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Image of a child refusing to go to school and quote by Rebecca Dautoff, Psy.D., NESCA

Helping Your Child Overcome School Refusal: A Place for Parents to Start

By | NESCA Notes 2025

Image of a child refusing to go to school and quote by Rebecca Dautoff, Psy.D., NESCABy: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

As a parent, it is excruciatingly difficult and painful to watch your child struggle with school refusal. School refusal often doesn’t involve a simple dislike of school; it can be a complex emotional challenge that affects your child’s mental health and academic progress, as well as the day to day logistics of parents and families. It can feel overwhelming to know where to begin and how to help.

Understanding the root causes of school refusal and applying a well-structured, therapeutic approach is key to helping your child reintegrate into the school environment and regain their confidence. While it is different for every child, a stepwise, therapeutic re-entry approach, such as the example below, can help provide practical ways to support your child.

Why a Gradual Return to School Matters

For children who have a long-standing pattern of school refusal, a sudden return to a typical school day may feel daunting and unmanageable. It’s essential to remember that the emotional and psychological barriers that prevent your child from attending school take time to address. As hard as it is to have a child out of school, rushing the process can lead to increased anxiety and reinforcement of avoidance behaviors.

Research shows that a gradual re-introduction to the school environment is the most effective approach. This method helps reduce the anxiety that comes with school refusal while promoting the confidence necessary for longer school days. Best practices suggest starting with just one hour of school attendance per day, then increasing the duration by one hour each week.

This “stepwise” method—beginning slowly and building gradually—has been shown to be successful and should be applied whenever your child transitions back into a school setting, whether at their current school or a new placement. The gradual re-entry helps to normalize the school experience, minimizing feelings of overwhelm.

A Collaborative Approach

School refusal places stressors on all parents and siblings alike, causing the anxiety and frustration emanating from the child to radiate throughout the family system. As a parent, it can be traumatizing to see your child struggle, but the trauma can be compounded by the adverse impact your child’s needs have on other facets of your life. Like the safety guidance offered before taking off in a plane, you must first put on your own oxygen mask before helping others. Parents who are able to be aware of these impacts, or better, seek help and support themselves, are often far more effective at addressing school refusal. Just as children sense the struggles of their parents, they can also draw strength from parents who model constructive behaviors.

Effectively addressing school refusal also calls for close collaboration between parents, teachers, and administrators. Developing a cohesive plan, tactics, contingencies, and even language, can help create consistency from which the child can draw a sense of safety and security. No one can plan for every contingency, and sometimes the best laid plans fall victim to an intransigent overwhelmed child, but consistency and coordination has been shown to dramatically increase the success of treating school refusal.

Key Components of a Successful Reintegration Plan

A successful reintegration plan for school refusal should involve more than just a slow return to the classroom. It’s important to address both the emotional and cognitive aspects of school refusal, as well as provide consistent, structured support. Below are the key components of a comprehensive plan to support reintegration and ensure that they are able to make a successful transition back to school:

1. Gradual Re-entry to Academic Demands: A plan should include a gradual re-entry to academic tasks, starting with smaller, manageable increments of time and progressively increasing in duration. This approach reduces the pressure of immediate academic demands, helping to prevent feelings of overwhelm. Begin by introducing your child to their preferred subjects—those they feel more comfortable with or enjoy the most. This positive reinforcement can help build confidence and reduce resistance to returning to school.

2. Addressing Distorted Thinking: Children with school refusal often experience distorted thinking about school. These cognitive distortions may include beliefs such as, “I’m not good enough,” “teachers and peers will judge me,” or “I won’t be able to keep up with my classmates.” Your child requires specific support in restructuring these distorted thoughts. It’s crucial that they work with a therapist or counselor to challenge these negative beliefs and replace them with more accurate and adaptive thoughts.

Role-playing and practice routines throughout the day can also help your child develop healthier perspectives on school and school-related social interactions. These exercises can prepare your child to cope with real-life situations and increase their readiness to face challenging scenarios in the classroom.

3. Prompt Response to School Refusal: One of the most important factors in overcoming school refusal is acting quickly when a refusal occurs. Research shows that the longer a child stays away from school, the harder it becomes to break the cycle of avoidance. Therefore, it’s critical that your child’s team (including you, their school staff, and any therapists involved) respond immediately when a refusal occurs. Ideally, you want to limit the number of school refusal days to one or two at most before implementing a formalized plan to address attendance.

