Dr. Paul Schwartz
It’s not uncommon for children to experience apprehension and jitters when starting school, but the anxiety should have dissipated by now. However, some children still experience fear, or panic, at the thought of going to school. Here I will explain the difference between school refusal and school phobia and clarify the problem.
What is the difference? There are similarities, but school refusal and school phobia are different disorders. School phobia is a child’s intense anxiety and fear of school. Phobias are irrational overreactions to a specific event, object or person such as dogs, thunder or strangers. Most children who experience the dread of school are consumed by a more complex scope of fear and anxiety. Most cases are not triggered by a single variable, as is the case with most phobias.
A child may have a problem in any number of areas causing them to not want to attend school. Many children who exhibit refusal are not fearful or anxious about school at all. Instead, they are fearful about separating from their parents, or they would just rather be at home where they feel safe and comfortable. Hence, the ‘school refusal’ was adopted to broaden the perspective on this problem.
Unlike other phobias such as dogs or the dark, which can be avoided without any significant setbacks, avoiding school leaves a child at risk for educational, emotional and social regression. It’s the reason that the child should be in a treatment program with a goal of getting back to school as soon as possible.
What are the symptoms?
School refusal affects 5% of elementary school children and 2% of middle school children. Symptoms often begin or worsen in September and October. A child may say he is not going to school and throw tantrums when it’s time to leave. He frequently complains of stomachaches, headaches or vague ailments that clear up by late morning, if allowed to stay home. He may also make frequent visits to the school nurse and, after being picked up, the symptoms go away once he’s home.
Some children may spend the school day in great discomfort, in a fog, not interacting with classmates, avoiding interactive activities and reluctantly engaging in academics. Sometimes she is angry and sullen after being sent to school and reluctant to being consoled, rarely relating the cause of her behavior.
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What are the causes?
The problem might be traced to a single negative past experience or a current one, such as being teased or bullied or being excluded by other classmates and left out of activities. There may be a problem with, or on, the bus. Some are fearful of using the school lavatory or changing for gym in front of other children. Try to get your child to express their fears to you or a professional. If refusal is tied to a specific issue or event in your child’s life, treatment is relatively easy.
School refusal can also be tied to academic or self-esteem issues. An extremely bright, vivacious ten-year-old girl became ill every morning while waiting for the school bus. She said that she was afraid of not being perfect and coming home a failure. Her father said that maybe he was too critical of her. He wanted perfection, which he believed she was capable of because she was so bright. Her father became more compassionate and her fears diminished rapidly.
Some children have difficulty separating from parents on any occasion, and school is just another situation that demands separation. Any dramatic change or crisis such as a death or illness of a family member, moving, divorce or even the birth of a new sibling can trigger school refusal. Although young children have anxious feelings about separating from parents and leaving for school, it’s normal and usually short-lived, needing no intervention. Most children who refuse to go to school are between eight- and thirteen-years-old.
Before deciding on treatment, ask “what is wrong that has created this level of stress for the child?” Is the problem at home, in school or both, or are there other reasons he doesn’t wan to go to school?
Responding early is critical. If left untreated, it can worsen family distress and spread to siblings. Chronic refusal can result in significant academic gaps, lack of development in peer relationships and a pattern of anxiety and avoidance that can continue into adult life.
The longer the child avoids school the greater the fear can become, making it even more difficult to return. When a child learns that avoidance decreases anxiety, he may use it in other anxiety-producing situations he encounters.
Try to get the child back to school as soon as possible. Keeping him home will only reinforce the problem and increase the dependency on you. If the child is unable to attend class, he should be allowed to stay somewhere in the school building where he feels safe, nurse or counselor office for example, rather than at home. You and the school counselor should find ways to modify the home or school environment so it alleviates some of the child’s discomfort.
Getting back to school
Although school refusal problems have potentially different solutions, here are some general guidelines that have been helpful:
- A key to success is early and direct intervention; the longer the behavior occurs the more difficult it is to treat.
- Don’t jump to change schools, teachers or classes. New situations can make the problem worse.
- Going to school should be non-negotiable. The more a child sees that he cannot manipulate the situation the more reluctant he will be to try.
- In a child must stay home, do not make it pleasurable. For example, duplicate his school schedule.
- Mornings are usually the most difficult time. This is when you need to be firm and demonstrate extra determination.
- Don’t follow a regimen that worked for another child.
Above all, be optimistic with your child. With early identification and effective intervention, school refusal is a short-lived problem. School is an exciting place to learn, socialize, play and develop life-long skills. With school and parents working together to develop an effective treatment plan, it can be all this for children with school refusal problems as well.
Paul Schwartz, Ph.D., is a professor of psychology and education at Mount Saint Mary College in Newburgh.