The Mental Health Corner Archive
'School Phobia' needs quick action
August 26, 2009
'School Phobia' needs quick action
David, a fourth grader, suffers severe headaches every morning as his mother works to get him ready to go to school. He often vomits and complains of nausea. These symptoms continue at school and he just sits and cries in his classroom, until one of his parents come to take him home.
Eighth grade Molly, complains of severe headaches and cries about various aches and pains at school, leading to her need to return home from her junior high school. Often, she refuses to even get out of the car when her mother brings her to school in the morning.
Sarah, a kindergartner, complains of severe stomachaches in the morning when her mother prepares for her to go to school. She cries and clings desperately to her mother when she first enters the school and ultimately is unable to attend kindergarten.
Symptoms observed
When these children are allowed to remain at home or they return home from school, most of their ailments and complaints disappear. Physical illnesses typically accompany “school phobia,” while they are usually not noted for children just refusing to go to school. Social, emotional and somatic symptoms are commonly observed for those with “school phobia.”
We are again noting the emergence of some children’s significant fears and anxiety related to school as the school year begins. They are more commonly noted at times of significant change in activities and schedule.
Children with “school phobia” exhibit an irrational fear and acute anxiety about going to school. They typically dread something about their school life, which is compounded with an exaggerated and illogical fear of becoming separated from home and mother.
The incidence appears to be about equally distributed between the sexes and there is no relationship to social status or age. The child exhibiting “school phobia” may be a preschooler or adolescent and may or may not have a history of regular school attendance and academic success. It does not appear to be related to the number of siblings or birth order. “School phobia” is, however, usually a serious emotional crisis for some children that threatens their emotional health and educational development.
The formal clinical diagnosis system used in mental health (DSM-IV) does not identify “school phobia” as a unique mental disorder.
However, within the educational system and among the mental health professionals that treat school aged children, “school phobia” is acknowledged as being distinguished from other mental disorders and viewed as a complex childhood anxiety disorder. The term “school phobia” has fallen in some disfavor, as it does not typically meet criteria for a specific phobia. It does however appear to be part of a pattern of generalized anxiety combined with aspects of other disorders.
Somatic complaints are common and include dizziness, nausea, stomach aches, head aches, and panic, which most certainly affect the child, but they also affect the family and teachers, all of whom invariably feel powerless and frustrated.
The selection of treatment methods for “school phobia” depends on the nature and severity of the presenting problem and the theoretical orientation of those treating the child. Everyone agrees however that it is necessary to return the child to school as soon as possible. When the child is allowed to avoid attending school, treatment becomes much more complex and lengthy and the prognosis worsens.
Behavioral interventions are as or more effective than traditional therapies in the elimination of this behavior. These include contingency contracting, systematic desensitization, relaxation training, modeling, shaping, emotive imagery, and contingency management. Because of its multidisciplinary team approach, behavior therapy with its cooperative focus and expertise of educators, administrators, psychologists, physicians, counselors/therapists and parents, involves a diagnostic-prescriptive approach that empowers parents and children to act as change agents themselves.
Correcting problems
It is the responsibility of parents, educators, physicians, psychologists, and counselor/therapists to quickly identify these children, to correct the problem, or alert others with expertise to treat and eliminate the fear and anxiety.
School phobia is a painful and frightening experience for children, and it is frustrating and baffling for parents and school personnel. Typically these children are in need of professional help that is prompt and focused. Even if there is success in returning the child to school, there is an increased risk for further school avoidance problems in the future and many experience and demonstrate emotional adjustment problems and other psychiatric disorders as they get older.
Parents need to be concerned and consider professional intervention if their child is excessively leaving the classroom and going to the school nurse or sick room at school, constantly wanting to stay home and exhibiting somatic complaints when pressured to attend, is more frequently crying or exhibiting other behaviors to gain individual attention at school, or increasingly passive, withdrawn, or fearful and anxious about attending school.
Good communication between school staff, parents and involved community service providers is needed for appropriate intervention and treatment of these children.
