School refusal would seem to be a symptom complex appearing in more than one psychological configuration. In its acute form, it is felt to arise out of difficulties that the child has experienced in achieving a sense of autonomy. This has been due primarily to fluctuant limit setting by over involved parents. Direct management of the situation to control the symptom is essential to restore the child to normal growth patterns. Since symptom displacement and recurrence are not common it is suggested that the symptom in its acute form is more situational in character than indicative of a structured neurotic illness.