Understanding School Refusal: A Neurodiversity-Affirming Approach
School refusal is often misunderstood. It may be seen as defiance or resistance, but more often, it reflects a child’s way of communicating that something in their current environment doesn’t feel safe or manageable. This might be related to sensory sensitivities, challenges with emotional regulation, social dynamics, or executive functioning demands.
Every child has the right to feel safe, supported, and understood in their learning environment. When a child is consistently struggling to attend school, it’s important to look beyond attendance itself and explore the underlying reasons why school may feel overwhelming or inaccessible.
By recognising and responding to these underlying needs, we can support children to build trust, confidence, and capacity in engaging with the school environment—at a pace that respects their readiness and individual differences.
How Occupational Therapy Can Support School Refusal
Paediatric Occupational Therapists (OTs) play a meaningful role in supporting children who are finding it difficult to attend school. Rather than focusing solely on getting children “back to school,” OTs take a holistic, child-centred approach to understand the reasons behind school refusal.
This involves working in partnership with children, families, and educators to explore sensory, emotional, environmental, and functional factors that may be contributing to the difficulty.
Sensory Regulation
For many neurodivergent children, the school environment can be overwhelming. Bright lights, loud noises, crowded hallways, or unpredictable routines can lead to sensory overload, making it hard to feel calm or focused.
OTs assess each child’s sensory profile to understand how they experience their environment. From there, tailored strategies can be introduced—such as sensory breaks, quiet zones, or movement opportunities—to support regulation and engagement in school settings.
Emotional Regulation
Navigating emotional experiences can be particularly challenging in school environments that demand frequent transitions, social interaction, or task persistence. OTs work with children to build emotional awareness, identify triggers, and develop calming strategies that they can draw on when needed.
With consistent support, children can build the tools and confidence to manage their emotions in ways that feel safe and empowering.
Supporting Everyday School Skills
Some children may also benefit from support with functional school-related skills such as fine motor tasks, self-care routines, or executive functioning (planning, organisation, task initiation). When these foundational skills are strengthened, children are more likely to experience success at school, which can improve their sense of competence and reduce anxiety around participation.
OTs also work with families and educators to co-develop routines, visual supports, and regulation strategies that are consistent across home and school settings.
Practical Strategies for Parents and Caregivers
If your child is finding school difficult to manage, here are some supportive strategies to consider:
1. Establish predictable routines
Consistent routines—especially in the morning and evening—can help reduce anxiety and give children a greater sense of control. Visual schedules and reminders can support children to anticipate what’s coming next.
2. Reintroduce school gradually
Supporting your child’s return to school doesn’t have to be all at once. It can begin with short, low-pressure visits to school, connecting with a familiar teacher, or exploring the classroom after hours. Small steps can help rebuild trust and familiarity.
3. Build coping strategies together
Help your child explore and practise calming strategies such as deep breathing, movement breaks, mindfulness, or sensory tools like fidget items or weighted blankets. Celebrate small successes and validate your child’s efforts.
4. Keep communication open with the school
Collaborate with school staff to adapt the learning environment and expectations to your child’s current needs. This might include access to a quiet space, flexible attendance plans, or additional supports during transitions.
When to Seek Professional Support
If school refusal persists or begins to significantly impact your child’s wellbeing, it may be time to seek support from a paediatric occupational therapist. Our team works collaboratively with families and schools to understand each child’s strengths and needs, and to design strategies that support their regulation, participation, and confidence in the classroom.
When children feel safe, understood, and supported, they are better able to learn, connect with others, and develop the skills they need to thrive.