DOI: https://doi.org/10.36347/sasjm.2026.v12i09.027

Pages: 971-977

Anxiety-based school refusal is a heterogeneous clinical phenomenon in children and adolescents, characterized by significant distress associated with school attendance and frequently associated with anxiety disorders, though not reducible to a single diagnostic entity. This narrative literature review synthesizes evidence from a corpus of 27 articles spanning systematic and scoping reviews, a community-based epidemiological study, clinical quantitative studies, psychometric studies, retrospective follow-up studies, and conceptual reviews, examining conceptualization, epidemiology and clinical profiles, associated factors, assessment, management, and prognosis. Conceptually, school refusal is distinguished from truancy, school withdrawal, and school exclusion, and is understood through a four-function behavioral model describing the mechanisms that maintain avoidance. Epidemiological data from a large community study indicate a 3-month prevalence of 2.0% for pure anxious school refusal, with substantial psychiatric comorbidity, particularly separation anxiety disorder and depression. School refusal is also more frequent among children with autism spectrum disorder, though the corpus does not permit estimating the prevalence of neurodevelopmental conditions among all young people with school refusal. Associated factors span individual anxiety and learning needs, parental psychopathology and family functioning, school climate, and peer victimization, largely derived from cross-sectional studies. Functional assessment is supported as clinically useful, while standardized instruments such as the SRAS-R require cautious interpretation in autism spectrum disorder. Regarding management, cognitive-behavioral and psychosocial interventions show the strongest, though tentative, support for improving school attendance, with less consistent effects on anxiety symptoms; pharmacological and digital interventions remain limited by small, dated, or preliminary evidence. Long-term o