For many parents, the first signs of school anxiety can be easy to overlook: a stomachache before the bus arrives, extra stalling while getting dressed, or a Sunday night that suddenly turns tearful. Early in the school year, these behaviors can seem like temporary resistance; for some children and teens, they can signal a growing pattern of anxiety and school avoidance.
School anxiety and avoidance encompass a range of emotional and behavioral responses that can emerge when school begins to feel overwhelming, from reluctance on school mornings to persistent difficulty attending. Without support, these patterns can become more difficult to break over time. With appropriate care, however, children and teens can make meaningful progress.
We spoke with Dr. Toni Boos, PsyD, Director of Child PHP and IOP Programs at Compass Health Center – Northbrook, about how school anxiety and avoidance can present in children and teens, how parents can distinguish these concerns from typical back-to-school nerves, ways they can support their child, and when it may be time to seek additional support.
This interview has been lightly edited for grammar and flow. The speaker’s original meaning and intent have not been changed.
Q&A
What Do School Anxiety and Avoidance Look Like in Kids and Teens?
Britt Teasdale: What do school anxiety and avoidance look like in daily life?
Toni Boos, PsyD: I always talk about it as a spectrum, because it’s helpful for parents to know there are early warning signs. It’s not always that a child has missed weeks or months of school. That’s the extreme end: a couple of days missed snowballs into a week or two, with outright refusal, maybe panic attacks, or just flatly saying, “I refuse to go.”
When school anxiety and avoidance are just getting started is where I like to focus with parents, because this is the best time to intervene or start noticing patterns. At this stage, kids are still getting to school every day, but at home you might see big emotional reactions in the morning. For example, it’s hard to wake them up; they keep hitting snooze; there’s a lot of stalling—they can’t find their clothes, can’t find their shoes, take an extra-long shower. These are also more passive refusal behaviors: You notice it’s taking more reminders, more effort, to get them through the morning routine.
In the middle of the spectrum, kids are getting to school but struggling to remain in class and with peers throughout the day. You might hear that they’re seeking out the nurse frequently, sometimes in a pattern, always during math, or gym, or lunch, which can point to specific stressors at certain times of day. Depending on school rules, kids may have access to a phone and be texting or calling to ask to come home. Similarly, they might report a lot of physical symptoms to the nurse or find ways to leave school early or miss portions of class or social time.
These are all signs that things could be moving toward outright morning refusal. I like to think of it as a continuum, because it helps parents see the earlier opportunities to intervene in small ways before it snowballs into a bigger issue.
Is Some School Anxiety Normal? How to Tell What’s Typical vs. a Warning Sign
BT: How much of this is typical, versus a sign that parents should really start paying attention? If a child or teen really doesn’t want to go to school one day, should a parent be worried?
TB: We’re always looking for patterns that become disruptive to daily functioning. A one-off, like the first day of school, is different. Developmentally, when kids are starting a more structured school day, like kindergarten, or shifting from elementary to middle school, some initial anxiety is normal as they adjust to longer separations from a caregiver.
After a day or two, once they’ve built some relationship with someone in the building, it should get a little easier, maybe not jumping-out-of-the-car happy, but quicker to regulate.
Some nervousness at the start of a new year is normal too; it’s a lot to adjust to. But if crying or clinginess persists for more than a week, especially after trying things like having staff walk them in, that’s a good time to start paying attention. I also recommend asking open-ended questions at home, like “What feels hard about being away from me?”
Ride out the first week or so, then assess whether things are getting better, staying the same, or getting harder.
Why Are Mornings the Hardest Part of School Anxiety?
BT: We hear a lot from parents that mornings are the hardest part of the day, and that the period right after school can be tricky too. Why do mornings seem to be so hard?
TB: Mornings are a real challenge. There’s a lot of uncertainty during a school day: not knowing if your usual seatmate will be on the bus, or who you’ll run into in the halls. That uncertainty is really the root of anxiety, the difficulty of tolerating not knowing.
As kids get ready for school, a lot of “what if” thoughts run through their minds. We talk a lot about anticipatory anxiety, the anxiety we feel before facing a stressful situation. We tend to overestimate the likelihood things will go wrong and underestimate our ability to handle stress, so kids may spend the morning anticipating everything that could go wrong that day.
That’s why we say the hardest part is just getting through the door. Anxiety peaks right before and as kids enter the building, and after about ten minutes inside, they usually start to feel better because their body catches up and realizes nothing bad is actually happening. Staying grounded in the meantime helps: focusing on breakfast, listening to music, or playing a game in the car like spotting certain colored cars, anything that keeps them in the moment rather than stuck anticipating.
