The child who will not go to school: separation anxiety, school refusal, or truancy
Three different problems produce an empty desk. The NCE gives you one detail that tells them apart, and it is usually about the parents.
By Dr. Andrew Wichterman · September 22, 2026 · 5 min read · Updated October 22, 2026
Three different problems produce an empty desk. The NCE gives you one detail that tells them apart, and it is usually about the parents.
The practice item discussed here was written for this site in the style of the NCE. It is not a question from the actual exam. NBCC does not release its items, and candidates sign a nondisclosure agreement.
The item
An 8-year-old cries and complains of stomachaches every school morning, begs to stay home, and worries that something will happen to her mother while she is at school. Her parents know she is at home and have kept her there most days for a month. The MOST likely diagnosis is:
A. Conduct disorder
B. Separation anxiety disorder
C. Specific phobia, situational
D. Oppositional defiant disorder
Keyed answer: B. Developmentally inappropriate fear about separation from an attachment figure, with somatic complaints on school mornings and worry about harm to the parent, lasting at least four weeks in a child, is separation anxiety disorder. The parents' knowledge and the anxious quality distinguish this from truancy or defiance.
What the item is really testing
The distinction between anxiety-based refusal and conduct-based absence, and within anxiety, what the fear is about. School refusal is a behavior, not a diagnosis; the exam wants the disorder behind it. Here the worry is about harm to the mother, which is the signature of separation anxiety.
Why each wrong answer tempts you
A. Conduct disorder involves violating others' rights; anxious refusal to leave a parent is not that.
C. The fear is of separation from the mother, not of the school building or a specific situation within it.
D. ODD is anger and defiance toward authority, not fear.
The parents tell you which one it is
School refusal: the parents know the child is home. The child is anxious, often somatic, and usually not in trouble otherwise. Truancy: the parents do not know. The child is not anxious, conceals the absence, and often has other conduct problems. The exam plants "parents know" or "parents were unaware" in the vignette for exactly this reason.
Two clocks for one disorder
Separation anxiety disorder is the one anxiety diagnosis with two durations: four weeks in children and adolescents, six months in adults. It can be diagnosed in adults, a change from DSM-IV, and adult items usually describe a parent who cannot tolerate a child leaving home or a partner traveling.
Treatment is return, not rest
The evidence-based response to anxiety-based school refusal is graded return to school with parent coaching, not extended homebound instruction, which reinforces the avoidance. A treatment item that offers "arrange homeschooling until the anxiety resolves" is a distractor. The exam wants exposure, in small steps, with the parents holding the plan.
Where this lives in the course
Domain 3, Areas of Clinical Focus: the lesson "Children and adolescents: bullying, abuse, school problems and self-harm". Read it, take its quiz, and add the key terms to your flashcard queue.
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Every deep-dive item on this site was written for the site in the style of the NCE. None is from the actual exam.