School Refusal and Anxiety-Related Absences in High School

When a high school student keeps missing school because of anxiety, stomachaches, panic or dread, the best results usually come from getting help early and planning a gradual return, not from waiting for it to pass. Blackburn Clinical Services offers one-on-one therapy in our West Los Angeles office or by secure video (for clients located in California) for teens 13 to 17 who are avoiding school, with family sessions to help parents handle hard mornings. With your written permission, we can work with your teen’s school on a return plan.

What school refusal looks like in teens

School refusal, sometimes called school avoidance, is not the same as cutting class for fun. The teen usually wants to be at school but feels unable to go. The American Academy of Child and Adolescent Psychiatry notes that physical complaints such as headaches or an upset stomach often appear just before school and fade once the student is allowed to stay home. In high school it often looks like:

• frequent visits to the nurse, or texting to be picked up early
• missing first period, or arriving late most days
• Sunday night dread and Monday absences
• staying in bed, refusing to get dressed or locking themselves in the bathroom on school mornings
• falling further behind, which makes going back feel even harder
• avoiding specific classes, tests, presentations or people

The causes vary: social anxiety, panic attacks, depression, a conflict with friends or a teacher, bullying, an undiagnosed learning or attention issue, or simply being so far behind that school feels impossible. In a small private school, a falling out with friends or embarrassment in front of a class can feel especially hard to escape.

What parents can do this week

• Keep the expectation of school. Stay warm and calm, and keep the message that going to school is the goal, even if it is only part of a day.
• Check in with your pediatrician to rule out a medical cause for recurring physical symptoms.
• Make home days boring. If your teen is home during school hours, keep screens, games and outings off until the school day ends.
• Ask what is hardest. A specific class, the hallway, a person, the morning itself. The answer shapes the plan.
• Start small. Getting to school for one class, or arriving at lunch, is a real step. Praise it.
• Get help early. AACAP notes that earlier help generally leads to better outcomes. Call for an assessment rather than waiting for the next semester.

When and how to involve the school

Private and independent schools each set their own attendance rules and support options, and many have a counselor, learning specialist or dean who can help. Involving them often makes a return plan work: a modified schedule, a quiet place to go when anxiety spikes, a trusted adult to check in with, or help catching up on missed work. With your written permission, we can talk with the school about what will help. When clinically appropriate, we can provide documentation for your teen’s school. Counselors can learn more at for school and college counselors.

If you prefer to keep things private at first, that is your choice. We can begin therapy and revisit the question as your teen improves.

What therapy at Blackburn looks like

• An assessment of what is driving the avoidance: anxiety, mood, learning, social stress, substances or sleep.
• One-on-one therapy in our office or by secure video for clients located in California. CBT, which AACAP describes as having the strongest support for school refusal, helps teens face school in manageable steps and handle anxious thoughts and physical symptoms.
• Family sessions to plan mornings, reduce arguments and agree on how parents respond when their teen says they cannot go.
• More support if needed. For teens who are out of school for weeks, the Blackburn Concierge Outpatient Program offers typically 3 to 5 hours a week of one-on-one therapy, with no groups. Psychiatric care can be arranged if medication may help.
• Testing when a learning or attention issue may be part of the picture: see ADHD and neuropsychological testing.
• Hours: Monday to Friday, 9 AM to 5 PM. Because the goal is more time in school, we try to schedule sessions in ways that protect class time.

If worry shows up well beyond school mornings, see teen anxiety treatment in Los Angeles, and if your teen has sudden surges of fear, read teen panic attacks: what helps.

When to get urgent help

If your teen is in danger right now, call 911. If your teen talks about wanting to die, is harming themselves or you are worried they might, call or text 988 to reach the 988 Suicide and Crisis Lifeline, any time of day. You can call 988 as a parent, for advice about what to do next.

Questions

How many missed days is too many?

There is no magic number. If anxiety, physical complaints or dread are keeping your teen home regularly, or they are falling behind, it is time to get help. Earlier help generally works better.

Should I make my teen go to school when they are panicking?

Forcing it without support can backfire, but letting avoidance grow usually makes it worse. A gradual plan, built with a therapist and often the school, is the most reliable path back.

Will you contact my teen’s school?

Only with your written permission. Some families want the school involved from the start; others prefer to wait.

Can you write something for the school?

When clinically appropriate, we can provide documentation for your teen’s school, shared only with your written permission.

What if my teen refuses to come to therapy too?

That is common. Parents can start with a session of their own to learn how to respond at home, and many teens join once they feel less pressured.

More for families: therapy for private school students, anxiety treatment and signs of teen depression parents miss.

Get started

You can also email info@blackburnclinical.com or contact us. Parents usually make the first call; your teen does not need to be on the line.

Sources

• American Academy of Child and Adolescent Psychiatry: School Refusal
• 988 Suicide and Crisis Lifeline