School Phobia – Reasons, Signs and Treatment

Parenting can be a difficult time, especially with the first child. As the child grows, you are concerned not just about the physical aspects of the child, like his diet, but also about his mental well-being. Parents are required to strike a balance between tough love and pampering the children, as too much of anyone can be detrimental to the mental growth of any child.

The first hurdle that parents face in this regard is usually when the child is admitted to a school. Inevitably, at some point or the other, your child will refuse to go to school. This problem is termed ‘school refusal’, and is common to a great extent. Tackling such problems can be difficult, but not impossible. It is important that the parents analyse the probable causes behind such behaviour, before making a move to make your child feel more comfortable about going to school.

What is School Refusal in Children?

School refusal syndrome occurs when the child simply refuses to go to school, owing to some reason or the other. The child may not want to go to school, maybe afraid or simply refuse to do so. He could also have a school avoidance disorder which may even manifest as physical symptoms, like sickness or general sadness in the mornings. Due to anxiety, the child may prefer staying at home and doing other activities instead of going to school.

Causes of School Phobia in Kids

The reasons behind why the child behaves like this can be many, and it is important to understand them from the perspective of the child. The common reasons behind school refusal syndrome and your child not going to school are given below.

• Anxiety about being evaluated: A school is a place of constant evaluation, where all the capabilities of the child are measured and put up on display. If the child refuses to go to school during days of activities like the sports days or days on which public speaking is mandatory, this can be the reason. The child may feel anxious about having to perform under pressure and thus choose to avoid the entire episode instead.
• Separation anxiety: It is not just babies that face separation anxiety, grown-up kids can experience it too. Having been raised with the care of his parents, the prospect of being thrust into an environment where such care is not given can be harsh for the child.
• Academic problems: Academic problems or learning difficulties are common in children, and the pressures associated with them can grow to such an extent that the child may choose to avoid school altogether.
• Peer issues. A school is a place where the child has to interact with a multitude of others, including his peers. Social isolation, bullying or conflicts with friends are common among children, so the child may refuse to go to school entirely.
• Conflict with teachers: If your child finds a teacher intimidating he might avoid school altogether.
• Traumatic events: Some traumatic events like separation of the parents, the death of a family member or divorce can result in school refusal in children.
• Transition: Moving to a new school or even a new place can make it difficult for the child to adjust, and he may choose to stay at home in a comfortable environment rather than go to school.
• Rewards at home: Staying at home means that they get to spend time with parents or do trivial fun activities like watching TV, so the child may choose to do that instead of spending time at school.

School Phobia Symptoms

School phobia is something that can easily be noticed, especially by the parents. There are obvious symptoms that the child does not like going to school, like straightforward refusal. Some of the common symptoms are given below.

• The child may cry and get tearful over the prospect of going to school and plead with the parents to let him stay at home.
• Tantrums, dawdling or even running away from school are another common symptoms.
• In order to fake a legitimate reason, the child may complain about illnesses like stomach ache, headaches or dizziness when the time to go to school arrives.
• Another common symptom is when the child has a noticeable difficulty to return to school after long absences, like holidays, vacations or even sports days.
• The child may choose to spend time elsewhere without going to school and have long, unexplained absences.
• Occasionally, the child may miss classes or be absent for specific periods, with no real explanation given.
• Late to arrive at school is another manifestation of school refusal syndrome in children.
• In order to stay away from the spotlight, the child may be a frequent visitor to the sick bay at school.

Consequences of School Refusal

School plays a huge role in forming a child’s personality, and the mental growth of the child. Going to school not only gives the child knowledge about the world but also cultivates his personality. The school puts children in an unknown environment and prepares them for the real world and adulthood right from the start. Not attending school can make the child lag behind in terms of mental and emotional development, and they may end up clingy towards their parents.

Tests to Diagnose School Refusal

The tools which help the parent determine whether the child is going through school withdrawal symptoms are:

• The Child Behavior Checklist
• The SCARED Test (The Screen for Child Anxiety Related Emotional Disorders)
• The Children’s Manifest Anxiety Scale
• Children’s Global Rating Scale

How is School Phobia Treated?

The treatment largely involves a psychological approach, and various counselling and desensitisation techniques.

