% of children and adolescents with school can’t were identified as neurodivergent (by their parents). In order of decreasing prevalence, the following neurotypes/traits were most likely to have school can’t:

1. Autistic children and adolescents
2. Sensory processing difficulties
3. ADHD individuals
4. Children with learning challenges, such as dyslexia, dysgraphia and language difficulties.

It is important to note though, that these four conditions/traits can frequently co-occur, making the challenges our children face feel insurmountable.

This study then investigated other mental or physical health challenges within these populations. Anxiety was the most consistent factor that predicted school can’t, with 92.5% of children and adolescents who have school can’t had a diagnosis, or suspected diagnosis of anxiety. Demand avoidance (or as I like to call it a drive for autonomy) was also a contributing factor to school can’t.

Who experiences school can’t?

There are lots of studies and research that discussed reasons for children and adolescents not being able to attend school without significant distress. But it is important to understand, there is no one reason why children have school can’t.

There are multiple factors and each child’s reasons will be different. The other thing to remember as parents, is our children aren’t always aware of, or can articulate what makes school difficult. They just know it is and their body is telling them not to go!

In the table below are some of the most common factors identified in research and literature that contributes to school can’t.

Factors	Most common reasons for school can’t
Individual Child/Adolescent Factors	Mental Health Challenges: Depression and/or anxiety (Generalised & Performance anxiety are the most common, but separation anxiety or a specific school phobia is also common) Learning Challenges: Language and/or learning difficulties. Having a neurodivergent brain: Having a different way of regulation emotions, sensory needs and regulation differences (e.g. needing to stim, having painful experiences to loud noises, lights too bright etc), social problem solving or social communication differences, sleep patterns, executive functioning skills (such as planning, problem solving, working memory challenges). Personality: A quieter person, perfectionist, challenges with self confidence and esteem, someone who enjoys known routine, children who have negative self talk, prefers interest based or hands on learning. Previous experiences: Past negative experiences of or at school, specific school fears: such as a particular teacher, subject, event or expectation.
Family Functioning Factors	Family dynamics: Family conflict, poor communication and/or unpredictable, chaotic and unsafe family situations and/or families who do not share feelings & emotions, trauma history, stressful events (e.g. divorce, relocation, new baby). Parenting & Supports: Relationship conflicts, low perceived levels of caring, lack of support for family, challenges in morning, afternoon or evening routines. Parents/carers: Parent/carer mental health, poor self-efficacy, illness, limited involvement in education, limited coping or resilience factors.
School Relational Factors	Peer Relationships: Bullying, social isolation, exposure to aggressive peers, changes in peer group (e.g. new students, peer leaving), academic comparison, social interactions or exclusion at play and break times, peer conflicts (incl when not directly involved), peers negative perceptions of the students challenges or needs, no or minimal acceptance of neurodivergent behaviours Teacher-Student relationships: Teacher-student communication, teaching style, fairness & consistency, frequent changes of teachers, inconsistent responses or relationships with teacher/s, teacher’s emotional understanding and support, teacher- student bond, identification and response to distress, no or minimal acceptance and advocacy for neurodivergent behaviours
School Environmental Factors	School Environment: Frequently moving schools, frequent change within school routine, overcrowding, no or little sensory adaptations, homework demands, limited strengths based activities and classes. School Transitions: Entering into primary school or transitioning to high school. Routines: No or limited routines, frequent transitions, limited warnings of change to routine, limited warnings of change.
School Policy & Program Factors	Inflexible or non-neuro affirming policies: Inflexible attendance policies, lack of understanding of neurodiversity, adherence to neurotypical expectations and a one size fits all approach, strict uniform policies, strict technology policies. Academic Pressure: Heavy workloads, high expectations, rigid testing routines, praising and prizing academic achievement only, rigid grading systems. Behavioural & Disciplinary Programs/Policies: punitive or harsh discipline, lack of follow through on discipline policies, zero-tolerance policies,

It is important to remember each child experiencing school can’t there will be a combination and interaction of these factors. It is vital that we become curious about each child’s challenges not paint each child with the same brush.

Another reason that looking at all the factors is important, is because it shouldn’t ALL be on the neurodivergent child or adolescent to change! It is vital that we are not just looking at the child or adolescent as the one with the school can’t problem. There are always a mix of individual, environmental, community and societal factors that impact and it should not be left up to the individual child or adolescent alone to adapt.

Yes, we can definetly teach the child adaptive skills (such as stress reduction or mindfulness techniques), but we also need to change the environment, ways we interact with our children and embrace inclusive practices, to be more accepting and accessible for our neurodivergent children. This is how we truly embrace neurodiversity!

As an aside: It is important to know that there might also be a ‘one time’ incident that causes school can’t. This could be something like bullying, a traumatic incident or even abuse or assault. This is not what we are discussing in this blog.

However, If you think your child or adolescent has been a victim of a traumatic event head over to the Australia Institute of Family Studies website page: Responding to children and young people’s disclosures of abuse and/or contact the Child Protection Helpline on 13 21 11.

