School Refusal in Teenagers: Middle and High School

School refusal in teenagers is the same pattern as in younger children, serious difficulty attending school because of emotional distress, but it can look quieter and be harder to shift. A teen may stay in bed or go silent instead of crying at the door, and depression, friendship problems and bullying are more often part of the picture.

Researchers also report that older students respond less well to treatment than younger ones. That is a reason to act early and to involve parents and the school, not a reason to give up.

Why school refusal looks different in teenagers

School refusal tends to appear around transitions. The American Academy of Child and Adolescent Psychiatry (AACAP) says it is most common around school entry and again at ages 11 to 14, and Children's Hospital Colorado names the jump to middle school and to high school as typical triggers. What a parent sees changes with age.

• Shutting down instead of crying. The UK charity YoungMinds lists signs that fit this age: "not wanting to get up and get ready," not sleeping well, "not doing schoolwork, or their grades dropping," and seeming low or withdrawn.
• Size and autonomy. You cannot carry a fifteen year old into a classroom, and YoungMinds advises parents not to "physically force them into school." Attendance has to be worked out with a teen.
• Social stakes. AACAP notes that when school refusal "shows up for the first time in an older child or teenager, it's more often tied to problems with friends, bullying, depression, or other mental health concerns." It also links bullying, including online bullying, with avoiding school.
• Sleep. A Norwegian study of more than 8,000 adolescents aged 16 to 19 found short sleep and sleep deficiency were the sleep measures most strongly linked with missing school. It could not show which causes which.
• Low mood. An Australian clinic study of adolescents with school refusal found high rates of mood disorders as well as anxiety, and a US community study linked anxious school refusal with depression.
• Academic backlog. Clinicians consistently report that the longer a student is out, the harder the return becomes.

None of this means your teen has a particular condition. See school refusal and anxiety for more on the anxiety side.

What the research says about teens and treatment

The evidence base for school refusal treatment is small at every age, and thinner for adolescents.

• Older students respond less well. A 2014 paper by Heyne and colleagues states that "the poorest treatment response is observed among older school refusers."
• Improvement is often partial. In a 2017 randomized trial of 62 anxious school-refusing adolescents, all groups improved with CBT, but attendance "remained stable, at around 54 %" through one-year follow-up.
• Teen-adapted CBT shows early promise. A 2011 study of a CBT program designed for adolescents reported better attendance and less anxiety in 20 teens, but it had no comparison group.

For a teenager whose refusal is well established, it is fairer to expect progress in steps than a quick, complete return. Our overview of school refusal treatment options explains each approach.

What follows from that

• Act early. The American Academy of Pediatrics suggests seeking professional help if school avoidance lasts more than one week.
• Get a proper evaluation. AACAP describes one as talking with the child, parents and teachers, a doctor's visit to rule out physical causes, and "figuring out what's really driving the avoidance."
• Involve parents and school. In a trial with 7 to 14 year olds, parent and teacher training did as well as child therapy by follow-up.
• Take mood seriously. If depression is present, it needs treatment in its own right. Whether medication has a role is a decision for a prescriber such as a pediatrician or child psychiatrist.

What parents can still control

• The expectation. Children's Hospital Colorado calls clear, consistent expectations the most important factor in getting kids back to school.
• What a school day at home looks like. The American Academy of Pediatrics says a day at home "should not be a holiday," with no screen time privileges, and Children's Hospital Colorado advises keeping daytime hours as similar to school as possible.
• Your own response. Keep mornings brief and calm. Do not shout, lecture or punish anxiety.
• Contact with the school. Report absences honestly, ask for one contact person and request a plan.

When your teen will not talk or will not go to therapy

Some teenagers decline therapy at first. That does not leave you without options.

SPACE (Supportive Parenting for Anxious Childhood Emotions), developed by Dr. Eli Lebowitz of the Yale Child Study Center, is delivered to parents, and in most cases the young person does not attend. Parents learn to respond more supportively and to reduce accommodations. A 2020 randomized trial found SPACE was not inferior to child CBT for childhood anxiety disorders. The limits matter: participants were 7 to 14, the trial was not about school refusal, and attendance was not measured.

At Mountainside Behavioral Health, parent training sessions are for parents and cover school refusal, so you can ask about starting before your teen is ready to come in. There is also a page written directly for teens who cannot face school that you can pass along.

Colorado law: consent to therapy at 12 and older

C.R.S. 12-245-203.5 says a mental health professional "may provide psychotherapy services" to a minor who is 12 or older without the consent of a parent or guardian, if the professional determines that the minor "is knowingly and voluntarily seeking such services" and that the services are "clinically indicated and necessary to the minor's well-being." It does not cover inpatient psychotherapy and says nothing about medication.

The statute builds in parent involvement. The professional must discuss with the minor "the importance of involving and notifying" a parent or guardian and "shall encourage such notification." The professional may notify a parent with the minor's consent, unless that would be inappropriate or detrimental to the minor's care, and may notify a parent without consent if, in the professional's opinion, the minor is unable to manage their own care or treatment.

It also addresses refusal: "A minor may not refuse psychotherapy services when a mental health professional and the minor's parent or legal guardian agree psychotherapy services are in the best interest of the minor." A legal rule does not make a teenager engage, so the approach still matters. This describes the statute and is not legal advice.

Credits and catching up

Ask the school counselor which work is essential to make up, what can be dropped, and what options exist for recovering credit. Policies differ between districts and schools, so get the answer for yours in writing.

Federal guidance on Section 504 for students with anxiety disorders gives letting a student make up work without penalty as an example accommodation. See 504 plans and IEPs for school refusal.

Self-harm, suicidal thoughts, and older teens

Severe school refusal can come with threats of self-harm. Take any such statement seriously. AACAP states that any child or adolescent with suicidal thoughts or plans should be evaluated immediately by a qualified mental health professional, and that asking a teen directly about suicide can be helpful.

Call or text 988 at any time. In Colorado this reaches the 988 Colorado Mental Health Line. You can also text HOME to 741741 for the Crisis Text Line. If your teen is in immediate danger, call 911.

For teens whose emotions escalate fast, dialectical behavior therapy (DBT) teaches skills for tolerating distress and regulating emotion. DBT has been adapted for school refusal, but that research is at an early, pilot stage, so it is best understood as work on emotion dysregulation and not as a proven school refusal treatment. Mountainside's Teen Multi-Family DBT Skills Group is for ages 12 to 18 and meets for two hours weekly on Mondays over 24 weeks.

A note for parents of 17 and 18 year olds

Colorado's compulsory attendance statute applies to children under 17, and the legal definition of "habitually truant" uses the same age range.

At 18, rights over education records under the federal law FERPA transfer from the parent to the student. Talk with your teen before that birthday about how you will stay in the loop with the school.

If your child talks about wanting to die, is harming themselves, or you are worried about their safety, call or text 988 to reach the 988 Colorado Mental Health Line (free, confidential, 24/7). If anyone is in immediate danger, call 911.

Frequently asked questions

Related reading

• For teens: when you can't make yourself go to school
• School refusal and anxiety
• School refusal treatment options
• What to say when your child refuses school
• Teen Therapy in Denver
• School refusal and school avoidance support

All school refusal resources →

This page is general education, not medical or legal advice, and it does not replace an evaluation by a licensed professional who knows your child. Laws, district policies and program details change; confirm them with your school district or the organization named.