School Daze

Robin was always an excellent student who had many friends and enjoyed participating in school activities. Last September, she nervously anticipated the first day of middle school. As a new kid making a transition from private school to a Los Angeles public school, her jitters were normal. However, what began as mild anxiety escalated, and after several days of school, she refused to return. Robin (her name has been changed to protect her privacy) had developed an extreme case of school phobia.

School phobia describes a condition whereby a child becomes highly agitated about attending school. The symptoms range from frequent physical complaints, such as headaches and stomachaches, to a paralyzing fear.

The disorder can wreak havoc on a family’s life. “My husband and I missed many days of work,” says Lynn, Robin’s mother. “Plus, we were so concerned about Robin, we spent less time with our son. He began to model her behavior to get attention.”

Another L.A. mother, Nancy, felt frustrated when her daughter, a first-grader, had tantrums every morning before school. “I would start screaming, ‘Get in the car, already!’ I knew this wasn’t a good way to interact with my child.”

School phobia often occurs during transition periods such as when a child begins kindergarten, first grade, middle school or high school. It is more likely to occur when the child returns to school after a break. “It can strike at any time, but especially after an extended absence due to an illness or a vacation,” says Elaine Massion, a Los Angeles Unified School District psychologist.

Occasional fears about school or reluctance to go are not uncommon, but true school phobia is rare. The National Assn. of School Psychologists estimates that it affects about 2% of schoolchildren. It occurs with equal frequency in girls and boys.

Experts advise parents who suspect school phobia to first take their child to a pediatrician to rule out any illnesses a child may be claiming to avoid school. If there is no physical illness, parents should be sympathetic, but at the same time remain firm. “Have minimal discussion,” Massion says. “Tell the child that you sometimes don’t feel like going to work, but we all have our responsibilities. There is no choice. Going to school is the law.

“Get him back in school as quickly as possible,” Massion says. “The longer the child stays out, the easier it is to develop the habit of not going.”

This approach may work for children with mild trepidation or with children who aren’t actually fearful, but instead are testing or manipulating parents.

However, if the problem continues, something else is going on. “The parent needs to be Sherlock Holmes and try to discover the source of the fear,” says Patricia Edmister, director of Developmental Psychology and Children’s Services at Phillips Graduate Institutes in Encino, which offers advanced degrees to therapists.

Experts suggest asking the child about his school day. Questions should be open-ended and not elicit just “yes” and “no” answers. Parents should also ask the teacher if their child is having problems socializing with classmates or having difficulties with schoolwork. In some instances, the teacher could be the reason the child dreads school.

Changes at home, such as family illness, death, divorce or a new sibling can also trigger school phobia. Nancy suspects that her daughter’s problem was linked with the arrival of a new baby.

Another possible cause for fear of school is the child’s innate temperament. “Some children are just anxious children and their fears become magnified,” Edmister says.

Separation anxiety--a fear of leaving parents and home--is also often related to school phobia. Parents sometimes contribute to this disorder. “Moms and Dads should evaluate their own feelings about their child going to school. They may unconsciously send signals encouraging him to stay home,” Massion says.

Other psychological problems, such as depression, can coexist with school phobia. “You have to treat the depression, in addition to the way it’s being displayed,” says Dr. David Feinberg, director of Outpatient Services for Child and Adolescent Psychiatry at UCLA. “Adults go to their therapist and say, ‘I’m depressed. I feel suicidal.’ Kids, unable to articulate their feelings, instead may say, ‘I’m not going to school.’ ”

Problems that prompt a child to become school phobic should be addressed, but, whatever the cause, it is important to establish a plan of action. “It’s best to have a team approach that includes the parents, teacher, school administration and the therapist, if one is involved, all working together to enable the youngster to cope,” Edmister says.

Allowing a child to phone home during recess or to visit the school nurse for a few minutes each day may be all that is necessary to make school seem less threatening. Having a child bring a favorite object from home and giving him choices such as what to wear are additional ways to help him feel secure and in control.

For persistent cases, a behavior modification program can be effective. “Slowly desensitize the youngster to school,” says Feinberg. This is a step-by-step process in which the child approaches the classroom in increments. For example, the first day, the parents drive him by the school. The second day, he walks to the entrance. Eventually he attends class for a short period of time.

Simultaneously with behavior modification, the child is taught relaxation techniques. A therapist can help him break down each fear he associates with school, and together they discuss how to handle these anxieties. Some therapists also find antidepressants and anti-anxiety medications helpful when used with behavior therapy.

Most important, a school phobic child should not be perceived as a truant. “The child is not involved in antisocial behavior. He’s not cutting school to paint graffiti on a wall. He’s at home with his parents’ knowledge,” Feinberg says. “Moreover, the parents should not be considered irresponsible. They have made reasonable efforts to get the child to school.”

Unfortunately, Robin’s school used punitive measures instead of providing support when dealing with her. “School personnel need to be educated about this issue,” says her mother.

After therapy and a switch to a more enlightened school, Robin was able to go to school for half days. She is now up to staying in school almost all day, and is expected to achieve full days soon.