What are some common signs of school can’t?

Every child is different, and just like every child will have different factors contributing to their school can’t, every child will show different signs and symptoms. It is also important to know that researchers, such as Christopher Kearney (2018) believes that school can’t develops along a continuum. Most children don’t just wake up one day and refuse to go to school. There are often many signs early on, which increase and then turn into significant school can’t.

It’s important for parent/carers (and teachers) to be aware of these signs as early identification and supports is critical. The more a child/adolescent doesn’t attend school, the more likely it is they will end up not being able to return.

In my family we are at the point of outright school refusal, where my daughters are having panic attacks and other significant signs of distress when we talk about school. We are working with the school to be able to get them back to full days, but it’s going to be a long road.

When looking back at their school development journey, these signs didn’t come out of no where. When my daughters were in preschool (they are now in year 5 and year 4) they showed some mild-moderate signs of stress around school and I have spent years giving them ‘mental health days’ off and promising lunch orders or special dates with me to encourage them to go. I wish I recognised these earlier, as with most things, early intervention will reduce the more significant and longer term challenges, but hindsight, as they say, is 20:20.

The table infographic below outlines this continuum and some signs of stress your child might be showing you.

It is important to know that these signs of stress, are usually only related to school attendance and will often fade once they have left school or school attendance isn’t forced. If your child has these symptoms at other times or consistently, it is important to always get them checked out by a GP, Paediatrician, or specialist (even if you think it is just related to school) to rule out any underlying medical conditions or co-occurring conditions they may have (e.g. anxiety).

Some of the most common and significant signs of stress and distress can be mild changes (e.g. talking about how difficult school is), to severe and significant symptoms (e.g. self-harm and suicidal ideation). It is VITAL we are watching out for any of these signs in our children and seek help immediately if we observe them. Some of these are outlined below in the infographic.

THE IMPACT OF SCHOOL CAN’T

Research tells us that school can’t affects children and adolescents, as well as their family and peers in the short and long term.

Chockalingam et al (2023) conducted a systematic review of the literature and cited that some short term impacts of school can’t are: a breakdown in family and/or peer relationships, increased family conflict, social withdrawal, declines with academic performance and increased anxiety. Some of the long term impacts of school can’t are, reduced career opportunities, limited relationships, and even has an impact on a child’s intellectual development and mental health.

The longer a child is away from school, or experiencing significant school can’t, the less likely they are to re-engage in school.

The child or adolescent with school can’t also isn’t the only person that experiences significant distress in attempting to re-engage with school. Speaking from experience, which is also backed up by the research – the stress and emotional impact of the child’s school can’t, plays a significant role in a parent or carer’s mental health, distress/stress levels, perceived or actual parenting capacity and, as in our case, like so many other parents/carers, an inability to engage in paid employment.

Due to the impact and distress that school can’t can have, it is vital that neurodivergent individuals are commencing schooling with as many supports in place as possible, and as soon as the earliest signs of school can’t are identified, we need concrete plans and strategies in place to support them. These plans need to be implemented following collaborative discussions between the parents, carers, the child or adolescent, the school as well as any other professionals involved (such as their psychologist, occupational therapist or speech pathologist. This allows for everyone to be on the same page, and to determine what the best evidence based supports are available for each individual child.

What does the research/evidence say about how to help our children?

It is VITAL to understand that there is no, one size fits all set of approaches or supports for school can’t. It is vital to consider every factor, build a strong team around the child and family and put in individualised supports for every individual child or adolescent who has school can’t.

This is a significant and growing issue. So much so, that a senate inquiry was completed in 2022-2023 in Australia, into “The national trend of school refusal and related matters.” The report was handed down in August 2023 (full report here) which came up with 14 recommendations (read the full report to see all 14). Some of these, evidence based research supports, as well as my own ideas and suggestions for strategies based on my own, and my children’s school can’t (as well as what I had wished I had done earlier) are outlined below:


1. Early Identification and support is vital – but prevention is better than cure:

Since we know that neurodivergent children, and children with learning differences are more likely to have school can’t, it is vital that we identify these children early and put supports into place that will allow them to flourish at pre-school and school before any school can’t shows up – and act as a preventative!

Ensure we as parent/carer’s are aware of school can’t and what signs to look out for. Set up channels for communication between all individuals involved with the child and be open and honest with your communication. And trust your instincts! You know your children. It is very common for teachers or school staff to not be fully aware of what neurodiversity looks like in the classroom, and it may look like the child is coping well, when in fact they are hiding behind a mask.

2. Respond as SOON as you notice signs of school can’t.

It is much easier to put supports in place when the child is still going to school than when they haven’t been there for a while. Never assume that school can’t will get better without supports in place. This is highly unlikely and is most likely to only become more significant over time. Research tells us that FORCING children with school can’t to go to school can have significantly adverse effects, including exacebating mental health challenges and often can lead to more school can’t.

