Dr. Christopher Kearney, Ph.D. is clinical child psychologist, a Professor of Psychology and Director of the UNLV Child School Refusal and Anxiety Disorders Clinic. He has authored numerous articles about anxiety-based disorders and school refusal in children and is the author of the book Helping School Refusing Children and Their Parents: A Guide for School-based Professionals.

Q: Why is school refusal so important to know about?
A: People fail to understand that this is a serious problem that has a greater prevalence than other child behavior disorders, like ADHD or depression or substance abuse.

It's a much more common thing than those kind of problems and yet one that's particularly devastating to families. If you think about it there only certain basic things we expect our children to do. We expect them to go to sleep at night, we expect them eat their dinner and we expect them have some friends, to do well in school and go to school. And when they violate one of those it's highly disruptive to the family. It really messes things up in the family.

Q: Why is this no longer called "school phobia"?
A: School phobia is sort of the ancient term that was used to describe fear-based absenteeism. It was specific to a very particular kind of absenteeism; it referred to those kids who were sort of fearful of school. What we know now is that it applies to a very small minority of kids. Usually kids aren't going to say that they're afraid of X, Y or Z in the school, so the term got broadened over the decades to include a sort of anxiety-based absenteeism.

Q: When is school refusal most likely to appear?
A: The highest risk time is when kids enter middle school, so 10 - 13 years of age is the highest risk.

The next highest risk is anytime kids enter a new school building for the first time. So, if they enter kindergarten, if they enter middle school, if they enter high school or if they move from a rural area to an urban area and are entering an urban school for the first time. It can occur at any age.

Q: What are differences between school refusal and just refusing to go to school?
A: There is a subtle difference between school refusal and what I call school refusal behavior. School refusal essentially refers to anxiety-based absenteeism but school refusal behavior tends to include many different types of reasons including non-anxiety based reasons. So, for example, you may have high schoolers who ditch school at lunchtime  because they want to be with their friends. They're not particularity anxious about school, they're not looking to be home, they just want to have fun with their friends. That would fall into the category of school refusal behavior but not necessarily school refusal.

Q: What are some hallmark signs that parents should be aware of?
A: Certainly complaints about school and complaints about threats at school especially if they're not particularly legitimate. Somatic complaints, physical complaints especially vague untestable kinds of things like stomaches, headaches, abdominal pain and back pain. A lot of kids will have more obvious symptoms like diarrhea or vomiting.  Obviously any form of absenteeism, so if they're missing certain classes or chronically tardy.

Q: At what point should they seek professional assistance?
A: The general rubric we use as psychologists is whether it interferes with the child or family's daily functioning. Has it gotten to a point, for example, where the child's grades are suffering, where there's a lot of family conflict, where the parents are missing a lot of work, where the family is in legal trouble, or there's a lot of arguing that's going on?

You could have a problem that's lasted for four weeks but the family's managing it and that doesn't necessarily need clinical assistance and then you could have a problem that's only lasted a week that the family is being torn to shreds by. So we look at whether it's affecting the child or family's daily functioning.

Q: How can a school help a child?
A: Schools need to know what's going on because the last thing you want to do is have parents and kids implement something and it violates the school policy and blows up in your face. We have to work closely with school officials because if initially a child's been out of school for a while we institute a part-time schedule and we've got to work closely with the school to coordinate that. Sometimes school officials can develop a 504 plan or we'll work with school officials to ease the amount of makeup work a child has initially so they're not faced with a mountain of work when they get back.

We'll work with school officials about escorting a child from one class to another if they need greater supervision or with young kids if they're a flight risk. We'll set up sort of a quick depositing thing with parents if they're having a difficult time getting a child into the school building in the morning, we'll have  a teacher meet the child on the playground or meets the child and quickly escorts her to the classroom.

Q: What's the biggest problem you face when it comes to creating a plan to get a child back to school?
A: Too much acquiescence is the biggest problem. The default option should always be sending the child to school and to maintain that expectation. What happens is that parents get a little upset and a little lenient about staying home and kids realize "Oh, there's a lot of wonderful things I can do while I'm at home, I can play video games" and now the problem builds.  They're refusing school maybe not because of the all the anxiety problems but because of all the tangible rewards they're getting at home.

Kids will say "I'll go but I want to sit in the library all day, I don't want to go to class" and I'll say "that's great, I'll take that"  because it's better that they do that then be home all day. At least they're going to school, they're getting all the cues about going to school. A lot of times what will happen is they'll reconnect with their friends and if not, at least we've got them at a point where we've got them in the school.