Why Kids Avoid School and What Parents Can Do About It With Dr. Karen Lynn Cassiday

Dr. Karen Lynn Cassiday is the Clinical Director and Owner of The Anxiety Treatment Center of Greater Chicago, which provides evidence‑based therapy for anxiety and OCD. As a nationally recognized clinical psychologist, she is the former President of the Anxiety and Depression Association of America, and a Founding Fellow of the Academy of Cognitive Therapy. Dr. Cassiday is also the author of The No Worries Guide to Raising Your Anxious Child and Freedom from Health Anxiety. She frequently speaks and trains internationally on treating complex anxiety disorders.

Here’s a glimpse of what you’ll learn:

[2:57] Dr. Karen Lynn Cassiday shares how she discovered exposure-based therapy for anxiety and OCD early in her career
[5:43] Top reasons kids avoid or refuse to attend school
[8:29] Recognizing patterns of anxiety in younger children with stomach aches and headaches
[9:18] How to identify panic attacks and avoidance behaviors in middle and high schoolers
[11:37] Understanding the group of kids who avoid school without anxiety
[13:51] Girls on the autism spectrum as a hidden high-risk group for school refusal
[18:29] Why letting kids stay home “just once” often leads to a progressive avoidance pattern
[19:29] Treating school refusal as an emergency and the importance of immediate intervention
[24:43] Tips for creating a home environment with zero reinforcement for avoidance behaviors
[49:50] Case study of a middle schooler overcoming panic-driven school refusal through exposure therapy

In this episode…

Some mornings can feel like a battle when a child refuses to go to school. Parents are left wondering if it’s a passing phase, a health concern, or something far more serious. How can you tell when school avoidance is actually a sign of anxiety, and what steps can you take to get your child back on track?

According to Dr. Karen Lynn Cassiday, a nationally recognized expert in treating anxiety and school refusal, the key lies in recognizing the underlying reason behind a child’s avoidance. Anxiety disorders like separation anxiety, phobias, panic disorder, and social anxiety often drive kids to resist going to school. Avoidance quickly reinforces fear, creating a cycle that worsens over time and can lead to long-term academic, social, and emotional setbacks. Dr. Cassiday also emphasizes that treating school refusal as an “emergency” and responding with calm, firm, and structured action is essential for helping kids build resilience and confidence.

In this episode of The Coping Podcast, Dr. Leigh Weisz sits down with Dr. Karen Lynn Cassiday, Clinical Director and Owner of The Anxiety Treatment Center of Greater Chicago, to talk about why kids avoid school and how parents can respond effectively. She explains how to spot early warning signs, why avoidance reinforces anxiety, and practical steps to break the cycle. Dr. Cassiday also shares strategies for creating supportive school plans and building a child’s resilience at home.

Resources Mentioned in this episode

Quotable Moments:

“Prior to exposure therapy, people thought anxiety disorders, especially OCD, were incurable and untreatable with behavioral methods.”
“The worst thing you can do is to have them not go to school at all.”
“If we have one incidence of school refusal, the rate of having a second skyrockets.”
“Your anxiety or your depression is telling you you can’t do it, and it’s lying.”
“Self-worth comes from knowing I can rely on myself and achieve what truly matters most.”

Action Steps:

Treat school refusal as an emergency: Immediate intervention prevents avoidance from becoming a long-term habit that disrupts learning and development.
Maintain consistent school attendance criteria: Following clear illness guidelines ensures anxiety-driven absences are minimized and resilience is built.
Remove home-based reinforcements during avoidance: Eliminating comforts like devices or snacks reduces the reward for staying home and encourages school attendance.
Collaborate closely with school staff: Engaging teachers, counselors, and administrators creates unified support and effective accommodations for struggling students.
Seek specialized therapy early: Professional guidance with evidence-based approaches like exposure therapy helps break anxiety cycles and restores confidence.

Sponsor for this episode…

This episode is brought to you by Coping Partners.

Coping Partners is a mental health practice dedicated to helping children, adolescents, and adults manage various challenges including anxiety, divorce, behavioral issues, relationship problems and much more in the Chicago suburbs.

Our practitioners are devoted to building on our clients’ strengths and bolstering weaknesses.

To gain insight and tools for getting unstuck check out our website at CopingPartners.com, email us at support@copingpartnersgroup.com.

Episode Transcript:

Intro: 00:01

Welcome to The Coping Podcast, where we share strategies for coping with the stressors of life, especially the difficulties of parenting. And here is your host, Dr. Leigh Weisz.

