Understanding excessive absenteeism is important to ameliorating the negative outcomes associated with the behavior. The present study examined behavioral reinforcement profiles of school refusal behavior: negative reinforcement (avoidance) and positive reinforcement (gaining parental attention or receiving tangible benefits from not attending school). School social workers obtained information on school refusal behavior for 99 upper-elementary and middle school students referred for attendance problems. Three profiles were identified: 17.2 percent missed school to avoid fear- or anxiety-producing situations, escape from adverse social or evaluative situations, or gain positive tangible rewards (multiple profile); 60.6 percent missed school to gain parental attention or receive tangible rewards (positive reinforcement); and 22.2 percent had no profile. All three groups significantly differed in mean scores for behavioral difficulties, with children in the multiple profile group having the highest level of behavioral problems and children in the no profile group having the lowest. Children in the multiple profile group had higher mean scores on frequency of victimization and total number of traumatic or stressful events than did those in the other groups. Although more studies are needed, these findings suggest that school refusal behavior assessments may serve as a tool to better understand the phenomena of school attendance problems.