1. Cognitive Behavior Therapy: A derivative of Behavior Therapy, this is done to correct inappropriate and maladaptive behaviour in the children.

2. Systematic Desensitisation: The child is gradually taught and helped to modify his reaction to school and make it less harsh on himself emotionally.

3. Exposure Therapy: The child is exposed to the stressful environment gradually, and is guided throughout to correct his maladaptive reactions to the situation and cope well with the changes.

4. Operant Behavioral Techniques: This involves rewarding the child for the desired behaviour so that the frequency of the behaviour increases.

Other Therapies and Medication for Children Who Experience School Phobia

Serotonin reuptake inhibitors like Prozac are useful when trying to cure depression in the child. However, these have to be used with caution as children can become dependent on the drugs, thereby worsening the depression. Such dependency can also increase the chances of bipolar disorders and suicidal tendencies. Sudden discontinuation can also cause anxiety, insomnia and headaches in the child.

Some drugs which help the child mask the symptoms of anxiety, like sweaty palms and racing heart are also useful. However, drugs like propranolol have to be used with utmost care, and never in asthma patients. These should also not be discontinued suddenly, as this can lead to an increase in blood pressure.

Is Follow-up After Treatment Essential?

If the child is being or has been treated for school withdrawal syndromes, after-treatment follow-ups are absolutely essential. The child has to be monitored closely by the family, school staff and the treating professionals in the period after treatment.

What Should Schools Do to Cope with School Refusal?

Here are a few ways schools could cope with a child’s school refusal.

School Refusal Strategies at the Policy Level:

• Create a positive school atmosphere with a strong sense of community between the students and the teachers
• Establish peer support and mentoring programs so that students have a feeling of belonging
• Make the children understand the importance of constant attendance in school
• Closely monitor student attendance so that such problems can be detected early

School Refusal Strategies at the Individual Level:

• Understand why the child is missing school, and obtain school refusers advice with the help of the family
• Maintain close relationships with the family, even if the child is missing school consistently
• Understand that parents face just as many challenges as the school, to get the child to attend
• Provide recognition or positive feedback to children who are trying to bring up their attendance levels

What Can Parents Do About It?

Parents dealing with a child with school refusal can consider the following approaches.

1. While You Are Talking To Your Child

• Talk to your child about the measures you can take to ensure that he is comfortable at school
• Talk positively, and show your child that you believe that he can tackle the problems at school to build his self-confidence
• Be calm and clear while speaking, and use ‘when you go to school…’ rather than ‘if”
• Do not give your child a chance to say ‘no’, by using direct statements

2. While You Are At Home

• Always remain calm, and never appear frustrated at the situation
• Establish routines regarding the school in the morning and evening, like folding the uniforms or packing the bags for the next day
• Make your home ‘boring’ during the school hours, so that the child is not enticed to stay there
• Get your child’s sleep cycle right

3. Getting to School

• Let somebody else drop your child at school, as your home is the better place for separation rather than the school gates
• Let your child know that you are proud of him for going to school despite it being hard
• Reward your child with something at the end of the day for going to school

4. Working With School

• Talk to the teachers or the principal for advice regarding the situation
• Get a referral towards a good counsellor or psychologist
• Set up regular appointments with the primary contact at school- class teacher, principal, or even the support staff

How to Control or Prevent School Refusal?

• Listen to what the child has to say regarding the reasons for his behaviour so that you understand whether there is any bullying or peer pressure involved
• Another important thing in dealing with school refusal is to get your child to attend school regularly and on time so that it becomes a habit
• Reinforce your child’s self-confidence and make him believe that he is strong enough to get over this problem
• Reassure the child by saying that the parent or caregiver will be at home when he returns from school, and reiterate how boring the home is during the time he is in school

Prognosis of School Phobia

If a preschooler refuses to go to school it is nothing new. The routine usually improves with a little bit of care and counselling by the parents and teachers. However, if the problems tend to go on for too long or become worse, the prognosis is still excellent with the help of professional treatment.

School can be a daunting process for children, so the refusal to go to school is nothing new- it is a common behavioural trait among children. While this can be tackled with the help of some small lifestyle and attitude changes by the parents, you might need to get the help of professional support if the school refusal behaviour worsens over time.