As always, in order to understand how to combat the problem, we first need to understand its causes. “Understanding the reasons that students avoid school is the first step in getting them to return,” writes school psychologist Mary Wimmer. In her 2008 article entitled “Why Kids Refuse to Go to School,” Wimmer stresses that school refusal or school avoidance can’t be attributed to a single cause, it results from a complex mix of factors including mental health problems, family issues and the school environment. Mental health challenges, whether anxiety, depression, Oppositional Defiance Disorder (ODD), Obsessive Compulsive Disorder, Panic Disorder or some combination of these, account for 90% of the cases of school refusal. According to authors Packer & Pruitt (2010), anxiety, more specifically Separation Anxiety, Generalized Anxiety Disorder, and Social/Performance Anxiety, is the leading cause of school avoidance behaviour, affecting 22% of school refusers. Children with Separation Anxiety are usually very young, tend to be preoccupied with the possibility of harm befalling loved ones, and are overly dependent on their parents or caregivers. Social or Performance Anxiety, which accounts for 3.5% of school avoidances cases, is slightly different. Rather than worrying about loved ones, this type of anxiety disorder manifests itself as intense fear of judgement from others. As a result, children with this condition typically experience extreme nervousness prior to test taking, making presentations and participating in sports. Generalized Anxiety Disorder (GAD), a diagnosis received by 10.5 % of children affected by school phobia, refers to excessive anxiety and worry about any number of different events and situations. Just like individuals with Performance Anxiety, students who struggle with GAD are usually very unsure of themselves. Unlike cases of performance anxiety, individuals with GAD are perfectionists about their schoolwork; they may also consider the world to be a threatening place. This type of anxiety is associated with secondary health problems including fatigue, restlessness, irritability, sleep problems and muscle tension. In about 4.9% of case of school avoidance, depression is a primary casual factor. The presence of depression in school refusers is very serious as it is associated with very severe symptoms: self-mutilation, suicidal ideation, suicide attempts and uncontrolled worry. In addition to mental health problems, scholars also point to school-based factors as drivers of school avoidance behaviour. Large class sizes, an authoritarian style of school management, a high level of discipline problems in school, large groups of low-achieving older students and school violence all can contribute to a student’s anxiety and worry about attending school. These variables may be compounded by family factors as well. Unfortunately, identifying these factors in a specific case can be extremely difficult. “Parents of students who refuse to go to school for emotional reasons are a diverse group,” writes Wimmer. Some parents of school avoiders are healthy and high functioning, while others struggle with dependency, anxiety, depression, substance abuse, high levels of conflict, and/or emotional detachment. Specific events in the family can trigger school refusal behaviour including prolonged illness, a death of a parent, a vacation or even a weekend. This is part two of a three-part daily series on back-to-school anxiety. Part three will be published on Friday.