If your child does refuse school, the plan should prioritize early intervention. This may include additional support, communication with the school to reduce missed work, and mental health check-ins to ensure your child feels supported emotionally. By acting swiftly, you reduce the risk of a prolonged period of school avoidance, which can become harder to reverse over time.

4. Managing Homework and Academic Workload: One of the most common sources of stress for children with school refusal is the idea of falling behind in schoolwork. Your child may feel overwhelmed by the accumulation of missed assignments, which can further fuel avoidance behaviors. To prevent this, it’s essential that a plan be put in place to manage missed work. This could include prioritizing essential assignments or offering extensions on deadlines to help your child feel less pressured.

By reducing the academic burden during the reintegration process, your child can focus on gradually adjusting to the school environment without being overwhelmed by the expectations of their coursework.

Concluding Thoughts

School refusal is not a simple issue to resolve, but with a thoughtful, stepwise approach, your child can successfully transition back into school. A gradual reintegration into the academic environment, support for restructuring negative thoughts, and quick intervention at the first sign of refusal are key to helping your child overcome this challenge.

Parents and caregivers play a vital role in this process. Your understanding, patience, and advocacy are essential to your child’s success. With the right support, your child—and other children facing school refusal—can regain confidence, rebuild their academic skills, and develop the resilience needed to thrive in school and beyond.

If your child is experiencing school refusal, don’t hesitate to reach out to your child’s school or a mental health professional to create a tailored plan that best meets their needs. Neuropsychological testing can also be useful in determining underlying causes of the school refusal and planning a re-entry to their current school or another program that sets your child up for a positive educational experience.

If you would like to learn more about NESCA’s neuropsychological evaluation services, please complete our online Intake Form.

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Rebecca Dautoff headshot and quote

Pediatric Neuropsychologist Rebecca Dautoff, Psy.D., Joins NESCA

By | NESCA Notes 2024

Rebecca Dautoff headshot and quoteBy: Jane Hauser
Director of Marketing & Outreach, NESCA

You adapt your approach with neuropsychological evaluations for each individual based on their developmental stage. Tell us about that.

With younger kids, it’s a much more interactive experience. Their attention spans are shorter, so they often need a warmer environment that feels less intimidating. Sometimes it’s getting on the ground and playing with them, other times it is starting testing under a table until the individual feels confident enough to sit at a table. I try to make it feel like a collaborative process.

It ultimately comes down to how you connect with someone. I connect very differently with a four-year-old than I do with a 14-year-old or a 20-year-old.

How do you get older adolescents, who may not be eager to be evaluated, to buy-in on engaging in evaluations?

This can be tricky. Usually, we can find a reason that they are comfortable sharing about why they are being evaluated, and I use that to explain what an evaluation can do to help them with that reason or issue. I try to understand what they want to get out of an evaluation and what it will help clear up for them.

Sometimes parents and adolescents are not aligned. Maybe a parent wants their child evaluated because they think that they have ADHD. The individual being evaluated may agree that they are neurodivergent, but may feel like their symptoms align better with Autism than ADHD. We can work with whatever that individual is feeling, even if it’s different from their parents’ concerns. We take the information and feelings from both the parents and adolescents – as well as input from educators and professional providers – and combine that history with the testing data, our observations during the evaluation, and synthesize it all to identify a diagnosis (when applicable). Then we develop highly personalized recommendations for interventions and hope to partner with the family along the way to support both parents and the adolescent.

You conduct neuropsychological evaluations and also projective testing here at NESCA. What is your approach to projective, or psychological testing?

If you’re questioning major psychiatric diagnoses that often feel very scary and are hard to talk about, projective testing can be very useful. It gives us a way to look at someone’s inner world or emotions, especially when they’re unwilling or unable to talk about it directly.

Describe the most challenging but rewarding individuals you’ve evaluated.

I enjoy working with the kids who think differently from their parents. It can be really rewarding to validate their feelings, explain their concerns to their parents and do some psychoeducation for their parents to get the adolescent or young adult and the parents back on the same page. Getting members of a family to understand each other’s perspectives is a really rewarding experience.

I also enjoy working with families who have gone through some kind of really hard experience, perhaps for a long time – whether that’s a traumatic experience or an adoption. And again, the part that I like so much is the feeling of bringing people back together and giving them some hope for the future.

