When “I Can’t Go to School” becomes something more.
By Annika Lydiate
Senior Occupational Therapist | Western Kids Health
Most parents know the feeling…
It’s 7:30am, the school bag is by the door, and suddenly there’s a stomach ache. Or tears. Or a child sitting frozen on the bed, unable to explain why they just cannot face walking through those school gates. For many families, this is occasional. But for a growing number of children and young people across Australia, this is every morning. The struggle is real, exhausting, and often deeply misunderstood. This is what many families are calling “school can’t”. If your family is living it, or you’re a teacher watching it unfold in your classroom, we are here to help.
It’s not “I won’t”. It’s “I can’t”.
The language we use matters. For a long time, this experience has been called “school refusal” but that framing can make it sound like a choice. Many families, educators, and clinicians are now shifting toward more accurate, compassionate language: “school can’t”, because for these young people, that is exactly what it feels like. Not won’t. Can’t.
“School can’t” is not about bad behaviour, poor parenting, or a child simply “not liking school.” It is a health issue, a pattern where a young person experiences genuine, significant distress about attending school, driven by anxiety, overwhelm, and often very real physical symptoms. Parents are aware their child isn’t at school, and most of these young people desperately want to feel okay about going. They just can’t.
You may also hear the term Emotionally Based School Avoidance (EBSA), a broader term that captures the emotional and anxiety-driven nature of this experience. What EBSA highlights is something important: avoidance tends to grow when school demands feel unpredictable or unmanageable. When a child doesn’t know what to expect, anxiety fills the gap. Over time, avoidance becomes the nervous system’s solution to feeling unsafe.
Common signs include:
Globally, anxiety-driven school avoidance affects 1–5% of school-aged children, while occasional school reluctance affects a much larger proportion of children.
It tends to peak at three key transitions: starting school (ages 5–7), moving to high school (ages 10–11), and early to mid-adolescence (ages 12–14).
Some children are at significantly higher risk including those with anxiety, depression, ADHD, or autism. For autistic students, research suggests non-attendance rates can range from 9% to as high as 72%, reflecting just how overwhelming a busy, sensory-rich, socially demanding school environment can be.
“But their stomachache goes away by lunch time…”
This is one of the most common sources of confusion for parents and teachers, and it’s completely understandable.
When a child’s headache disappears by mid-morning, it’s natural to wonder whether they were really sick. But what’s actually happening is the body’s protective response at work. The nervous system perceives school as a threat and responds, for some kids this can be tight chest, nausea, headache, racing heart. When the threat is removed, the nervous system settles, and the symptoms ease.
This does not mean the child was faking. It means their nervous system is doing exactly what it’s supposed to do.
What’s particularly important to understand is that this cycle runs in both directions. Physical symptoms make school feel impossible, but staying home can also make the symptoms worse. Research tracking thousands of adolescents found that school absence itself acts as a maintaining factor for physical symptoms. The longer a child is away, the more the body and mind learn that school is dangerous. Gradually returning to school is not just about education, it is part of the recovery.
For some children, physical symptoms like pain, fatigue, dizziness or weakness become persistent and disabling; not because something is structurally wrong, but because the nervous system has learned to send and amplify signals in an unhelpful way. This is sometimes called functional somatic symptoms. It is real, it is recognised, and it is treatable; and it is exactly the kind of situation where a coordinated plan across school, family and health becomes essential.
What actually helps school refusal?
The most effective interventions are those that help young people gradually face feared situations rather than avoid them.
Australian clinical trials have shown lasting improvements in attendance, maintained years after treatment ends. The focus is on helping young people understand what their body and brain are doing, developing practical tools for managing difficult moments, and building the confidence to return to school gradually, at a pace that feels manageable. It’s not about forcing a return, it’s about building skills and tolerance step by step.
But individual therapy alone is not enough.
The most effective approaches involve school, family, and health working as a team.
What schools can do:
Watch for early warning signs; frequent late arrivals, requests to leave early, increasing absences.
Appoint a designated staff contact; someone the student knows, trusts, and can turn to when things feel hard.
Prioritise social and emotional safety over academic performance during reintegration.
Respond to physical symptoms with calm and compassion rather than frustration or disbelief.
Develop individual plans for students with FND or significant functional symptoms so all staff respond consistently.
One of the most powerful things a school can do is shift from a reactive to a proactive approach. Rather than managing each crisis as it arrives, schools and families can work together ahead of time to identify the situations most likely to feel unmanageable; assessment blocks, difficult subjects, transitions between classes, or periods of social uncertainty. Having agreed strategies already in place before those moments hit can significantly reduce the cycle of anxiety and avoidance. Predictability is protective.
What Occupational Therapists can do:
This is where OT has a meaningful role to play. Occupational therapists can work with young people, families, and schools to:
Support families to understand the anxiety and avoidance cycle and to develop consistent strategies at home and at school.
Map the school day to identify specific points of high demand or unpredictability and build strategies around them.
Collaborate with teachers to adjust the environment, tasks and expectations in ways that reduce overwhelm without removing challenge.
Design individualised, graduated return-to-school plans that are tailored to the young person’s specific sensory, cognitive, social, and emotional needs.
Bridge the gap between health recommendations and practical school implementation translating clinical advice into workable, real-world plans.
The goal is not just getting a child back through the gate. It is building the conditions in which they can actually stay, participate, and feel safe.
What families can do:
Learn about your child’s condition. Understanding changes everything.
Gently encourage attendance without escalating distress.
Remember that parental anxiety can feed a child’s anxiety, getting support for yourself matters too.
Work openly with school & health providers as a genuine team.
This is not a behaviour problem. It is a health and wellbeing issue that deserves a health and wellbeing response.
Behind every child who is struggling to get to school is a young person who is overwhelmed, not oppositional. Most of them want to go. They want to see their friends, feel normal, and just get on with growing up. The anxiety, the physical symptoms, and the avoidance that keep them home are not a choice.