We also see heightened anxiety the evening before, so I tell parents to watch out for Sunday nights. It can be confusing when an afternoon goes fine and then a child suddenly gets upset, but it’s often because they’re starting to anticipate the week ahead, and evenings have fewer distractions to pull them out of their thoughts.
Additionally, we see increased emotional dysregulation after school, since kids come home physically and emotionally tired, with a much smaller threshold for frustration. Especially early in the year, afternoons can be tough until kids re-acclimate, and that should settle down along with the morning anxiety.
School Anxiety in Younger Kids vs. Teens: What’s the Difference?
BT: Could you give an overview of how these symptoms might differ between younger kids and teens?
TB: There are real differences, but also some surprising similarities. With younger kids, we see more outward emotional dysregulation—crying, hiding, not wanting to leave the room, clinging to parents. In our lobby, we often see kids wanting a parent to walk them in and not wanting to physically let go.
With older teens, we see less separation anxiety, though it can still be present. The concerns shift from being away from parents toward social pressures, like becoming more aware of others’ judgment and navigating unstructured times like the moments at a locker before class, group work, or big social gatherings like assemblies. These experiences can be very anxiety-provoking and can lead to not wanting to be at school.
With older teens, anxiety can look more hidden: not waking up, taking a very long shower, or flatly saying, “I’m not going, I don’t like school,” without naming it as anxiety. It can look more like irritability or anger: getting mad at parents for waking them up, or withdrawing, which can resemble depression on the surface even when the root is anxiety.
One thing that’s consistent across age groups is somatic complaints like headaches, stomach aches, GI issues, and difficulty sleeping. These can be hard for parents to gauge: is this really a bad stomachache, or is it anxiety?
Is School Avoidance Always About School? What’s Really Driving It
BT: Is this really about school most of the time, or is something else going on that’s manifesting as school avoidance?
TB: It can be both. In practice, most children and teens with school anxiety and refusal have anxiety in other areas of life too—somatic symptoms are usually worst during the school week, but they can also show up before soccer practice or a friend’s birthday party.
School is often the first place we notice it, given all the uncertainty and stressors there, but it tends to bleed into other areas over time. If it starts affecting willingness to do extracurriculars, spend time with friends, be around family, go to restaurants, or attend religious services, that’s a good sign that more intensive intervention is needed.
Some students do struggle only at school, but that’s fairly rare in practice. More often, if it isn’t addressed early, it starts infiltrating other parts of life, too.
How Should Parents Respond to School Anxiety? Finding the Right Balance
BT: How should a parent respond if their child is having a hard time getting to or staying at school, or is experiencing physical symptoms? Is there a line between pushing them and giving in too much?
TB: Start with open-ended conversations about school: “Tell me about your day. What are the harder parts?” Get curious about their school world and identify specific stressors you could problem-solve together. If the bus is hard, for example, maybe you notice kids their age tend to sit toward the front and encourage them to try that. If you’re seeing these signs, it never hurts to ask if they’d want to talk with someone to learn coping strategies. Opening that door early can be a positive introduction to therapy, before things get really tough.
As for pushing too much versus not enough: in practice, things tend to go awry more often when we’re too lenient or accommodating toward the anxiety than when we push too hard. I rarely see a family putting too much pressure on a kid. More often, we’ve let a child avoid pushing themselves, which can get in the way of building resilience, problem-solving skills, and the ability to tolerate discomfort.
The best approach is to express confidence in your child’s ability to handle these things, while working together on what’s making the day hard and how to make it more manageable, without necessarily saying “you don’t have to go” or “you can skip math.”
What Is Family Accommodation, and How Does It Reinforce School Anxiety?
BT: What does accommodation actually look like in real life?
TB: I like to start with the definition, because I think it helps parents. Family accommodation refers to well-intentioned things we do to reduce our child’s distress. The more we do these things for them, or let them opt out, the more it backfires. It reinforces the anxiety and their difficulty tolerating distress on their own.
Common examples include letting a child avoid school or skip soccer because they’re anxious. There’s a difference between an occasional mental health day, which parents can absolutely offer during a rough stretch, and continuously allowing avoidance because “school is too hard right now, why don’t you just stay home.” The latter sends the message that you don’t think they can handle it.
Some parents say, “We’re not allowing them to stay home, but they’re outright refusing. What do we do?” That’s where natural and logical consequences at home come in, like tying screens and time with friends (which should be earned privileges) to being able to attend school that day. School refusal without any follow-up action is accommodation too.
