Behavioural Difficulties & School Refusal

By the time a parent ends up reading a page like this, the morning routine has usually been a battle for a while. Maybe the school has called again. Maybe the meltdowns last two hours, not twenty minutes. Maybe your child won’t get out of the car, won’t get on the bus, won’t get out of bed. Maybe you’ve started to wonder whether this is just who they are, and whether you’ve already failed them.

None of that is the right read. Behaviour is communication, especially in children. When a child’s behaviour gets stuck (disruptive, defiant, withdrawn, refusing), there is almost always a clinical signal under it that hasn’t been named yet. The work I do with families is, first, to figure out what the signal is. Second, to give parents specific tools that change the pattern. Third, to coordinate with the school so the environment is part of the solution, not part of the bind.

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What I see in the room

• Tantrums and meltdowns that are more intense, longer, or more frequent than the child’s age would predict.
• Defiance and argumentativeness that have become the dominant texture of family life. Every request a negotiation, every transition a fight.
• Aggression toward siblings, peers, or parents, including hitting, biting, and damage to property.
• Difficulty with transitions and unmet expectations, where small disappointments turn into big storms.
• School refusal, ranging from morning negotiations to full withdrawal from attendance.
• Social difficulties at school. Trouble joining in, frequent conflicts, friendship breakdowns.

Many of these children get labelled with Oppositional Defiant Disorder, conduct problems, or “behavioural issues,” and sometimes those labels fit. But the underlying drivers vary widely. Anxiety, ADHD, autism, learning differences, mood disorders, sensory processing, trauma, and family dynamics all show up first as “bad behaviour.” Getting the formulation right is the work. The intervention only lands when it’s matched to what’s actually going on.

School refusal — its own clinical concern

School refusal is one of the most urgent presentations a family can land in, and one of the most consistently misread. The everyday assumption is that a child who refuses school is choosing not to go. In most of the cases I see, that is not what is happening. The child is not choosing not to go. The child cannot go.

The drivers, in clinical experience and in the research, are usually some combination of:

• Anxiety. Separation anxiety, social anxiety, performance anxiety, panic. The body is registering school as a threat, not an option.
• Underlying ADHD or autism, where the school environment is overwhelming or mismatched and the child has run out of compensations.
• Bullying, social exclusion, or a specific bad experience at school that the child has not yet been able to put into words.
• Family stress or transition, where staying close to home becomes a survival strategy.
• Mood difficulties, where mornings become impossible and the child cannot mobilise.

The longer school refusal goes on, the harder it is to reverse, because avoidance is reinforcing. Effective treatment names the driver, builds a graded return-to-school plan that the child can actually follow, and coordinates with the school directly so re-entry is supported rather than ambushed. With your written consent, I work with the school as a partner from the first session.

My approach, by age

Younger children (ages 2–7) — Parent-Child Interaction Therapy (PCIT)

For younger children with disruptive behaviour, the gold-standard treatment is Parent-Child Interaction Therapy (PCIT), and it is one of the most rigorously studied interventions in child psychology. PCIT is parent-coached: I work with you in real time while you are with your child, often using a one-way mirror or earpiece, so the parenting strategies are practised live rather than handed off as homework. Most families see meaningful change within 14 to 20 sessions.

I am PCIT-certified, trained at UT Health San Antonio’s PCIT and ADVANCE Clinics during my predoctoral internship.

School-age children (8–12) — behavioural family work plus individual skills

For older children, the work usually has two tracks running in parallel. With parents, behavioural and emotion-coaching strategies that change what reinforces the behaviour at home. With the child, individual sessions that build emotion regulation, problem-solving, and CBT skills for anxiety and frustration. When the formulation points to ADHD, autism, or a learning difference, that part of the picture gets named and treated as well.

Adolescents (13–17) — collaborative, parents-as-partners

Teenagers don’t respond to the same parenting strategies that work at age six, and that is a feature, not a bug. With adolescents, the work is more collaborative. A working relationship with the teenager themselves, individual CBT for anxiety, mood, or avoidance, and structured parent guidance on the side. Family sessions when they are useful. School coordination always.

The school side

For behavioural and school-refusal cases, working with the school is part of the treatment, not an optional extra. With your written consent, I speak directly with form teachers, school counsellors, allied educators, and, where relevant, the child psychiatrist or paediatrician already involved. I write structured letters of support when they help. I help parents prepare for IEP-style meetings.

My own school-based training is part of why this piece matters to me. During doctoral training, I worked at East Chapel Hill High School running individual and family therapy, parent training, and classroom observation. During internship, I served on Central Regional Hospital’s Child and Adolescent Psychiatric Unit (a Level 1 state psychiatric hospital), where school-reintegration planning was part of every discharge. The school is not a side conversation. It is part of where the child lives.

When neurodiversity is part of the picture

This practice exists for neurodivergent people and the people who love them, and a high proportion of the children I see for “behaviour” are neurodivergent, diagnosed or not yet. Disruptive behaviour in an undiagnosed ADHD or autistic child is often the visible part of an unmet need. Part of the work is naming that, getting the diagnostic picture clear, and matching the parenting and school approach to the child’s actual neurology rather than to the assumption that they are “choosing” the behaviour.

If formal assessment is needed, see ADHD & neurodiversity for children (6–12) or teenagers (13–17).

Who this is for, and who it isn’t

This page is the right starting point for parents of children and adolescents with disruptive behaviour, defiance, school refusal, or social difficulties at school, with or without a clear diagnosis underneath.

This is not the right starting point if the primary presentation is severe trauma requiring specialist trauma-focused work, active self-harm or safety concerns that need a higher level of care than my outpatient practice can provide, or a young person who is already settled with a clinician they trust. If we’re not the right fit, I’ll say so on the first call and point you to the right service. /clinical-fit/ walks through how I think about fit.

Sessions, fees, and scheduling

Sessions are sixty to ninety minutes, pro-rated at SGD 300 per hour. The first consultation is usually up to two hours at SGD 600. PCIT typically runs 14 to 20 sessions; behavioural family work for older children is usually shorter. After-hours sessions (weekday evenings, Saturdays, Sundays and public holidays) carry a published rate. Full structure on the fees page. Payment is due before each session.

If you are not yet sure whether to book, the free 15-minute Meet & Greet (Zoom or phone) is the easiest place to begin.