Adolescence is a period of significant physical, emotional and social transition. Young people must adapt to changes in their bodies, increasing academic and social pressures, shifting friendships, emerging sexuality and identity, and questions about study, employment and their future. At the same time, they are beginning to separate psychologically from their parents and develop a more independent sense of self.

Some rebellion is therefore a normal part of adolescence. Questioning family rules, becoming more private, challenging authority and placing greater importance on peers can all reflect healthy movement towards autonomy. Kobak and Sceery (1988) describe adolescence as involving a developmental shift towards greater independence while the young person continues to negotiate a secure and cooperative relationship with their parents.

This creates an understandable tension. An adolescent may want independence while still needing emotional security, reassurance and care. They may demand to be treated as an adult one moment and feel overwhelmed by adult expectations the next. Parents may also need to reconsider how they offer support, establish boundaries and respond to their child’s growing need for privacy and choice.

Conflict does not necessarily mean that something is wrong. It can be part of a family renegotiating closeness, authority and responsibility as the young person develops. However, when anger, withdrawal or refusal becomes persistent, intense or significantly disrupts school attendance, relationships or everyday functioning, it may be communicating more than ordinary adolescent rebellion.

The adolescent’s behaviour may be expressing distress that they cannot yet recognise, understand or put into words.

Depression does not always look like sadness

Adults often imagine depression as visible sadness or tearfulness. In adolescents, it may instead appear as:

• Irritability, anger or frequent conflict
• School refusal or declining attendance
• Withdrawal from family, friends or activities
• Alcohol or other drug use
• Fighting, impulsivity or risk-taking
• Sleep disruption and difficulty getting up
• Falling grades or reduced motivation
• Hopelessness, self-harm or suicidal thinking

The World Health Organization identifies irritability, withdrawal, school difficulties and increased risk-taking as possible features of depression in young people. Depression and anxiety can both significantly affect school attendance and functioning (World Health Organization, 2025).

An adolescent who appears hostile or oppositional may be struggling to communicate sadness, shame, fear, loneliness or helplessness. Their behaviour may express something they cannot yet recognise or put into words.

Persistent anger or withdrawal can sometimes communicate feelings that are difficult to express directly.

A psychodynamic understanding of anger

From a psychodynamic perspective, behaviour has meaning, even when the young person cannot consciously explain it.

Anger can provide a temporary feeling of strength when an adolescent feels frightened, rejected, ashamed or powerless. It can create distance when closeness feels exposing and protect against feelings of dependency at a time when the young person is trying to become more independent.

Anger may also move in different directions. It can be directed outward through arguments, hostility or defiance, inhibited because the adolescent fears damaging an important relationship, or turned inward as guilt, self-criticism, self-harm or suicidal thinking. Research has identified conflicted anger as an important dynamic in adolescent depression.

This does not mean all anger is depression. Behavioural changes may also relate to anxiety, trauma, bullying, substance use, family stress, learning difficulties or neurodevelopmental differences. Anger should therefore invite curiosity and careful assessment rather than simply punishment.

Understanding school refusal

School refusal describes difficulty attending or remaining at school because of significant emotional distress. A young person may experience headaches, nausea or exhaustion, become distressed the night before school, struggle to leave home, repeatedly ask to be collected, or become angry whenever attendance is discussed.

School refusal is not a diagnosis and does not have one explanation. It may be associated with:

• Depression, anxiety or panic symptoms
• Bullying or feeling unsafe
• Academic pressure or fear of failure
• Social difficulties or fear of judgement
• ADHD, autism or learning difficulties
• Sensory overload
• Trauma, grief or family stress
• Sleep disruption
• Difficulty with separation, uncertainty or independence

Current research suggests that school refusal is best understood through the interaction of individual, family, peer, school and broader social factors (Gonzálvez et al., 2022).

School refusal is usually a sign of significant distress rather than simple unwillingness.

What might school represent?

From a psychodynamic perspective, school is not only a place of education. It can also represent separation from parents, peer judgement, competition, authority, performance and the growing expectation that the adolescent should cope independently.

Refusing school may protect a young person from anticipated humiliation, failure, rejection or separation. Staying home can provide immediate relief and restore a sense of safety or control. Over time, however, avoidance may increase isolation, dependency, shame and anxiety about returning.

Christogiorgos and Giannakopoulos (2014) describe how school refusal may involve conflicts around dependency, separation and autonomy within the parent–child relationship. This does not mean parents have caused the problem. Rather, the adolescent’s distress needs to be understood within their relationships, development and wider environment.

Is it attention-seeking?

Behaviours such as school refusal, fighting, substance use or self-harm are sometimes dismissed as “attention-seeking.” This can obscure the communication contained within them.

Young people need attention, connection and recognition. More useful questions include:

• What is the young person unable to say directly?
• What feeling occurs before the behaviour?
• What situation are they trying to avoid or control?
• How do others respond afterwards?
• What does the behaviour temporarily provide?

The adolescent may be communicating: “I cannot manage this,” “I feel like a failure,” “I need help but cannot admit it,” or “I do not know how to tell you how hopeless I feel.”

Understanding the behaviour does not mean accepting aggression, removing every expectation or allowing avoidance to continue indefinitely. It means responding to both the behaviour and the distress beneath it.

How therapy can help

Adolescents may resist therapy because accepting help can feel like admitting weakness or surrendering independence. Therapy arranged by parents or school may also feel like another adult attempt to control them.

Psychodynamic therapy offers a relationship in which the young person can gradually understand feelings and patterns that may initially be expressed through anger, withdrawal or action. The aim is not to “fix” the adolescent, but to help them make sense of their internal experience.

Therapy may help a young person to:

• Recognise what lies beneath anger and avoidance
• Connect behaviour with feelings and relationships
• Understand fears of rejection, criticism or failure
• Express anger without harming themselves or others
• Tolerate sadness, shame and vulnerability
• Develop a more stable sense of identity
• Find alternatives to withdrawal, substance use or acting out
• Gradually re-engage with school and relationships

Research into psychoanalytic psychotherapy with depressed adolescents found that collaborative exploration was associated with better outcomes, while interactions dominated by anger and challenges to the therapist were more prominent in poorer-outcome cases (Fiorini et al., 2024). The goal is not to suppress the anger, but to recognise and understand it within a safe relationship.

Supporting a young person

Parents can help by:

• Beginning conversations during calm moments
• Describing what they have noticed without accusation
• Validating distress without agreeing with every demand
• Avoiding labels such as lazy, manipulative or attention-seeking
• Remaining curious about bullying, anxiety and academic pressure
• Maintaining predictable routines and appropriate boundaries
• Working collaboratively with the school and clinicians
• Developing a gradual return-to-school plan where appropriate

The first task may not be obtaining a complete explanation or immediately restoring full attendance. It may be helping the young person experience adults as steady, interested and emotionally available.

Anger may be anger—but it may also be grief, shame, fear or depression wearing protective armour. School refusal may be refusal—but it may also be an attempt to avoid an experience the young person currently feels unable to manage.