School refusal is a significant problem and is associated with long-term educational and psychological sequelae. However, treatment interventions and services remain inadequate for children who refuse school. School refusal is frequently associated with anxiety and, for this reason, cognitive therapy is often chosen as an intervention for this group of children. Few studies, however, have demonstrated the efficacy of cognitive therapy for school refusal, and it has become apparent that the links between cognition and school refusal have been poorly researched. The review paper discusses the literature on school refusal anxiety, and cognition, and evaluates the evidence for associations between these factors. Thought is given to the treatment implications arising from this literature and conclusions are drawn with regard to the continued use of cognitive therapy in children who refuse school. The empirical study aims to provide novel information on the roles of anxiety and cognition in a non-clinical sample of adolescents. A between-groups design was used to explore whether adolescents who refused school differed from a control group, on measures of anxiety, automatic thoughts, and self-efficacy. Relationships between anxiety and measures of cognition were also explored. Statistical analyses revealed no significant differences between the groups on any of the measures. However, clinical levels of automatic thoughts were more frequent in the school refusal group, and positive correlations were established between anxiety and each of the measures of cognition. Implications for treatment and future research are discussed, and limitations of the study are acknowledged.