It was not uncommon for Abbie Whitworth to feel so anxious about going to primary school that she would vomit.
"Her stress around noise was manifesting in her body," Abbie's mother Meredith Whitworth said.
At 16 years old, the Hunter teenager feels far away from the child that once only made it to school half the time.
Diagnosed as autistic when she was in kindergarten, the year 10 student is now able to take classes from the comfort of her own home.
At the start of year 7, her parents enrolled her in Aspect Distance Education, an autism specific online school based in Thornton.
"I can have my own time to decompress, I enjoyed the fact that I can remove myself from the situation if something stresses me out," Abbie said.
Abbie is part of a cohort of students who feel intense distress or anxiety about attending school, which can cause school refusal or school can't.
Education researchers at University of Southern Queensland, Western Sydney University and the University of Sydney defined school refusal as when a child feels overwhelmed by stressors that make school feel threatening, unsafe and impossible.
"School refusal is more common in some groups for example neurodiverse students, gender-diverse students and students born with innate variations of sex characteristics," they said.
Lack of data and the different ways that absences are recorded across states and school systems have made it difficult to estimate the prevalence of school refusal.
A 2023 Greens-commissioned survey, however, found 39 per cent of 1000 Australian school children were unable to attend school at one point because of anxiety or stress.
Attendance levels in NSW public schools have also dropped over the past six years, according to the Centre for Education Statistics and Evaluation.
The proportion of kindergarten to year 12 students attending school 90 per cent or more of the time was at a historic low in 2022 at 44.7 per cent.
While 2025 levels had risen to 59.8 per cent, they were still lower than in 2019, before COVID-19, which was 72.6 per cent.
Aspect's distance school is hoping to help alleviate school refusal for autistic students.
Since it started in 2020, the online classes have increased from nine students to 108 in NSW and South Australia.
Ms Whitworth wanted to get ahead of any potential school refusal when she enrolled Abbie at the distance education hub.
"Autistic people, because there aren't accommodations made in mainstream schools, they can have poorer outcomes financially and health-wise," she said.
"I wanted to start high school on the front foot."
With online classes, one-on-one support and occasional in-person excursions Abbie said she was happy taking things at her own pace.
Her father, Donovan Whitworth, said attendance was never a problem with the online model.
"The biggest thing for me is that Abbie had a place that she felt safe and supported and there would be a path to being a productive adult," he said.
There were no options for Abbie to continue at Aspect for years 11 and 12, so the family was looking at other options.
"I think she would have spent years 7 to 10 just in fear the whole time and wouldn't have a gained the skills she needs for life," Mr Whitworth said.
