NANCY'S TIPS Up to five percent of school-aged children exhibit school refusal. Students who are entering school for the first time or transitioning to a new school are at particular risk. A typical precursor to school refusal is separation anxiety, When it is time to go to school, a child may present with physical complaints such as a stomachache, or with temper tantrums, yet is often calm once at school. School refusal behavior often serves one of four purposes. One is to avoid school-based stressors such as the cafeteria, PE, or transition between classes. Another is to escape social or evaluative situations. A third purpose is to pursue tangible reinforcement outside of school such as sleeping late, watching television, or playing with electronic devices. The fourth is to seek attention from significant others. The first two purposes are driven by a desire to avoid anxiety-producing situations, while the latter two indicate a desire to pursue non-school-based positive reinforcement. The longer the child does not attend school, the higher the anxiety level rises, the more entrenched the refusal behavior becomes, and the harder it is to return to school. The goal is