The current article reviews the literature on school refusal behavior. Definitional inconsistencies, the effects of biased assessment processes, and the consequences of the lack of ethnic, racial, and economic diversity in school refusal research samples are highlighted. An increase in the use of low-income, ethnic minority, community samples in school refusal research is proposed in order to create a more representative and useful literature. Concerns regarding artificial and impractical divisions between the commonly used labels of school refusal and truancy are also discussed. Suggestions are proposed for a new pragmatic framework of school refusal assessment for research and clinical work that utilizes and enhances Kearney's functional approach. The framework has the potential to incorporate the influences of multiple cultural contexts in order to aid professionals from different disciplines in both prevention and early intervention for school refusal in low-income, ethnic minority populations. Additional suggestions for future direction in school refusal research are also discussed.