Topic: School Phobia
Researched and written by:  Kristina L. Keifer
                                                I attest that the following report is a product of my own original work.

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School phobia is a disorder that may not affect a large number of children, but when a child is diagnosed with school phobia, it is very debilitating for the child and his or her parents and teachers. School phobia may sound as though it only affects the school environment but home life is disrupted by this disorder as well. It is not easy for a child to have school phobia because it interferes with peer relations, academic performance, and self-esteem. There are several characteristics of a child with school phobia that differentiate it from normal apprehensions about attending school. There are certain issues that must be addressed in relationship to the classroom environment, of which anyone working with a child with school phobia should be aware. School phobia can be treated and a variety of treatment options are available, with most focusing on a collaborative effort between home and school.     Most children do not have significant difficulty attending school. A small minority of children are diagnosed with having school phobia. School phobia is a disorder that prevents a child from attending school on a regular basis. It is a psychosocial disorder that causes children to refuse to attend school. This can be present in both young children and adolescents (Phelps, Cox, Bajorek, 1992). Children or adolescents suffering from school phobia have extreme difficulty attending school and remaining in school once there. It was originally found that children who were school phobic and refused to attend school did so for three reasons. These reasons included acute anxiety, maternal anxiety, and an enmeshed mother-child relationship. This would be characterized as an extreme attachment to the mother by the child. Enmeshed relationships are those where the two people are unable to function as they typically should when away from one another. (Kearney, Eisen, Silverman, 1995). Research did not address the possibility that school phobia could also involve the child’s relationship with the father. Studies have only focused on mother-child relationships. Extreme fear of school and the ongoing avoidance of school are thought to result from a specific aspect of school that elicits this neurological reaction (Brulle, McIntyre, Mills, 1985). Being separated from the family, especially the mother, is very difficult for children who are first attending school, but school phobic children fail to appropriately adapt to this separation. The intense fears of school phobic children are not eliminated and positive school bonds are not formed (Kearney, et al., 1995). According to the DSM-III-R, school phobia, which is a specific example of a simple or social phobia, involves a fear or humiliation or embarrassment while at school, in addition to fears about the school in general (Phelps, Cox, & Bajorek, 1992).       School phobia is often misdiagnosed; therefore, the actual prevalence of school phobia varies from one source to another. Simple refusal to attend school was found in approximately 5% of school-aged children (Kearney, et al., 1995). Other statistics say that acute school phobia exists in about 1-1.5% of the population. In the middle school age group, approximately 0.2- 1% of students suffer from school phobia (Jenni, 1997). Children are increasingly being diagnosed with school phobia, so the numbers are rising.        There have not been any significant differences identified by research to say that one gender or ethnicity is more susceptible to school phobia. Both males and females have the same chance of being diagnosed with school phobia. The only differences related to gender are that school phobic males are more likely to be aggressive and defiant, while females are submissive and quiet (Cherry, 1992). Antisocial behaviors are seen more in older males suffering from school phobia than older females also afflicted (Cherry, 1992). School phobia usually is not present before adolescence and if it is present before this, the severity increases significantly. Older school phobic children normally have a more severe level of school phobia and have a more negative prognosis (Elliott, 1999). Onset of school phobia normally occurs at a mean age of 14.3 years. Other research has found that children with school phobia and other separation anxiety disorders have parents who are diagnosed with psychiatric problems. This is more prevalent in mothers who have children with school phobia. When the mother of a child with school phobia has previously suffered from school phobia or another type of separation or anxiety disorder, it is more likely that the child will also suffer. The child is more likely to suffer from school phobia if his or her mother as opposed to the father, also had school phobia (Pilkington & Piersel, 1991). It has also been found that 75% of mothers who have children with school phobia also suffered from school phobia themselves (Phelps, et al., 1992).        School phobia is marked by a persistent fear of school or anything school related. This agitation and panic are only present when the child is in the school environment (Phelps, et al., 1992). Children who have school phobia are afraid that something negative is going to happen to them while they are at school. Even if a child does attend school, it is very difficult for them to remain there, even if pressure or punishment from parents, teachers, or the school administration is present (Pilkington & Peirsel, 1991).  