Unlike SAD, school refusal is not a DSM-IV diagnosis; it is a symptom associated with several diagnoses, including SAD, GAD, SP, major depression, and ODD. School refusal is often defined as difficulty attending school associated with emotional distress, especially anxiety and depression (King and Bernstein 2001). Terms such as separation anxiety and school phobia have been used synonymously with school refusal. However, the term school refusal is favored because it is descriptive and inclusive and does not imply etiology (King and Bernstein 2001). School refusal does not typically include youth who are not attending school due to truancy, antisocial features, or conduct disorder.