Given the variety of reasons a student may be absent from school, a number of theories regarding classification systems have been developed to describe the phenomena that lead a student to engage in behaviors such as refusing or attempting to refuse school or to experience great distress when at school. When researchers began to see chronic school absenteeism as a clinical concern, rather than merely a more common feature of delinquency as was typically described (e.g., Healy, 1915; Burt, 1925; Williams, 1927), the initial descriptions of nonattendance were ­primarily related to the role of anxiety in chronic school absenteeism.

Broadwin (1932) described two types of “truants;” first those who were truant for more traditional reasons such as, “a loss of interest because of inability to keep up with the pace of the class or because the child can do more advanced work, unwitting and even willful encouragement of the parents, and ‘bad’ associates,” (p. 253) and secondly, those students who are truant because of, “a deep seated neurosis of the obsessional type or displays a neurotic character of the obsessional type” (p. 254). Broadwin (1932) suggests that these children are in need of additional study and describes them as students who are “miserable, fearful, and (will) at the first opportunity run home despite the certainty of corporal punishment”. This description of truancy as a function not of an aversive environment or competing reinforcement outside of school but of a neurotic character led to additional work looking at school absenteeism as a clinical problem rather than a delinquency one.

Partridge (1939) described five types of groups engaged in truancy: an undisciplined group, a hysterical group, a desiderative group, a rebellious group, and a psychoneurotic group that was markedly different from the first four groups. Similar to Broadwin’s second group of truants, Partridge described the psychoneurotic group as individuals whose behavior was not simply a means of escaping environmental concerns or fulfilling wants but instead reflected an overabundance of anxiety. Partridge also noted that this group frequently had an overprotective parent.

Johnson, Falstein, Szurek, and Svendsen (1941) spoke similarly about an emotional disturbance that led to prolonged absences from school, which they referred to as “school phobia.” Similar to Partridge and Broadwin, Johnson et al. reported a subset of school refusers for whom anxiety was considerable, which were different from those who were seen as simple truants. Johnson et al. suggested that school phobic children had an acute anxiety that was caused by either an emotional conflict or an organic disease. The children’s anxiety subsequently created an increase of anxiety in their mothers, which was followed by a poorly resolved dependent relationship of these children to their mothers.

Building on the “school phobia” diagnosis, Coolidge, Hahn, and Peck (1957) talked about school absenteeism as something specific to the school and not wholly related to the dependent nature of children’s relationships with their mothers. Like the Johnson description, Coolidge et al. described a neurotic type of school phobia that was characterized by younger children with anxiety symptoms that suddenly occurred. Unlike the Johnson descriptions, Coolidge et al. also included a more traditional group of school refusers who were typically older and had a more gradual onset of school refusal behaviors. This group was similar to the non-anxiety groups described by Broadwin (1932) and Partridge (1939) while still adhering to the school phobia term.

Kennedy (1965) continued on the Coolidge et al. (1957) dichotomy related to school phobia. He described school phobia as being either Type 1, having acute onset, or Type 2, reflecting a “way of life” that was more gradual in development and more chronic in nature. He suggested that both types had common symptoms including:

Despite their similarities, Kennedy maintained that the two types were two different categories of disorders that would require differing types of treatments.

Berg, Nichols, and Pritchard (1969) continued classifying school phobic children as acute (nonproblematic school attendance for at least 3 years prior to the current episode) and chronic (all other cases) but added additional classification requirements:

While there are a number of similarities across each of these explanations of excessive absence, and though they frequently use similar terminology (with varying degrees of relatedness) there are a number of differences as well. Differences across the foundation of and use of classification systems have made it difficult for researchers and clinicians to come to a consensus about the definition and classification of students who engage in school refusal behaviors. This difficulty is bolstered by the fact that both the DSM-IV (American Psychiatric Association, 2000) and proposed DSM-V diagnostic categories (American Psychiatric Association, 2011) do not include a specific formal diagnosis related to problematic absenteeism. Instead, school refusal behaviors are typically addressed under coexisting conditions that often occur comorbidly with school refusal behaviors. These can include but are not limited to Oppositional Defiant Disorder, Conduct Disorder, Separation Anxiety Disorder, Panic Disorder with Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Specific Phobia. While all of these diagnoses could be related to school refusal behaviors, it does not necessarily follow that a student who engages in school refusal behaviors would qualify for any of these disorders.

