School Phobia/School Refusal

Reluctance or refusal to attend school.

School phobia is an imprecise, general term used to describe a situation in which a child is reluctant to go to school. According to the American Academy of Child and Adolescent Psychiatry, refusal to go to school is most common in the period from preschool through second grade. In most cases, school phobia is a symptom of an educational, social, or emotional problem the child is experiencing.

The child with school phobia develops a pattern of predictable behavior. At first, the child may begin the day complaining that he is too sick to go to school, with a headache, sore throat, stomachache, or other symptom. After the parent agrees that the child may stay home from school, he begins to feel better, although his symptoms often do not completely disappear. By the next morning, the symptoms are back in full intensity. When the child repeats this pattern, or simply refuses to go to school without complaining of any symptoms of illness on a chronic and consistent basis, school phobia is considered to have evolved into school refusal (or school refusal syndrome).

School refusal is a diagnostic criterion for separation anxiety disorder, a mental condition characterized by abnormally high anxiety concerning possible or actual separation from parents or other individuals to whom the child is attached. When school refusal is related to separation anxiety disorder, it is likely that the child will also display aversion to other activities (after-school clubs and sports, birthday parties, summer camp) that involve being away from the person to whom the child is attached. In addition, he may cling to the person, and refuse to allow her out of his sight for even short periods of time. Children experiencing separation anxiety disorder and school refusal may express feelings of fear when left alone in a room.

Refusal to go to school may begin as a result of any of the following stresses: birth of a sibling; death of a family member, close friend, or pet; change in school, such as a new teacher; loss of a friend due to a move or change in school; or a change in family, such as divorce or remarriage. It may also follow summer vacation or holiday break, when the young child has spent more time with his primary caregiver.

Almost every child will display behavior to avoid going to school—for academic or social reasons—at some point during his school career. In these cases, the situation the child is trying to avoid is usually temporary—an argument with a friend, the threat of a bully, or the consequences of a missed homework assignment, for example. When the avoidance of school becomes a chronic pattern, the child may develop serious social and academic problems. A professional counselor or child psychiatrist working with the child's teacher and other school personnel can all support the family in overcoming a child's refusal to go to school.

Returning the child to school is the highest priority so that disruption to the child's educational and emotional development is minimized. Depending on the severity of the fears that produced the symptom of school refusal, ongoing counseling or psychiatric treatment may be necessary for a length of time, even after the child is successfully back in school.