Each fall there is a normal reluctance among most children to
begin school. However, if the reluctance worsens or persists beyond 
the first few weeks in autumn, the child may be in the early stages of 
developing a school phobia. While the word phobia usually conjures up 
many dreaded connotations the word itself really only means an 
unreasonable fear. There are many cases in which each of us would be 
quite understandably afraid, however, when this fear becomes 
associated with something that is part of our normal routine and 
interferes with our ability to do something that most people can do 
quite easily, the term phobia is used. 

There are more than 250 different commonly recognized phobias. 
Understandably school phobia is a very common one. The term school 
phobia is actually misleading since children are seldom afraid of 
anything associated with school. The root of the problem is generally 
related to separation anxiety based on, and too often encouraged by, a 
persisting emotional tie with the mother. The child who is a good 
candidate for school phobia is one who is frequently ill, in the 
nurses office, tends to be very dependent and reluctant to leave home, 
and has a history of frequent absence from school due to illness. 
Usually the mother in such cases tends to be compassionate and 
sympathetic, and may overindulge the child. School phobias are most 
commonly rooted in this mother-child relationship. This disorder is 
more commonly found in girls than boys. In fact, the typical school 
phobic child is about 10 or 11 years of age, female, and has had 5 or 
6 years of normal school experiences, with perhaps somewhat more 
absenteeism than normal. In fact, in many cases the child may have 
really enjoyed school. This can be very confusing to the parents. 

The phobia is usually triggered by some minor incident at school
such as a threatening teacher or peer, a brief illness from which the 
child is reluctant to recover, etc. This minor incident, however, if 
not handled properly can lead to an even greater reluctance to resume 
school. The longer the child is allowed to remain home the greater the 
problem becomes. With school phobia, as with all phobias, there is a 
tendency for the fear to generalize the longer the person is removed 
form the threatening situation. In school phobia cases, attempts should 
be made to return the child to school immediately. The longer he or she 
stays away, the more difficult the problem becomes. If the child is 
unable to attend class he or she should be allowed to stay in the 
nurse's office, the principal's office, the counselor's office, or 
anywhere within the school building where he or she feels safe, rather 
than at home. 

It is important for those involved to understand that school
phobia is often not an evasive maneuver and that the anxiety that the 
child feels is real and terribly frightening to him or her. Likewise 
the physical symptoms of which they so frequently complain (dizziness, 
nausea, headaches, etc.) are real. They are related to the bio-
chemical reaction that occurs as a result of the separation anxiety. 
It should be recognized that these children really are suffering from 
physical symptoms resulting from their emotional state. In extreme 
cases these children can developed intense anxiety which can lead to 
intense panic reactions. In some cases of extreme panic the child may 
be willing to accept any consequence rather than attend school. 
Occasionally, children have threatened to hurt themselves or even kill 
themselves. It is hard sometimes for adults to imagine the extreme 
panic that the child feels; however, if you were to imagine that while 
sitting in the room at this moment a lion were to enter the room, you 
would quite understandably experience severe anxiety and panic. 
This is the same emotional reaction the child has when entering 
school. With any avoidance reaction the negative element of the 
situation become more intense the closer the individual gets to the 
anxiety and panic. This is the same emotional reaction the child has 
when entering school. With any avoidance reaction the negative 
elements of the situation become more intense the closer the 
individual gets to the anxiety producing situation. The anxiety may 
begin to develop in the evening when the child is preparing to go to 
bed, since this is when his thoughts first turn to attending school 
the following morning. The anxiety then usually becomes more intense 
the closer in time and physical distance the child becomes to the 
school situation. As this anxiety becomes more intense the child 
quite naturally begins to experience physical symptoms which his 
parents usually feel are legitimate reasons to keep the child home 
from school. Vomiting may become commonplace, especially if it is 
reinforced by allowing the child to stay home. In rare instances 
children have even been able to induce a fever simply through this 
intense emotional reaction. In most cases, these reactions are 
unconscious and are not a planned attempt to manipulate parents to 
avoid school. However, in some cases manipulation does occur as the 
child begins to use other tactics to avoid the unpleasantness of 
attending a situation which he greatly fears. Firmness and insistence 
that the child attend school is a must. It is especially important 
for the parents to be quite firm in insisting that the child attend 
school. If they feel that he/she may be ill it is best for her to 
have him/her attend school and go immediately to the school nurse to 
rule out the possibility of a real physical illness. Keeping the 
child at home will only reinforce the problem and increase the 
dependency on the parent. The goals here is to have the parents 
gradually encourage the child to become more independent while at the 
same time expressing their concern and support. The school 
psychologist should also be consulted to work with the school and the 
family in alleviating the causes of the child's anxiety. In some 
cases the child may fear for the safety or health of the parent. They 
may mistakenly feel that their presence is needed at home for 
emotional support or physical well-being. As already mentioned, it is 
imperative that the child remain in the school building. If the child 
cannot attend classes, then he should still remain with a "safe" adult 
somewhere in the building. If some progress is not seen within the 
first few weeks of persistent effort by those involved, then the 
family should be referred to a mental health agency for counseling. In 
extreme situations a referral to a psychiatrist may be necessary to 
obtain medical assistance to manage the physical symptoms which the 
child is experiencing to make it easier for the child to attend 
school. in about 60% of the most severe cases of school phobia 
medication is helpful in having the child return to school in a 
relatively short period of time. If parents and school personnel act 
quickly and with consistent effort the problem is usually easily 
remediable within a few weeks. 


Suggestions for Teachers and Parents:

1. Consider carefully a change in school or class since new 
situations may aggravate separation anxiety. Attempting to 
make school less demanding or easier does not help. 

2. Do not consider home instruction unless all other options have 
been attempted. Home instruction may communicate that the 
child does not have to attend school. 

3. When home instruction is initiated, the criteria for re-entry 
should be discussed. 

4. All school personnel should adhere to an agreed upon plan as to 
the length of the school day. Do not encourage the child to 
do more than what was previously agreed upon or confront the 
child with unexpected new demands (e. g. arbitarily extending 
or shortening school day). Mutual trust is the basis for 

5. If physical symptoms are present, a thorough medical assessment 
may be helpful. Parents should be encouraged to sign releases 
to continue communication with school personnel. 

6. Parents should have a singular approach when dealing with the 
child's school refusal. Focus should be on the family's 
approach to handling school refusal, including making and 
enforcing family rules. Specific contingencies and exceptions 
should be developed and clearly defined. A written plan is 
often helpful. 

7. It is important for the child to know that school attendance is 
expected and that parents are committed to this course of 

8. The teacher should ignore somatic complaints and acting-out 
behavior while positively reinforcing the cooperative behavior 
of the child. The teacher should not show too much solicitude 
for any crying or complaining, but use a firm, kind approach. 
A brief time-out period may be used. 

9. Manipulative, ambivalent behavior and animosity are common 
characteristics of school avoidance. Avoid reacting with 
counter hostility. Be prepared to deal with the anxiety and 
panic that is likely to occur in mother and child. 

10. Any home stay should be made more aversive than attending 
school (i. e. , structured routine, absence of TV, etc.). 

11. Do not discuss or try to rationalize school attendance with the 
child. Do not discuss phobic symptoms. 

12. Do not stress what important/exciting things were done at home 
in the child's absence.