When Your Child Says “I Can’t Go to School,” What Do You Do?
The stomach ache is real. The nausea is real. The fear is real. But does feeling awful mean a child should stay home?
School avoidance can leave adults stuck between two fears: pushing a child who genuinely cannot cope or accidentally strengthening the anxiety that keeps them from going.
In this episode of Overpowering Emotions, Dr. Caroline Buzanko breaks down what may be happening underneath school avoidance and why the behaviour you see in the morning may only be the end result of a much bigger problem.
Dr. Caroline explores how anxiety can create very real physical symptoms, why neurodevelopmental differences and sensory overload need to be considered, and how the brain can quickly learn that escaping school brings relief. She also explains the important difference between removing an unnecessary barrier and removing every source of discomfort.
You’ll learn why regulation should lead to movement, how to validate a child’s experience without reinforcing avoidance, why predictable drop-off routines can help, and how to choose a manageable next step that builds capacity.
You’ll also hear six practical strategies for difficult school mornings, including what to say when a child tells you their stomach hurts, how to reduce unnecessary sensory load, why long goodbyes can make separation harder, and what to praise when a child approaches something difficult.
Kids do not need to feel completely comfortable before they can move forward. They need repeated experiences that teach their brain: I felt scared, I did something hard, and I handled it.
Listen now to learn how to respond to school avoidance with compassion, confidence, and a focus on building a child’s capacity to approach hard things.
Dr. Caroline specifically describes the prediction-making brain, how relief from escaping school can reinforce avoidance, and why participation should build the child’s experience of “I can handle this.”
Homework Activities
The School Avoidance Pattern Map
For one week, track when physical symptoms or distress appear rather than immediately trying to explain them.
Write down: when symptoms start, what happens immediately before them, whether they appear on non-school days, what the child is anticipating, what happens when they stay home, and how quickly symptoms change after the demand is removed.
Dr. Caroline stresses that these patterns provide useful information about what the brain may be anticipating.
Find the Unnecessary Load
Ask: What is making school more expensive for this child than it needs to be?
Look for noise, lighting, hunger, clothing discomfort, chaotic entrances, rushed transitions, sensory demands, social pressures, learning difficulties, or executive functioning demands.
Choose one unnecessary load you can reasonably reduce without removing the main approach goal.
Dr. Caroline gives options including quieter entry, arriving before the rush and noise-cancelling headphones when there is a genuine sensory need.
Choose One Approach Goal
Don't make the goal “have a perfect school day.”
Choose the smallest meaningful step.
It could be entering the building, unpacking a backpack, completing work in the library, staying with a designated staff member, or entering the classroom.
The step should create some discomfort but remain within the child's window of tolerance.
Create a Drop-Off Script
Choose one short, predictable goodbye and practise using it consistently.
Dr. Caroline’s example is:
“I love you. Ms. Chen is here. I’ll see you after school.”
Avoid adding repeated questions, extra hugs, reassurance, negotiations, or checking whether the child feels ready.
Change What You Praise
For one week, intentionally praise approach rather than absence of anxiety.
Instead of:
“See? There was nothing to worry about.”
Try:
“Your stomach was hurting, and you still walked through the door.”
Dr. Caroline specifically recommends reinforcing the difficult action the child completed rather than teaching them that success means anxiety disappeared.
Resources:
Cummings, K. K., Jung, J., Zbozinek, T. D., Wilhelm, F. H., Dapretto, M., Craske, M. G., Bookheimer, S. Y., & Green, S. A. (2024). Shared and distinct biological mechanisms for anxiety and sensory over-responsivity in youth with autism versus anxiety disorders. Journal of neuroscience research, 102(1), e25250. https://doi.org/10.1002/jnr.25250
Johnsen, D. B., Lomholt, J. J., Heyne, D., Jensen, M. B., Jeppesen, P., Silverman, W. K., & Thastum, M. (2024). The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial. Research on child and adolescent psychopathology, 52(9), 1397–1412. https://doi.org/10.1007/s10802-024-01196-8
Metin, B., Tas, Z. C., Çebi, M., Büyükaslan, A., Soysal, A., Hatıloglu, D., & Tarhan, N. (2018). Reward Processing Deficits During a Spatial Attention Task in Patients With ADHD: An fMRI Study. Journal of attention disorders, 22(7), 694–702. https://doi.org/10.1177/1087054717703188
Munkhaugen, E. K., Torske, T., Gjevik, E., Nærland, T., Pripp, A. H., & Diseth, T. H. (2019). Individual characteristics of students with autism spectrum disorders and school refusal behavior. Autism : the international journal of research and practice, 23(2), 413–423. https://doi.org/10.1177/1362361317748619
Sung, J. Y., Mumper, E., & Schleider, J. L. (2021). Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation. JMIR mental health, 8(7), e29538. https://doi.org/10.2196/29538
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Want to learn more about helping kids strengthen their emotion regulation skills and problem-solving brains while boosting their confidence, independence, and resilience? Check out my many training opportunities! https://drcarolinebuzanko.com/upcoming-events/
