School phobia (known to professionals as school refusal), a complex and extreme form of anxiety about going to school (but not of the school itself as the name suggests), can have many causes (see below) and can include related anxiety disorders such as agoraphobia and selective mutism. Symptoms include stomachaches, nausea, fatigue, shaking, a racing heart and frequent trips to the toilet.
Young children (up to age 7 or 8) with school phobia experience separation anxiety and cannot easily contemplate being parted from their main career, whereas older children (8 plus) are more likely to have it take the form of social phobia where they are anxious about their performance in school (such as in games or in having to read aloud or answer questions in class).
Children with anxieties about going to school may suffer a panic attack if forced which then makes them fear having another panic attack and there is an increasing spiral of worry with which parents often do not know how to deal.
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How Does a School Phobia Start?
Going to school for the first time is a period of great anxiety for very young children. Many will be separated from their parents for the first time, or will be separated all day for the first time. This sudden change can make them anxious and they may suffer from separation anxiety. They are also probably unused to having the entire day organized for them and may be very tired by the end of the day, causing further stress and making them feel very vulnerable.
For older children who are not new to the school, who have had a long summer break or have had time off because of illness, returning to school can be quite traumatic. They may no longer feel at home there. Their friendships might have changed. Their teacher and classroom might have changed. They may have got used to being at home and closely looked after by a parent, suddenly feeling insecure when all this attention is removed; and suddenly they are under the scrutiny of their teachers again.
Other children may have felt unwell on the school bus or in school and associate these places with further illness and symptoms of panic, and so want to avoid them in order to avoid panicky symptoms and panic attacks fearing, for example, vomiting, fainting or having diarrhea. Other children may have experienced stressful events.
Possible triggers for school phobia include:
(Depression has not been included here as a cause of school phobia as in the points above the underlying reasons that might have caused it have been covered.)
Some children have a particular susceptibility to school phobia because of a medical condition such as Asperger Syndrome and Attention Deficit Hyperactivity Disorder. Children with Asperger Syndrome need to be dealt with differently to children without the syndrome as, for example, teaching them relaxation techniques can actually make them more anxious.
How to Help:
The longer school phobia goes on, the harder it is to treat so referrals to Child and Adolescent Mental Health Services are usually quite quick to ‘nip it in the bud’. However, if your child is severely affected, it is better to ask for a referral (from your child’s doctor or head teacher) to the service before you are desperate as it is often overstretched: in reality it can take some time to get an appointment.
Things you can do yourself as a parent include getting help from your child’s school. Teachers need to be aware there is a problem. Sometimes being taught in a special unit in school (if the school has one) may help your child feel more secure as it is a cosier place and acts as a half-way point between home and school. (Some children are so severely affected that they stop going to school.) It should be made quite clear to your child’s teachers that she is not ‘playing up’ but that her anxiety is very real and she is suffering from it.
At home, life should continue and your child should be encouraged to carry on as normal. But she might want to stop going out, especially without you, even to parties that she was quite happy being left at before. Although you need to deal sensitively with her, if she doesn’t absolutely have to miss something, it is best to help her go by going with her for part (or all) of the time so that her world does not shrink altogether. It is also helpful to:
The above information has been taken from School Phobia, Panic Attacks and Anxiety in Children, by Márianna Csóti (her own daughter was severely affected by school phobia), published by Jessica Kingsley Publishers (ISBN 1843100916, price £16.95). It is aimed at helping children aged 5 to 16 and includes practical advice for the 14 points mentioned above and social phobia, as well as information on therapies and anxiety disorders. Further advice is available in the book, including photocopiable dos and don’ts pages for parents and professionals to give to the child’s teachers or Head of Year.
She also sells relaxation tapes suitable for children from age 8.
Her website is: www.bookstohelppeople.co.uk