Is it School Refusal or Truancy? A key diagnostic question for your school refusal cases - With Dr. Wilfredo Rivera

By Wilfredo Rivera-Pérez, Psy.D., Licensed Psychologist

Illustration - The New York Times

As a new school year begins, more children are struggling to make it through the school doors. Some cry, complain of stomachaches, others cling to parents, or shut down entirely.  

This isn't just about "not wanting" to go to school - for some students, it's a sign of school refusal, a complex emotional issue that can seriously affect their development and mental health. 

But here's the challenge: how do we know when a child is emotionally unable to attend school versus choosing not to go? 

Understanding the difference between school refusal and truancy is critical because they require very different types of support.  

Misunderstanding the root cause can lead to ineffective responses, more distress for the child, and growing frustration for families and schools. 

Illustration - The New York Times

At NBI, we use research-backed tools to help families and educators make this important distinction. Here are three key factors we look for: 

1. What the child feels about school 

• School refusal involves real, often intense anxiety. These students typically wantto attend but feel overwhelmed by emotional distress, panic, or physical symptoms like headaches or nausea. 

• Truancy, in contrast, usually involves little distress. The student may skip school without much worry - and often tries to hide their absence from parents or caregivers. 

2. Where the child is during school hours 

• Children with school refusal usually stay home, often with a parent aware (even if reluctantly). The home feels like a “safe zone.” 

• Truant students are often out in the community, engaging in unsupervised or risky behavior, and parents may not even know they’re missing school. 

3. What else is going on emotionally or behaviorally 

• School refusal frequently co-occurs with anxiety, depression, or obsessive-compulsive behaviors. 

• Truancy is more commonly associated with oppositional or defiant behavior, and in some cases, conduct issues. 

How common is school refusal? 

More than 25% of children in the U.S. will refuse school at some point, especially during major transitions like starting kindergarten, middle school, or high school. But persistent school refusal - where fear or emotional pain keeps a child home for extended periods - affects about 1 to 5% of students. 

That means in any school community, you likely know a child going through this right now. 

Why this matters 

If left unaddressed, chronic school refusal can lead to long-term challenges - including social isolation, academic struggles, family stress, and increased risk for mental health and substance use issues in adulthood. 

That’s why early identification and the right support matter so much. 

At NBI, we partner with families, educators, and clinicians to guide effective, compassionate responses rooted in neuroscience and mental health best practices. 

> Have you seen these patterns in your school or home? What strategies have helped you? Join the conversation in the comments. 

If you found this helpful, subscribe to NBI Exposure to receive our next editions. At NBI, our approach is always evidence-based and collaborative - designed to support the professionals who support families. 

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