Despite the long standing theoretical bases that have led to these differing classification systems, they all leave something to be desired because of the number of different environmental contingencies that lead to the same behavior, school refusal. This is easily seen in the number of differing nosologies related to the same behaviors. Whether considered school phobia or psychoneurotic truancy, the behaviors being described are similar and could be related to a number of common symptoms as suggested by Kennedy (1965). Even though distinctions such as chronic vs. acute and anxiety related vs. conduct disordered may be useful in classification, it does not stand to reason that a student who is engaging in school refusal for the first time (acute) has not been anxious about school for a long period of time. Additionally, problematic conduct outside of school does not necessarily mean that a student does not have debilitating anxiety problems within school. Students who engage in externalizing problematic behaviors are not necessarily free from internalizing problems or social anxiety. Research has repeatedly found that individuals referred with school refusal problems have been comprised of a number of subgroups including individuals with anxiety disorders, depressive disorders, and both (Bernstein, 1991; Bernstein & Garfinkel, 1986).

This heterogeneity of school refusers led Kearney and Silverman (1993) to create a functional model of child-motivated school refusal behaviors. In this model they aimed to examine school refusal behaviors from a functional point of view, probing environmental contingencies that could reinforce school refusal behavior, rather than only assessing perceived diagnostic correlates that use internal states to explain behavior. This functional view allows a greater direct link from behavioral function to treatment. Similar to prior functional explanations of behavior (e.g., Iwata, Dorsey, Slifer, Bauman, & Richam, 1994; Durand & Crimmins, 1988), Kearney and Silverman break maintaining variables broadly into positive and negative reinforcement and then more specifically into avoidance of stimuli providing negative affectivity, escape from aversive social or evaluative situation, attention getting behavior, and positive tangible reinforcement.

Given the number of differing definitions of school refusal behaviors suggested over the years and taking into consideration data regarding differing functions related to topographically similar behaviors, the authors of this paper would like to endorse the use of the Kearney and Silverman definition of school refusal behaviors as a means to describe this class of behaviors. Kearney and Silverman (1996) describes school refusal behavior as, “child-motivated refusal to attend school or difficulties remaining in classes for an entire day.” They go on to say:

this definition includes youth aged 5–17 years who, to a substantial extent, (a) are completely absent from school, and/or (b) initially attend then leave school during school days, and/or (c) go to school following behavior problems such as morning temper tantrums, and/or (d) display unusual distress during school days that precipitates please for future nonattendance. (Kearney & Silverman, 1996, pp. 345)

This definition encompasses a number of historical classifications including delinquent truancy, school phobia, and anxiety-based absenteeism. While research on functional profiles of students engaged in school refusal behaviors shows that many profiles do at times match prior definitions (i.e., that students motivated by negative reinforcement were more often reporting high levels of fear and anxiety than those in positive reinforcement groups (Kearney, 2002; Kearney & Albano, 2004) this model allows students who are engaging in school refusal behaviors for multiple reasons (mixed functions) to be included under one umbrella definition.

A study by Weeks, Coplan, and Kingsbury (2009) investigated both what correlates with social anxiety in childhood and what the consequences may be for children who experience symptoms of social anxiety. Their sample included 178 children in second grade. They found that anxious students liked school less and avoided school more than their non-anxious counterparts. They also found that anxious students reported themselves as more lonely at school than same aged non-anxious students. Additionally, anxious students’ teachers perceived them as weaker students academically than the non-anxious students. These findings suggest that anxious students who dislike school are likely to display more school refusal behavior than non-anxious students.

Because of the great heterogeneity related to school refusal behaviors and myriad of theoretical explanations for these behaviors, a number of assessment procedures have been utilized over the years to assess school refusal. As a means of covering multiple sources of assessment procedures, the current authors chose to report on a variety of assessments used to examine school refusal. These may be of varying benefit depending on the nature of school refusal. It is suggested that multiple methods are used when examining behavior, but that in all cases, assessments be used to inform intervention.