Over-reassurance is another common form of accommodation. It can start small, like answering “Will you be home when I get back?” every single day, and if we soothe every anxious question in the moment, kids become reliant on us to manage their anxiety instead of learning to work through it themselves.
Accommodation also shows up as new family rules dictated by a child’s anxiety: not going out to eat, not taking trips, not having people over. When a family’s activities are shaped around minimizing a child’s anxiety, that’s a sign the anxiety is controlling how the family operates.
With teens especially, it’s easy to become their spokesperson, emailing the teacher or reaching out to the principal on their behalf. There may be a place for that, but the goal should be doing it together, so they learn to advocate for themselves, building skills that carry into adulthood.
What Does Treatment for School Anxiety and Refusal Look Like?
BT: If symptoms get severe enough that daily functioning becomes difficult, what does treatment for school anxiety and refusal typically look like?
TB: It depends on severity. In the early stages, weekly therapy is often a good starting point. A big piece school anxiety, avoidance, and refusal treatment is psychoeducation: teaching the child or teen about the anxiety cycle, and how, without other coping tools, we default to avoidance.
From there, we teach healthier coping skills like grounding and thought reframing, along with cognitive behavioral therapy, an evidence-based approach for school anxiety, and often exposure therapy. This involves identifying specific triggers and practicing facing them gradually, so the body learns to tolerate that anxiety. Something that felt hard the first time, like asking a question to an unfamiliar adult, gets easier with repeated practice.
Family and school involvement are also major components. If accommodation has crept in, therapy works to reduce it and increase expectations at home. This is hard: we’re asking kids to move toward doing the thing that feels difficult, which requires motivation. Kids need immediate, tangible incentives, like earning screen time by getting to school, because “you’ll feel better long-term” isn’t concrete enough for a still-developing brain.
We also work with schools to gradually reintroduce a student into the day, maybe starting with mornings only and adding time as confidence builds. The approach is always tailored to severity.
For students on the more severe end, I believe strongly in partial hospitalization and intensive outpatient programs, which provide comprehensive support in one place: skills teaching, daily practice, therapy, family support, school collaboration, and possibly medication management.
Final Advice for Parents Supporting a Child Through School Anxiety
BT: Is there anything we haven’t covered that you think is important, or any closing thoughts?
TB: I’d encourage parents not to be afraid to reach out to the school team earlier on. There’s often hesitation about sharing what tough mornings look like at home, especially if the child seems fine once at school. But the more the school knows, the more they can watch for warning signs too.
Feeling disconnected at school can be a risk factor for refusal. If a teacher or social worker is aware, they can check in, ask how the child’s day is going, and keep them on their radar. Schools can also get creative, like setting up lunch groups if a child is struggling to find people to sit with, even without a formal IEP or 504 plan.
I’d also encourage parents to keep having open-ended conversations with their kids about school, during dinner or car rides. Kids might roll their eyes at being asked daily, but those questions can still open the door to sharing more and give you insight into what’s hard.
Finally, no matter how tough things have gotten, there is a way through this. Supporting a child through anxiety takes consistency, and the limits you set can feel harsh. Having a therapist to check in with can help, since parents often need reassurance too.
It’s also worth knowing that things can get harder before they get better. When you hold firmer limits, you may see anxiety spike and more pushback, because you’re asking your child to confront it instead of relying on avoidance. If you’re in the middle of this work and it feels worse than when you started, that’s normal. Stay consistent, and it will get better.
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Bios
Toni Boos, PsyD, is a clinical psychologist and the Director of Child PHP and IOP Programs at Compass Health Center – Northbrook. She earned her PsyD from Adler University and has extensive training across therapeutic schools, partial hospitalization and intensive outpatient programs, developmental clinics, and public school systems. Toni specializes in supporting children and adolescents with anxiety and related challenges, with a particular focus on school anxiety and school refusal. She helped develop Compass’s targeted services in this area, including exposure-based interventions and individualized school re-entry support.
Britt Teasdale is a writer, photographer, and creative strategist. As Associate Director of Brand and Content at Compass Health Center, she has spent nearly a decade shaping narratives that translate complex clinical ideas into stories that resonate, reduce stigma, and help families access care. She holds a degree in Broadcast and Investigative Journalism, MFA in Creative Nonfiction Writing, and began her career as a reporter. She is also co-host of Compass’s podcast, You Only Know What You Know.