Any time spent by a child with school phobia in a school environment is filled with constant thoughts of escape and avoidance of school. Part of this stems from the anticipation of negative consequences associated with school (Akande, 1999). This fear can come from several different things. If a child has been diagnosed with a learning disability, this may exacerbate the refusal to attend school because of frequent failures in academics. Another explanation for a fear of school may have begun with a negative school environment involving threats present in the school environment. When school phobia is diagnosed in younger children, the onset is immediate and normally results in a crisis, where older children have a slower onset of symptoms (Cherry, 1992).  Even though the child with school phobia may be aware that his or her fears of school are unjustified and irrational, this does not stop the child from avoiding school.             School phobia is a very emotionally draining disorder for any child suffering from it. Symptoms may include severe tempers, excessive fearfulness, and misery. Children who are diagnosed with school phobia are more susceptible to depression and other anxiety disorders (Elliott, 1999). School phobia causes problems between the children suffering from this disorder, the parents, teachers, and peers. Children who have school phobia often have problems with school officials because by not being in school, they are going again school rules. It is also a fight for school officials and staff to keep these children in the classroom and deal with the emotional and behavioral problems associated with school phobia. Peer relations are also a problem for children with school phobia because they are viewed differently by peers and they do not want to bond with anything relating to school.  These problems cause the child with school phobia to feel a sense of isolation. School phobia also causes children to be hypervigilant. They are more sensitive to danger, whether it is actual or only perceived (Jenni, 1997). Considering the high levels of stress and anxiety associated with school phobia, it is not uncommon for a child to also be diagnosed with depression or an anxiety disorder. This makes school phobia very disabling (Phelps, et al., 1992).             School phobia does not only produce emotional symptoms, but children also experience physical symptoms when suffering from school phobia. The emotional upset of the child is accompanied by physical complaints that normally reside once the child is allowed to avoid school or go home from school. These complaints of physical ailments are normally not present during summer vacation, holidays, and weekends. It is also possible that the psychical complaints are the only symptoms that a child exhibits when they suffer from school phobia. Refusal to go to school may be displaced in more discrete ways as opposed to very direct and overt refusal tactics (Pilkington & Piersel, 1991). Symptoms seem to be somatic and include abdominal pain, headaches, stomachaches, dizziness, nausea, and vomiting. As previously stated, these complaints normally disappear once the child realizes that he or she will be permitted to remain at home and not attend school (Elliott, 1999). Actually being forced to attend school may be so traumatic for a child with school phobia, that this child may truly become physically ill. This results from severe stress and anxiety related to school (Cherry, 1992).             A major assumption associated with school phobia is that children who have this disorder have an extreme reluctance from being separated from their mothers. This attachment to the mother is not just a typical reaction of a young child being separated from his or her mother for the first time. This is a dysfunctional reaction to the parent-child separation. The severity of this attachment may range from the child simply not wanting the mother to be out of sight to the child not wanting to give up physical contact with his or her mother (Cherry, 1992). Younger children who have school phobia normally demonstrate this by temper tantrums, crying, and desperately clinging to their mothers when there is to be a separation for school. Older children normally will use physical aliments and complaints as a reason to stay at home (Pilkington & Piersel, 1991). Every child suffers from some anxiety and emotional upset the first time he or she must be separated from the mother or caregiver. Children with school phobia however, have much higher levels of anxiety and never seem to adjust to the separation. Most children with school phobia do recognize that there is a problem and they desperately want to attend school. Like any other disorder, school phobia is not controlled by the suffering child and they do not choose to have this disorder. The characteristics associated with school phobia can vary from one child to another, as can the severity of the disorder. School phobia can be negative for any child suffering from this disorder, along with be debilitating to the parents and teachers of a child with school phobia.          