School refusal as the first presentation of adverse childhood events and autism spectrum disorder: a primary care case report

Since the pandemic, school refusal has become an increasingly alarming issue, representing the emotional conflict manifested when a child refuses to attend school. This case study describes the management of a 13-year-old girl who presented to a primary care clinic with school refusal due to a history of adverse childhood events, leading to a diagnosis of a mood disorder and newly suspected high-functioning autism. This report shares a unique interplay between school refusal, adverse childhood events, and psychological disorders. The patient’s complex comorbidities require individualized case formulation and effective management through parental and teacher support. Primary care physicians play an important role in identifying Adverse Childhood Events (ACEs) as a preventable cause of school refusal, to lead and coordinate a multidisciplinary team intervention activity for a favourable prognostic outcome.