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
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.