The extreme fears, temper tantrums, and crying of children with school phobia create a disturbance in the classroom. If a child with school phobia is forced to attend school, he or she is going to exhibit antisocial behavior while at school. He or she will also make it difficult for other students to concentrate on the teacher and their studies (Jenni, 1997). When a child with school phobia becomes physically sick at school and gets hysterical, teachers have trouble dealing with these classroom disruptions. In most classrooms, there is only one teacher in each classroom, and if that teacher must concentrate on the child with school phobia, then the other children are not being supervised the way they should be or receiving the attend they should. When this disruption gets to be more than the classroom teacher can handle, the child is normally removed from the classroom, into a resource room or a similar setting. This just reinforces and increases the child’s fits of violence and emotional outbursts (Cherry, 1992). Teachers must be aware of this and make efforts not to give up on these children who have school phobia. It is very important for teachers who work with children with school phobia to exhibit sensitivity and vigilance. When a teacher is confronted with a child with school phobia, it is essential that the teacher not interrogate or engage in lengthy inquisitions about the child’s behavior or fears. This only results in the child becoming very defensive and even more sensitive about his or her problem (Elliott, 1999).             The classroom and school environment also plays a big role in how children with school phobia adjust and react to school. School phobia can be brought on by a negative school environment. This can include bullying by other students, fear  of a teacher, or another fear associated with school. It is very important that the school be aware of any of these incidents and take proper action to rectify the situation (Kahn, 1968). Careful supervision and management by school personnel is essential in preventing and effectively controlling school phobia. Appropriate assessment and testing should be available at the schools in order to accurately diagnose school phobia (Elliott, 1999).             Children with school phobia have a very negative impression of school in general and every effort must be taken by the school and classroom teachers in order to ensure that the child’s fears are not reinforced. Teachers must make sure that classrooms and the school environments are positive and create an atmosphere that the child wants to be a part of. Teachers should create a feeling in the classroom that attempts to alleviate child’s fears and create calming environments (Brulle, et al., 1985). When emotional and behavioral problems arise in children with school phobia, teachers should be taught to be firm and patient with these children. Communication should be soothing and gentle so that the child wants to remain in school, and is not further traumatized by an insensitive teacher (Brulle, McIntyre, & Mills, 1985). Children with school phobia are very sensitive and embarrassed by their disorder and teachers must be reminded that calling attention to these students in any way will only make their fears worse. Teachers should ask the students with school phobia about whether they wish to called upon or greeted while in the classroom. Convincing a child with school phobia to attend school may take special accommodations. Sometimes, it is necessary to seat the child next to doors from where he or she can freely exit from. Considering it is so difficult and stressful for a child with school phobia to attend school, he or she may need a specific location on school grounds to exit to when the classroom environment gets too stressful (Jenni, 1997). Arrangements with the parents and the school should be made in the incidence that the child is unable to remain in school and must return home. Teachers should be aware of these issues and permit children with school phobia to leave the classroom to go to the designated safe area when needed. By law, any child with a disorder must have access to free and appropriate education and school phobia provides special challenges that must be met by teachers and school officials (Jenni, 1997).            Research has shown that the best treatment methods involve a collaborative effort between the child, the parents, teachers, and school officials. All parties must be actively involved in order to insure the success of the treatment. Parents, teachers, and school officials must make an effort to approach treatment of school phobia in a calm and non-anxious manner, so that the child does not become even more stressed about his or her conditions. It is also believed the school is the best place for treatment to occur (Jenni, 1997). Overcoming school phobia means developing positive bonds with the school itself and realizing that school is not a fearful and negative place. The child with school phobia has to feel that he or she is integrated into the school environment. In addition to this, the child must feel that he or she is respected and valued by peers and school staff (Cherry, 1992).             The ultimate goal of treatment is to reintroduce students into the school environment and decrease or eliminate the fear and anxiety associated with the school environment. One technique for getting children with school phobia back into school on a regular basis is behavioral therapy. This technique relies on systematic desensitization, meaning that the school stimuli that previously elicited negative feelings for the child are turned into non-anxiety producing stimuli. The child should be brought back into school as soon as possible in order to make treatment more successful, because the longer the child is away from school, the harder it will be to reverse this behavior (Elliott, 1999). The child’s return to school should be gradual and be done in steps so that the child is not overwhelmed. Normally, this type of treatment involves the school psychologist working with the child in addition to the help of parents and teachers. The first step is to develop a Fear and Avoidance Hierarchy. This is a list of 10 items that the child fears in relation to the school environment. These