School refusal can be a common presentation for General Practice.
Human behaviors are often driven by fear, or driven by passion/value/love of something.
I suspect that most school refusal are driven by a fear/stress of some sorts, and fear/stress is a usual sign of needs not met.
So the next question is, what needs are not met for the child?
1. Are PHYSIOLOGICAL needs met like sleep, nutrition, and general physical health? A thorough physical screen is important here.
2. Are SAFETY needs met? Is there bullying? Is there a fear of failure? Is there a fear of being judged? Is there a fear of not being good enough?
3. Are CONNECTION needs met? Are there friendship issues? Are there relational issues with teachers? Are there boyfriend or girlfriend problems? Are there social skills issues? Are there ASD traits? Are there IQ EQ mismatch issues leading to poor peer connection?
4. Are there enough GROWTH, learning and newness? Are they bored? Are they gifted? Are they being challenged enough? Do they have a learning difficulty?
The answers to the above will guide our next step.