Finally, I like incredibly complicated cases where there isn’t a clear answer – the ones where it’s a bit of a struggle to figure out or, in some instances, you work with a family as part of a longer-term partnership to gradually see a path forward. It’s not always clear-cut. When you can’t immediately clarify all of the pieces, you need to find a path forward for the family to start out on, revisit that path and potentially change or enhance that path. I like knowing that I can be part of someone’s team for the long term, like I’m joining the family and other providers, who are all working for that child. I’m talking about the ones that aren’t one-offs, rather the ones where we can build lasting relationships on behalf of a child.

You’ve worked in private and public schools and at a clinical treatment center. What brought you to NESCA, and how do you feel your past experiences impact your work with NESCA families?

Having lots of different experiences at different places and settings makes it easier for me to connect with a huge variety of people. I’m very rarely uncomfortable or fazed by the families or individuals I work with, their comments, or experiences, because I feel like I’ve heard so much from so many different people throughout my career.

I enjoy working with adolescents and young adults. Since they spend so much time in school, it has been beneficial for me as a clinician to have spent years working in the school setting. You have that perspective on schools – where they spend more waking hours than even at home. I have a good understanding of how schools work and the social dynamics for adolescents in schools. That has been especially useful in my work as a neuropsychologist.

What brought you to NESCA and why?

In my last position, I was in a mostly administrative role, doing a lot of supervision and teaching, which I really liked, but I missed the clinical work.

I was also looking for more exposure to different ways of doing things.

Since NESCA’s Founder and Director Dr. Ann Helmus is such a phenomenal clinician and is so well-known and respected, it felt like a great opportunity to learn from her. I had also trained as an intern with Dr. Miranda Milana, who is in NESCA’s Plainville office, and she talked a lot about the culture, the people, and how great everyone was. She was right! It’s a very supportive environment.

What I’ve found in the several months that I’ve been with NESCA is that the people are very smart here. I remember coming to one of NESCA’s weekly Case Conferences before I had agreed to join and thinking, “Wow, these people certainly know what they’re doing!” I learned something new in that Case Conference that I hadn’t thought about before, even though I had been practicing for years. I thought that was really powerful. NESCA is a group of professionals who truly love what they do and are so passionate about it. It is impressive to see so many people who have different perspectives and experiences come together to be so skilled at what we do. To be quite frank, I have learned a ton since being here and it hasn’t even been that long!

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Image of the MA State House with quote from the blog

Access to Mental Health Care in Massachusetts: Challenges and Opportunities

By | NESCA Notes 2024

Image of the MA State House with quote from the blogBy: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

Access to mental health care is an increasingly critical issue across the United States, and Massachusetts is no exception. While the state is often lauded for its comprehensive healthcare system and progressive policies, barriers to mental health care still persist. In this blog post, we will explore the current landscape of mental health services in Massachusetts, the challenges faced by individuals seeking care, and the initiatives being implemented to improve access.

The State of Mental Health Care in Massachusetts
Massachusetts has made significant strides in mental health care over the years. The state boasts some of the country’s leading hospitals, research institutions, and mental health professionals. Organizations such as the Massachusetts Department of Mental Health (DMH) and the Massachusetts Behavioral Health Partnership (MBHP) work to ensure that residents have access to necessary services, yet many still find it difficult to access care. There are also continuing racial inequities in medical and mental health care and a significant shortage of mental health providers of color.

Types of Services Available
Massachusetts offers a range of mental health services, including:

  • Inpatient Treatment: Hospitals provide acute care for individuals in crisis.
  • Outpatient Services: Clinics and private practices offer therapy and counseling sessions.
  • Community Support: Programs that focus on recovery and support that are community-based.
  • Telehealth Services: An increasingly popular option, especially since the COVID-19 pandemic, allows individuals to access care remotely.

Despite this variety of resources available, the gap between those in need and those receiving care remains significant.

Barriers to Accessing Mental Health Care

  1. Stigma and Misunderstanding

Stigma surrounding mental health issues is a significant barrier. Many individuals hesitate to seek help due to fear of judgment or misunderstanding by others. This stigma can come from family, friends, or even within professional environments. Education and awareness campaigns are essential to reducing stigma and encouraging individuals to seek the care they need.

  1. Insurance Limitations

While Massachusetts has implemented laws requiring insurance companies to provide equal coverage for mental and physical health services, discrepancies still exist. Many individuals find that their insurance plans have high deductibles, limited provider networks, or caps on the number of therapy sessions covered.

  1. Workforce Shortages

There is a notable shortage of mental health professionals in Massachusetts, particularly in rural areas. While urban centers like Boston have many providers, individuals in more remote locations often face long wait times or a lack of available services altogether. The distribution of resources is uneven, exacerbating access issues.

