Understanding and Addressing School Avoidance with CBT

Sarah

Hey everyone, welcome back to The Well: Your Parent Resource Library. I'm Dr. Sarah Olivo, and today I'm joined by Dr. Karen Mitchell. Today, we’re taking on something that comes up a lot—school avoidance. It’s way more common than people realize, and honestly, the reasons behind it are more complicated than just “my kid doesn’t want to go to school.” Karen, you’ve probably seen this play out a few different ways in your years consulting with schools, right?

Karen Mitchell

Absolutely, Sarah. There's this huge spectrum—from those “Ugh, do I HAVE to go?!?” moments on a Monday morning, all the way to kids who are chronically refusing to attend for weeks or months. And sometimes, adults use all sorts of terms—school refusal, school phobia, just plain skipping—and I think it helps to actually define what we’re talking about. So, school avoidance is a pattern, not just a one-off event, right?

Sarah

Exactly. The way professionals look at it is as anything from mild reluctance—like not wanting to go back after winter break—to a more chronic, disruptive refusal. And what’s wild is that, technically, school avoidance isn’t even a diagnosis in itself. It's more like, “Here’s a kid who’s really struggling to participate in school for one—or more—underlying reasons.” And these reasons? There are actually four main ones. Let’s break them down.

Karen Mitchell

So the first two are all about escaping things that feel bad. Some kids avoid school because they want to get away from negative emotions—like anxiety, stress, sadness. Maybe they get stomachaches on test days or feel panicked about crowded hallways. Second, there’s escape from social situations—like kids with social anxiety who dread group projects, or worry everyone’s staring at them.

Sarah

Which is so easy to miss, because sometimes kids just look like they’re being oppositional, when really, their fight-or-flight is going off. Then, the third function is attention-seeking. This is the kid who stays home for comfort or closeness—classic separation anxiety. And the fourth is all about tangible rewards. Like, “If I stay home, I get to play video games or sleep in instead of dealing with school.”

Karen Mitchell

Right, and this fourth one is surprisingly common, especially as kids get older. There’s a lot of creativity when it comes to avoiding school!

Sarah

Oh, 100 percent. I have to admit, I’ve seen a little of that in my own house. My daughter, after spring break, suddenly started talking about how “sick” she felt every morning. At first, you know, my clinical brain kicked in—am I missing school avoidance here? But sure enough, after a couple of days back and reconnecting with friends, she was fine. That kind of transient stuff is totally different than the chronic pattern—one’s typical, the other’s something you wanna catch early.

Karen Mitchell

I think a lot of parents out there will relate to that. One bad Monday isn’t school refusal. But when those mornings keep happening—if there’s a pattern, missed days, or school performance starts to tank—that’s when we, or the schools, should look at what’s really driving it. And, it can have some real consequences, both short- and long-term, if it’s not addressed. But even before it gets to that point, understanding those four functions behind school avoidance can help parents and teachers respond to what’s actually going on, not just what they see on the surface.

Sarah

Absolutely. And knowing those underlying reasons—escape from bad feelings, escape from social stuff, getting attention, or chasing rewards—really matters, because the solutions look super different depending on what’s driving the avoidance. So, let’s dig into some of the evidence-based CBT strategies and practical ideas families and schools can start using. Because, trust me, there are things that work.

Sarah

Alright, so when it comes to actually helping kids get back to school—CBT, or Cognitive Behavioral Therapy, is the gold standard. It’s all about breaking avoidance patterns by making school feel safe and achievable, one small step at a time. And when I say step-by-step, I mean it literally. Sometimes, we’re talking about a fear hierarchy—like, what’s the smallest part of school they can handle, and then working up from there.

Karen Mitchell

Yeah, so maybe for one child, just getting in the car is the first win. For another, it’s walking into the school building, even if they sit in the nurse’s office for a while. Each gradual exposure is paired with loads of praise, and often, some kind of reward. And one thing that stands out in the research—and in my experience—is the absolute necessity of routine. Kids need to know what to expect, every single day.

Sarah

Totally. And I love routines not just as a psychologist, but—like, as a tired mom who needs to make mornings less chaotic. A simple morning routine checklist—like, “Get dressed, eat breakfast, pack bag, out the door”—it sounds almost too basic, but it helps anchor the day, removes extra decisions, and makes room for consistent expectations.

Karen Mitchell

And it lets you catch those little victories. “Great job brushing your teeth!” “Thanks for getting your shoes on by yourself!” Those are tiny things to an adult, but they’re big for a kid who’s anxious or avoiding.

Sarah

Right. And this is where the parent role is so critical. We want to give clear expectations—school attendance isn’t optional—but we also try to “empathize and encourage.” I use that phrase probably fifty times a day. Say, “I know it’s tough, but you can do it.” Even if your child is digging in, you gotta avoid letting that sympathy turn into accommodating the avoidance—don’t email the teacher for them, don’t let staying home mean extra screen time, that kind of thing.