Flying Under the Radar: School Reluctance in Anxious Youth

A subset of children with school refusal also have anxiety disorders. Though the combination of school refusal and anxiety in youth has been associated with a host of poor outcomes (Epstein and Sheldon in J Educ Res 95:308-318, 2002. doi:10.1080/00220670209596604; Birmaher et al. in Pediatr Clin North Am 45:1187-1204, 1998. doi:10.1016/S0031-3955(05)70069-9), little is known about youth with anxiety disorders who exhibit school reluctance. Youth with school refusal actually miss school, whereas youth who are school reluctant may want to avoid school but do attend. It is important to consider emotional and social functioning in youth with school reluctance, given that school reluctance may be common among anxious youth. Additionally, school reluctant youth may still exhibit significantly greater distress despite their school attendance than non-school reluctant youth. This study examined associations among school reluctance, somatic problems, social and emotional functioning, and anxiety severity in a sample of youth diagnosed with one or more anxiety disorders. Based on child self-report, school reluctant (SR) children exhibit greater loneliness and negative affect than their non-school reluctant (NSR) peers. Clinicians rated SR children as having greater anxiety severity than NSR children based on semi-structured interviews administered to each child. Additionally, SR children have greater somatic problems than NSR children according to parent-report. Results of this study suggest the need for parents, teachers, and clinicians to work together in the treatment of school reluctance in children with anxiety disorders.