Is it Playing Hooky or School-Phobia?

It’s been about a month since our kids started or returned to school. In spite of the whining and complaining, especially in the morning, most children are excited and coping well with the transition from summer break to busy school schedules.

For a few others, starting school can be mentally agonizing and even cause slight physical symptoms. A lot of kids play sick to get out of school, but a few others are actually suffering from Didaskaleinophobia, which is a fancy medical terminology for ‘fear of going to school’! While working in the ER this past month, I saw many kids with anxiety symptoms, abdominal discomfort, and headaches – without any medical cause. The symptoms were quickly relieved by missing school and staying at home.

School phobia (also referred to as school refusal) is a complex and an extreme form of anxiety DepressedKidabout going to school (but not of the school itself). It is a form of a true anxiety disorder and can cause considerable days of missed school and a variety of anxiety-related physical symptoms such as headaches, stomach aches, nausea, vomiting, diarrhea, tiredness, dizziness, shaking, and frequent trips to the toilet. These symptoms mainly occur in the morning and often worsen at the time of departure to school. The child otherwise seems healthy and vigorous. According to the Anxiety Disorders Association of America, the condition affects about 2 to 5 % of school children and has an average age of onset of about 7.5 years. Younger children (up to age 7 or 8) can experience separation anxiety and often show reluctance to separate from their care giver. Older children are more likely to experience symptoms of social phobia and have fear of unfamiliar or even humiliating environments, which they can associate with school.

Causes for school phobia mostly depend on age. First time school-goers may be extremely anxious about being separated from their care givers all day. This sudden change can make them anxious and trigger separation anxiety. They are also probably unused to having an entire day organized for them and may be very tired by the end of the day, causing further stress and making them vulnerable to school phobia. For older children, onset of school phobia commonly takes place at times of transition such as entering middle school or high school. Possible triggers for school phobia may include:

1. Moving to a new school and having to make new friends

2. Being off from school for a long time due to an illness or a holiday

3. Problems at home such as illness, bereavement of a person or pet, domestic violence, marital problems,   separation or divorce

4. Not having good friends at school or fear of being ‘unpopular’

5. Traumatic experience at school such as abuse, rape or having witnessed a tragic event

6. Fear about academic failure

7. About 75% of children with school refusal symptoms suffer from clinical and subclinical depressive symptoms in addition to anxiety

Helping your child overcome school phobia typically requires parent management or even family therapy. Relaxation exercises, deep breathing, music, visualization, meditation are some tools that can work for children. These anxious children often require special attention from teachers, counselors, or school nurses. Typically, parents who are coached to calmly send their children to school and reward the child for each completed day of school will be successful. It is also helpful to:

1. Talk with your child about school fears. Reassure your child and explain that these fears are brought on by thoughts that may not be true. Tell her you love her and you are proud of her for being brave.

2. Insist on immediate return to school. Be optimistic with your child and reassure her that she will feel better after she gets to school.

3. Be extra firm on school mornings. In the beginning, morning times may be difficult. But if your child is physically well enough to be up and around the house, then he is most likely well enough to go to school!

4. Find things that your child can look forward to each day at school or at the end of a school day.

5. If physical symptoms are concerning, have your child seen by your pediatrician promptly.

6. Help your child spend more time with friends their age. School phobic children tend to spend more time with parents, play indoors, or be alone in their rooms. Encourage your child to join clubs or athletic teams, and spend time with peers.

Referral to a Child and Adolescent mental health professional may be necessary if interventions at home and school are not helping your child overcome school refusal symptoms. The longer school phobia goes on, the harder it is to treat. Younger children with recent onset symptoms have a good outcome. Adolescents with gradual onset of symptoms and significant physical symptoms may require long term counseling and treatment. So, the next time your child is putting up a fight to go to school, just pause and think… Is he just playing hooky or is it school phobia!

Shobha Bhaskar, M.D. About Shobha Bhaskar, M.D.

Shobha Bhaskar, MD is a pediatric hospitalist with St. Louis Children's Hospital and Washington University School of Medicine, who also sees patients at Children's Hospital facilities at Missouri Baptist Medical Center and Progress West Healthcare. Connect with Dr. Bhaskar on Facebook: ChildrensMomDocs and .

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