Talk to your child! Ask them to tell you what they like, or don’t like about school, or the best and worst parts of their day each day. This can give you a really good idea of any themes that are coming up. We actually do it around the dinner table sometimes (as well as “what was the most embarrasing thing that happened to someone you know today!”) which can get some good conversations going.

Listen without judgement and respond with by saying things like “ooh that sounds tough! Friendship can be hard!” or “Oh that would have been really embarrasing. I remember when I…” and share a story of when you were at school and something similar happened.

Find a clinical psychologist who is neurodiversity affirming and has experience with school can’t. This can be extremely challenging to find – but don’t settle for anyone! Find someone who aligns with your beliefs about what support your child or adolescent needs. If they don’t, you are always free to find another person! Cognitive Behavioural Therapy (CBT) is the most effective treatment (currently according to Elliot & Place, 2019) for school can’t – however, research shows that CBT alone is not enough. It must be paired with parenting supports, school accomodations and capacity building supports.

Contact the school and set up a meeting. Be real and honest and set up a team around your child. Let the school know exactly what is going on and work on a school attendance plan together. My daughters at the moment are attending for 1-2 hours each morning. They now have a teacher, and a teacher’s aide who is sitting with them to co-regulate with them. Don’t let the school tell you that they are “fine” at school. This happened for too many years with my children, despite us advocating for them and explaining what was going on.

Identify any cognitive or academic causes for school can’t. If your school has a school counsellor who is able to conduct cognitive and/or academic testing ask your teacher to refer your child to them. They will be able to investigate any learning challenges that may be contributing. If there isn’t a school counsellor, then chat with your GP to find a clinical psychologist who is able to assess your child’s learning strengths and challenges.

Have a strong plan in place for your child, which has been made collaboratively between your family, the school and any other professionals who are supporting them. Don’t feel pressure to just do what the school wants – we know our children and what they need.

Never shame or punish your child for school can’t. Remember, kids do well if they can. They are lacking skills or capacity to attend now. But adding punishment and shame onto their already challenged little self, we are making the problem worse, not better.

Keep up the expectation that they need an education, and that learning is important. Discuss what your family expectations and values are and what is going to happen. For me, I gave up my paid employment, and am working from home on my own business as that gives me the flexibility I need to be with my children. However, I have still informed them that my goal for them is to get back to full time schooling. This isn’t going to work for everyone. Some families are unable to support this financially and have to work. Others might decide that the school can’t is so significant that they will home school their children. There is no right answer to HOW children get an education… what matters is that they receive one, that aligns with what your family is able to do.

And finally – remember to take care of yourself!

Take care of yourself as a parent / carer – this is an extremely emotional, challenging and distressing situation to find ourselves in as parents and carers. We feel this mirade of competing emotions – we want our children to go to school to get an education, but want to prioritise their mental health. We want them to be “ready” for the world, but also want the world to change for them.

You are also important. It is ok, not to be ok. It is ok to cry. It is ok to ask for help.
Get supports for yourself in place and ensure that you are not pushing yourself to the point of not being able to cope or support your children. Research tells us that parents with children who experience school can’t are very likely to be neurodivergent and have anxiety or depressive symptoms themselves. Make sure you are looking after yourself. You don’t have to be a superhero… and you are definetly not alone.

There are lots of good resources and pages to follow when it comes to school can’t. I have listed some of my favourite’s below:

Some of my favourite resources to help you:

1/ Australian Government’s Mental health and suicide prevention contact page.

2/ The senate inquiry into the ‘National Trend of School Refusal and Related Matters‘ (August 2023).

3/ The School Refusal: Every School Day Counts is an online pdf made in collaboration with NSW Government, NSW School Link, Sydney Catholic schools and ais NSW.

4/ Spotlight on Girls with Autism. This is a downloadable PDF, made in collaboration with Yellow Ladybugs and The State of Victoria (Department of Education and Training) that outlines some of the challenges that Girls will have in the classroom and education setting. Although it is focussed on Autistic Girls, this can be used as a fantastic resource for any neurodivergent individual.

5/ School Can’t Australia page on Facebook

Remember – you are not alone.

References

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• Chockalingam, M., Skinner, K., Melvin, G. et al. Modifiable Parent Factors Associated with Child and Adolescent School Refusal: A Systematic Review. Child Psychiatry Hum Dev 54, 1459–1475 (2023). https://doi.org/10.1007/s10578-022-01358-z
• Connolly, S. E., Constable, H. L., & Mullally, S. L. (2023). School distress and the school attendance crisis: A story dominated by neurodivergence and unmet need. Frontiers in Psychiatry, 14, 1237052. https://doi.org/10.3389/fpsyt.2023.1237052
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• Hancock, K. J., Shepherd, C. C. J., Lawrence, D., & Zubrick, S. R. (2013). Student attendance and educational outcomes: Every day counts. Report for the Department of Education,Employment and Workplace Relations, Canberra. https://doi.org/10.13140/2.1.4956.6728
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