Dr. Leigh Weisz: 00:15

This is Dr. Leigh Weisz. I am the host of The Coping Podcast, where I feature top experts on topics like raising healthy children, parenting, and so much more. Past guests include Dr. Doug Bolton, clinicians Ben Kessler and Michelle Winterstein, Dr. Aryn Froum and many more. Just a quick disclaimer. The information provided is for educational and informational purposes only.

This is not intended to provide mental health treatment and does not constitute a client therapist relationship. The information provided is not a replacement for being assessed and evaluated by a licensed professional, and is not intended to replace mental health or medical advice. This episode is brought to you by Coping Partners. Coping Partners is a mental health practice in the Chicago suburbs dedicated to helping children, adolescents and adults. We help manage various challenges including anxiety, divorce, behavioral issues, relationship problems, and much more.

Check out more episodes of our podcast and our website at copingpartners.com, and you can contact us with any questions you have. Before we dive into today’s topic, I wanted to introduce today’s guest, Dr. Karen Cassiday. Dr. Karen Cassiday is the owner of The Anxiety Treatment Center of Greater Chicago. She received her doctorate in clinical psychology from the Rosalind Franklin University of Medicine and Science. Nationally recognized as an expert in the diagnosis and treatment of anxiety disorders in children, teens, and adults, she has conducted extensive research into anxiety and is widely published.

She is the past president of the prestigious Anxiety and Depression Association of America, and served on the board of Beyond OCD Chicago. She is a founding fellow of the Academy of Cognitive Therapy. In addition, she serves on the faculty of the International Obsessive Compulsive Foundation, Behavior Therapy Institute, and the Rosalind Franklin University of Medicine and Science. A sought after national speaker on television, radio, and a professional training seminars, Dr. Cassiday has appeared as an expert consultant on NBC’s Today Show and has published two books as well. If that’s not enough, she is also a mother of five.

Today we will be addressing school avoidance and school refusal, and how parents and schools can partner to best help kiddos who struggle. So thank you so much, Dr. Cassiday, for being here.

Dr. Karen Lynn Cassiday: 02:50

Thank you Leigh. It’s such a privilege.

Dr. Leigh Weisz: 02:53

Can you share a little bit about your background and how you got into this work?

Dr. Karen Lynn Cassiday: 02:57

Well, when I was in graduate school, I had the great good fortune of having one of the first people that Edna Foer Foer, the founder of the first exposure based therapy for obsessive compulsive disorder, come to my university the same year I started. And what was so exciting was prior to exposure therapy, people thought anxiety disorders, especially OCD, were incurable and that if you dared to make anxious people do the things they are scared of, you would make them go psychotic. And so I got to have this experience where we had all these people come in who had been stuck in their homes doing horrible compulsions, you know, children, adults. And literally within weeks and months, completely transforming their lives. And that was such a thrill.

Real. Prior to that, as an undergrad, I’d been working with developmentally disabled, doing in-home behavioral training, and that process was much slower and frustrating. And my work with Dr. Richard McNally, who’s now at Harvard, was so exciting. I just knew that’s what I wanted to do. And it’s been a delightful journey since then because there’s been, of course, a huge amount of research where we know so much more about how to treat people with anxiety.

And then the other thing I didn’t realize at the time in grad school, because no one had done the prevalence studies, then the most common class of disorders anywhere is anxiety disorders. And so about one out of four are going to have experience with that. And you know, that means that working in this area is incredibly Important, you know, if you’re a clinician or if you’re a parent, it means you’re likely to know someone or have a friend or a relative who deals with this. And so I just can’t say enough good things about what you can do to make your life better if anxiety happens to be in your presence.

Dr. Leigh Weisz: 05:12

Yeah. No, it sounds like you kind of you both got lucky in terms of where you were at the time and who you were able to learn from. And then, you know, like you’re saying the prevalence, the relevance and all of the research since then, it’s very fulfilling to be able to see progress before your eyes. That’s really, really neat. So what would you say are the top few reasons why kids start to exhibit this school avoidance or school refusal in the first place?

Dr. Karen Lynn Cassiday: 05:43

Yeah, well, actually it kind of depends on the age group. Okay, so and also your gender. So we know and I’ll just give you some fun facts here that families might recognize. So we know when kids are younger. Okay.

So this would be prior to middle school. Oftentimes the biggest reason is an anxiety disorder. And and that would be kids might develop separation anxiety. They might have a phobia I’ve had kids that they’re worried about dogs. And so they’re afraid they’ve seen a dog barking near the school.

