School refusal is a persistent school attendance problem that: jeopardizes a young person's social, emotional, academic and vocational development; contributes to distress for concerned parents and school staff; and often presents a real challenge to education and mental health professionals (Kahn et al., 1996). Some authors (e.g. Kearney and Silverman, 1996) use the term school refusal behaviour to refer to a range of attendance problems, including truancy. Others draw a distinction between school refusal as one type of attendance problem and truancy as another, using the term school refusal to refer to cases where difficulty attending school is associated with emotional distress (e.g. King and Bernstein, 2001), is not associated with serious antisocial behaviour (e.g. Honjo et al., 2001) and involves the child usually staying at home versus being absent from home (e.g. Kameguchi and Murphy-Shigematsu, 2001). Like these authors, the authors of this chapter also prefer to distinguish between school refusal and truancy, as these often require different approaches to intervention (Berg, 2002).
Following the work of Berg and colleagues (Berg et al., 1969; Bools et al., 1990; Berg, 2002), school refusal is defined by: (1) reluctance or refusal to attend school; (2) the child usually remaining at home during school hours, rather than concealing the problem from parents; (3) displays of emotional upset at the prospect of attending school, which may be reflected in excessive fearfulness, temper tantrums, misery or possibly unexplained physical symptoms; (4) an absence of severe antisocial tendencies, beyond the child's resistance to parental attempts to get them to school; and (5) reasonable parental efforts to secure the child's attendance at school, at some stage in the history of the problem.