Returning to the case examples, thorough evaluations revealed that Emma's school refusal initially resulted from separation anxiety that was rewarded by gaining her mother's attention and playtime during school hours. A treatment plan to help Emma would therefore include relaxation training, cognitive restructuring of her anxious thoughts, practice in being separated from her mother, and parent training in contingency management of using rewards for school attendance and consequences for school refusal. Nicholas' assessment confirmed the presence of social anxiety and depressive symptoms, thus a treatment plan was devised to address these problems. His comprehensive treatment plan included anxiety management skills, cognitive restructuring, social skills and role plays, training in problem solving, and a gradual reintroduction into school. Thus, treatment for school refusal behavior requires a comprehensive treatment approach that accounts for the multiple factors that initiate and maintain this problem. Due to the individual variations among children and adolescents that refuse school, a treatment plan must be customized to address the specific problems and difficulties experienced by each youth and their family.

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