School refusal behavior refers to child-motivated refusal to attend school and/or difficulty attending classes for an entire day (Kearney & Silverman, 1996). As such, the term represents an umbrella construct for many historical ones that have been used to describe youths with problematic absenteeism, including truancy, psychoneurotic truancy, school phobia, separation anxiety, and anxiety-based school refusal. School refusal behavior refers to a spectrum of problematic, illegitimate absenteeism that includes youths who miss school for extended periods of time, youths who miss school sporadically, youths who skip certain classes or who are tardy to school, youths with severe morning misbehaviors to attempt to miss school, and youths who attend school with great anxiety and somatic complaints that precipitate ongoing pleas to miss school in the future (Kearney, 2003).