Parental characteristics such as psychopathology and parenting practices are understood to be implicated in school-refusal presentations. Expanding upon these largely affective and behavioral factors, the present study sought to examine the role of a parenting cognitive construct—parenting self-efficacy—in understanding school-refusal. School-refusing adolescents (n = 60, 53% male) and school-attending adolescents (n = 46, 39% male) aged 12–17 years (M = 13.93, SD = 1.33), along with a parent, participated in the study. Participants completed study measures of demographics, psychopathology, overall family functioning, and parenting self-efficacy. As expected, parents of school-refusing adolescents were found to have lower levels of parental self-efficacy than parents of school-attending adolescents. Parenting self-efficacy was inversely associated with parent- and adolescent- psychopathology as well as family dysfunction. Logistic regression analyses determined parenting self-efficacy to be a predictor of school-refusal. However, upon controlling for related constructs including family dysfunction, adolescent depression, and parent depression, the predictive capacity of parenting self-efficacy was eliminated. Taken together, the results highlight the likely complex relationships between parental self-efficacy, familial psychopathology, and dysfunctional family processes within this population. Research is required to further delineate these dynamic relationships among families of school-refusing adolescents.