And then they don’t want to get off the bus or get out of the car, or they’re afraid to wait, because what if the dog got loose and or afraid of vomiting, or of seeing other people vomiting and get sick? And so oftentimes there’s things like this that the family doesn’t realize that all of a sudden the kid is afraid that what if I, you know, get contaminated by germs and then I get sick? What if there’s a thunderstorm and I’m I’m not feeling safe. And one thing I should preface with these are called specific phobias. Separation anxiety or generalized anxiety disorder.

Chronic worry is usually in younger kids. The thing they can communicate is that they can’t, that they don’t want to. And oftentimes they’re not able to articulate that. All of a sudden I’m worrying about something. What you’ll see is tummy aches and headaches, saying I can’t go to school.

And one thing parents oftentimes don’t understand, or some mental health professionals, is that about 80% of the kids who are middle school and younger have daily headaches or tummy aches when they have anxiety disorders. So oftentimes they get misdirected to the pediatrician or the gastroenterologist, and then no one can find anything. And so the parent sees the tummy aches, the headaches. And I just can’t, I won’t I can’t describe in full. and the parent might notice that.

Then the other thing that we see is the perfectionist kids. They’re worrying about tests. They’re worrying about grades. Or there was a teacher who just comes across as sterner or more demanding, and they are afraid that they can’t meet the performance demands, or they have social anxiety and they’re afraid of, oh, it’s a class where I have to do something public, like physical education. Or I have to find someone at lunch to sit with or I, I’m supposed to speak up in class, or there’s a.

Dr. Leigh Weisz: 08:26

Give a presentation in front of the whole class, things like that.

Dr. Karen Lynn Cassiday: 08:29

And you start to notice there’s a pattern here. They’re always really sick when there’s one of these situations. So that’s that’s that younger group. When we see older kids like middle school and older than when it’s girls, we’re very often it’s panic disorder. Sorter.

So a kid is starting to have panic attacks, and to them, what they’re experiencing is I just feel this imminent sense of either terrible illness or doom, or what if I go crazy? It’s very hard to describe. And then you get a kid going. Just just tomorrow. Tomorrow.

Let me go. Tomorrow. Just today.

Dr. Leigh Weisz: 09:09

Desperate to avoid and put off that that feeling again.

Dr. Karen Lynn Cassiday: 09:13

Yeah. Or they’re constantly calling to be brought home.

Dr. Leigh Weisz: 09:17

Yeah.

Dr. Karen Lynn Cassiday: 09:18

They’re starting to get the the panic attack or the limited symptom attack where it’s a small version. And these are the ones where the school nurses are constantly calling, or the vice principal saying, hey, your kid is crying in my office.

Dr. Leigh Weisz: 09:33

We call them the frequent frequent flyers to the nurse’s office.

Dr. Karen Lynn Cassiday: 09:36

Yeah, exactly. And they they keep needing breaks. And then what we see in this group is they start making excuses that are potentially plausible. It’s my period. I have a migraine.

I feel sick. I just can’t do it. I need more time. So that’s one. Another group that we see are the.

Besides the regular anxiety, I’m going to call it the perfectionist. Okay. And these are the kids where they’re worriers or they have OCD and they didn’t do enough in their mind and they want more time. And so they want to stay home to work on something.

Dr. Leigh Weisz: 10:16

And so an assignment that was due that day, for example, they didn’t feel like they put put forth enough time. So they want to procrastinate a little bit to be able to make it better.

Dr. Karen Lynn Cassiday: 10:25

Yeah. And they’re they’re a good student. Everybody agrees. And then the parent gets kind of full because they’re like, wow, that’s wonderful. My child wants to work so hard.

I’m so proud. My friends, kids, all, you know, blow off their homework. This one stayed up till 3 a.m. and look at the beautiful thing he or she made. And that’s another category. And then we see a third category that doesn’t have anything to do with anxiety disorders.

And these are the kids where they just haven’t connected with school. So they are not engaged academically or socially or emotionally. And they are not going to school because it’s more fun not to. And they’re the ones that are up all night playing video games. And people might say they’re addicted to social media or they’re addicted to gaming.

And anxiety is not it. It’s just they’re able to easily fool their parents. Yeah. They know to act sick. They know to make excuses.

Or I’ve had kids that actually leave for school. Check in and then disappear. Going to the bathroom and get back home and climb in the window.

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