items can range from entering the school building, to walking into a classroom, to participating in classroom discussions (Phelps, et al., 1992). Systematic desensitization can occur in two different ways. Imagery is used to help the child overcome the fears listed in the Fear Hierarchy. The child is taught to visualize these different situations and practice relaxation techniques while the imagery is going on. This is to help children with school phobia learn how to calm their fears by the relaxation techniques when they are actually placed in these settings. Another way to approach systematic desensitization is through in vivo. This is when the child physically engages in the actions listed on the Fear Hierarchy or is exposed to the fearful environments. The child is slowly guided up the hierarchy by the school psychologist, through one of these methods, until the child has desensitized these fearful settings and actions (Last, Hansen, Franco, 1998).             Educational-Support Therapy is another treatment option for children with school phobia (Last, et al., 1998). This involves psychotherapy and educational presentations that focus on overcoming fear and phobias. Children are educated and given information about phobias and other anxiety disorders that can help them distinguish their own disorders and understand the nature of them. Part of this treatment involves the child with school phobia keeping a diary in which they make daily entries about what fears he or she encountered that day, what emotions where elicited by the fears, and how the fears were overcome. No actual instruction is given by therapists because this is a way for the child to take control over his or her fears and learn how to minimize these fears and confront the fearful situation (Last, et al., 1998). Until the child realizes that there is a problem and identifies what he or she actually fears, there can be no effective way to eliminate that fear.             In order to eliminate fears, the child with school phobia must learn how to restructure his or her thinking. Something can only produce a fearful reaction if an individual perceives it as being threatening or harmful. The cognitive aspect of therapy involves teaching children with school phobia how to alter fearful thoughts so that they can have a more positive perspective. Thoughts and statements that are producing the anxiety and the fear are enabling the phobia to continue. By challenging these thoughts and making them more realistic, the fear begins to be reduced (Elliott, 1999). The child is taught that when negative thoughts arise, they should be identified and immediately replaced with a more soothing and positive thought. This technique should be used during systematic desensitization and any other exposure therapy. This is a treatment method that is not only beneficial during the actual treatment sessions, but once the child has successfully reentered school (Last, et al., 1998).             No treatment can be effective if the school is not involved. This includes teachers as well as school officials and other personnel. Teachers need to be educated about school phobia so that they can correctly manage this disorder in the classroom. Reentry of a child with school phobia back into the classroom may require several concessions from the teacher. Missed work may need to be pardoned and most importantly, there must be positive reinforcement for the child to attend school. Many times the return of the child to school may be based upon the condition that the child only participate in activities that are not anxiety producing or that time in school be limited at first. The initial reentry may require parental involvement in which the parent of the child with school phobia is present in the school building (Evans, 2000).             There is not one single method that is effective in treating every child with school phobia. Treatment plans must be adapted and altered according to the needs and characteristics of each individual child. The focus of treatment is to show the child with school phobia that school is not a place that should be feared and give him or her a way to conquer the fear in order to attend school again (Phelps, et al., 1992). Every child has the right to an appropriate education, and this is something that the child with school phobia desperately wants. No child chooses to be afraid of school, and treatment should be based around positive reinforcement, not punishment for absence from school.             In sum, everyone has fears that alter or disrupt some part of their lives, but phobias can be severely incapacitating.  When someone has a phobia, there is intense fear and anxiety associated with a certain place, things, or situation. School phobia is an intense fear of school that prevents a child from regularly attendance. Just like any other phobia, the fears may be irrational, or they may have resulted from a traumatic event in one’s life. Children with school phobia may not be understood by their peers and teachers, but they are not choosing to act the way they do. Instead, they want to be apart of the school environment. School phobia is not a permanent condition and can be treated using cognitive and behavioral therapy. When one understands what school phobia is and the effects it has on everyone involved, it only stands to reason that the only way to approach a child with school phobia is with sensitivity and understanding. With the right treatment, it is possible for a child with school phobia to succeed academically and socially. Identification, treatment, and compassion are the key to helping a child with school phobia live a happy and healthy life.