School refusal (SR) is a major category of school absenteeism that occurs in 1–5% of students, presents as a characteristic group of school avoidance symptoms, is often associated with anxiety and/or depressive disorders, and shows an improved prognosis with early identification and intervention. This chapter will center on two common cases of SR: first, an initial acute presentation of a second grade girl (where help can especially impact because the SR is new or not yet routine), and second, a seventh grade boy with a history of fluctuating SR symptoms.