### DEFINITION School refusal is a condition characterised by reluctance and often outright refusal to go to school in a child who: (1) seeks the comfort and security of home, preferring to remain close to parental figures, especially during school hours; (2) displays evidence of emotional upset when faced with the prospect of having to attend school, although this may only take the form of unexplained physical symptoms; (3) manifests no severe antisocial tendencies, apart from possible aggressiveness when attempts are made to force school attendance; and (4) does not attempt to conceal the problem from parents.1 ### FEATURES Boys and girls are equally affected and there is no relationship to social class. Neither is there any relationship with intellectual or academic ability. The youngest in a family of several children is more likely to be affected and parents are often older than would otherwise be expected. It can affect a school child of any age, but young teenagers at about the time of transition from primary to secondary school are more likely to develop school refusal. Although uncommon in the general population, it forms a not inconsiderable proportion of referrals to child mental health services. Onset tends to be gradual, with increasing problems in facing up to leaving home to go to school, but it may occur suddenly after time away from school because of illness or holidays, it may occur after some upsetting event, or just come on without any obvious reason. There may be no associated social impairment, but there …