  1. Financial Barriers

Even with insurance, the cost of mental health care can be prohibitive. Copays, deductibles, and uncovered services can add up quickly, making it difficult for individuals to afford the care they need. Paying privately often leads to shorter wait times but is more expensive. Often families find themselves caught in a cycle where they need help but cannot afford it.

Current Initiatives and Improvements
To address these challenges, Massachusetts is taking steps to improve access to mental health care. Various initiatives are being implemented across the Commonwealth.

  1. Legislative Efforts

The Massachusetts State Legislature has been active in introducing bills aimed at improving access to mental health care. The “Mental Health Parity” law ensures that mental health care is treated on par with physical health care in terms of coverage. Advocacy groups continue to push for reforms that address loopholes and improve enforcement.

  1. Telehealth Expansion

The COVID-19 pandemic accelerated the adoption of telehealth services, which have proven to be a valuable tool for increasing access to mental health care. Telehealth allows individuals to connect with therapists and psychiatrists from the comfort of their homes, reducing barriers related to transportation, location, and time constraints.

  1. Community-based Programs

Community-based mental health programs are essential in providing support and resources. Initiatives, like the Massachusetts Community Behavioral Health Center (CBHC) program, aim to create a network of services that meet the diverse needs of communities. These centers offer a variety of services, including crisis intervention and case management.

  1. Educational Campaigns

Efforts to combat stigma and raise awareness about mental health are crucial. Organizations like the National Alliance on Mental Illness (NAMI) Massachusetts work tirelessly to educate the public about mental health issues, promote resources, and advocate for policy changes. These campaigns foster understanding and encourage individuals to seek help.

Looking Ahead: The Future of Mental Health Care in Massachusetts
The landscape of mental health care in Massachusetts is continually evolving. While significant challenges remain, the state is committed to addressing these issues through comprehensive reforms and community-based approaches.

  1. Continued Advocacy

Ongoing advocacy at both the grassroots and legislative levels is essential in pushing for systemic changes. By uniting voices and sharing personal stories, advocates can influence policies that prioritize access to mental health care.

  1. Innovative Solutions

As technology continues to advance, innovative solutions, such as mobile apps for mental health monitoring, digital therapy platforms, and AI-driven resources, could enhance accessibility.

Conclusion
Access to mental health care in Massachusetts is a multifaceted issue that requires ongoing attention and action. While challenges persist, the State legislature is committed to improving access to community programs and public awareness campaigns. By addressing stigma, financial barriers, and workforce shortages, Massachusetts can move closer to a system where mental health care is truly accessible for all. This journey continues. With continued advocacy and innovation, a brighter future for mental health care in the state is on the horizon.

How to Access Care
If you are or someone you love or care for is experiencing a mental health issue, you need to know how and where to find services. First, contact your primary care doctor or pediatrician. For parents or caregivers, the next contact should be someone at the child’s school. It could be an administrator, a teacher, or a mental health professional. Seek out additional information about what school personnel have observed about the child and find out about available resources at the school. This is an important part of treatment for a child.

 If you or the person you’re seeking to assist requires a crisis response to meet immediate safety needs, call 911, go to your local emergency room, or find your local Emergency Service Program by calling 877-382-1609.

Call or text the Massachusetts Behavioral Health Help Line (MBHHL) at 833-773-2445 for free, confidential support 24/7. Live chat is available at: https://www.masshelpline.com/. This helpline is useful even if you’re not sure what kind of help you need. Interpretation in over 200 languages is available in real time. Deaf or hard of hearing individuals can contact MassRelay at 711.

NAMI Compass is the information and referral helpline at NAMI Massachusetts. They provide resources and support to help people navigate the complex mental health system and problem solve in challenging situations. The COMPASS helpline is available Monday through Friday, 9 AM – 5 PM. Call the helpline at 617-704-6264 or 1-800-370-9085, or email them at compass@namimass.org.

SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

The Massachusetts Substance Use Helpline is a good resource for finding substance use treatment and recovery services. Helpline services are free and confidential. Call 1-800-327-5050.

The William James INTERFACE Referral Service aims to increase access to mental health and wellness services for individuals. Call the helpline at 888-244-6843 or 617-332-3666 from 9 AM- 5 PM on Monday, Wednesday and Friday, and 8 AM- 6 PM on Tuesday and Thursday, to work with a Resource and Referral Counselor who will help you navigate the challenges of finding mental health services. Communities served can be found on their website, https://interface.williamjames.edu/communities.

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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