School phobia, school avoidance and school refusal are terms that describe an anxiety disorder in children who have an irrational, persistent fear of going to school. Their behavior is different from children who are truant and express no apprehension about missing school. Children who have school avoidance want to be in close contact with their parent or caregiver, whereas truants do not. School phobic children are often insecure, sensitive, and do not know how to cope with their emotions. They appear anxious and may become physically ill at the thought of attending school.

Normal separation anxiety typically occurs between 18 to 24 months. Children this age may cling, cry and/or have temper tantrums when they are separated from their parent. However, some older children continue to have difficulty being away from home. The parents of these children are often attentive and loving, but may be overprotective. As a result some students lack self-confidence and the ability to cope with school life. A child who shows a higher risk for school phobia is one who has no siblings, the youngest child or a chronically ill child.

Most children object to going to school at one time or another. However, a school phobic child often misses many days for vague reasons. Parents should be concerned if their child appears irrationally anxious, depressed, scared, and/or regularly says that he or she feels too sick to attend class.

Symptoms of school phobia are:

• Frequent stomachaches and other physical complaints such as nausea, vomiting, diarrhea, exhaustion, or headaches that cannot be attributed to a physical ailment.
• Clinginess, tantrums, and/or panic when required to separate from a parent or caregiver.
• Fear of the dark or being in a room alone.
• Trouble going to sleep and/or having nightmares.
• Exaggerated fears of animals, monsters, school, etc.
• Constant thoughts concerning the safety of self or others.

Both home and school issues need to be considered when searching for the reasons that contribute to school avoidance.
Home Issues: A child may…

• Be experiencing a family change like a move, illness, separation, divorce, death, depression, or financial problems.
• Have been absent from school due to a long illness.
• Enjoy a parent's undivided attention when not in school.
• Be allowed to watch television, play video games or with toys rather than complete schoolwork.
• Have an overprotective parent who reinforces the idea that being away from him or her could be harmful.
• Be apprehensive of an impending tragedy at home.
• Fear an adult at home might hurt a family member while the child is at school.
• Be afraid of neighborhood violence, storms, floods, fires, etc.

School Issues: A child may…

• Fear criticism, ridicule, confrontation or punishment by a teacher or other school personnel.
• Have learning difficulties -- for example, afraid to read aloud, take tests, receive poor grades, be called on to answer questions or perform on a stage.
• Be afraid of not making perfect test scores.
• Be sensitive to a school activity such as singing a certain song, playing a specific game, attending a school assembly, eating in a lunchroom, or changing clothes for physical education in front of peers.
• Exhibit poor athletic ability, being chosen last for a team or being ridiculed for not performing well.
• Fear teasing due to appearance, clothes, weight, height, etc.
• Feel socially inadequate due to poor social interaction skills.
• Be a victim of peer bullying during school, walking to or from school, or on the school bus. (see Educator's Guide to Bullying).
• Receive threats of physical harm.
• Have difficulty adjusting to a new school (see Helping Children Cope with School Transitions).
• Have toileting issues concerning the use of a school restroom.
• Be environmentally sensitive to new carpet, fragrant cleaning supplies and/or poorly ventilated classrooms.

Usually, school refusal lasts only a short time, especially if a parent insists on school attendance. However, if the problem persists, consultation with school personnel will be necessary to form a unified home and school approach. If ignored, chronic school phobias can result in the deterioration of academic performance, peer relationships, work quality, and possibly lead to adult anxiety, panic attacks, or psychiatric disorders. Therefore, the issues of a child with school phobia must be addressed early so that his or her fears can be abated. The essential steps are recognizing the problem, discovering the underlying cause or causes for the child's discomfort, and working with school professionals to alleviate the difficulty. Parents need to view themselves as part of a team working together for the good of their child.

What can parents do?

1. Have a physician examine the child to determine if he or she has a legitimate illness.
2. Listen to the child talk about school to detect any clues as to why he or she does not want to go.
3. Talk to the child's teacher, school psychologist, and/or school counselor to share concerns.
4. Together determine a possible cause or causes for school avoidance.
5. Develop an appropriate plan of action to modify the school and home environments to help the child adjust to school.

Ideas for School Modifications

• Have the teacher or other school professional, such as the school counselor, establish a caring relationship with the child.
• Arrange for a school staff member greet the parent and child at the door and take the child to the class.
• Discuss the situation with the school nurse who can attend to the child's complaints and then return him or her to class.
• Help the child build self-confidence by discovering his or her strengths and by providing opportunities for the child to excel.
• Identify particular activities the child enjoys doing and those that produce anxiety.
• Monitor bullying activities that may be taking place.
• Include the student in a friendship group facilitated by the school counselor.
• Adjust work assignments to match the student's academic skills.
• Have a child with poor academic skills tested for special education services.
• Use a behavior contract to be reinforced with a reward such as a sticker (see Rewards in the Classroom).

Ideas Concerning Home Modifications

• Assist the child in overcoming his or her fear by gradually increasing exposure to it.
• Eliminate any "fun" activities at home when school is in session.
• Have the parent who is better at encouraging attendance take the child to school.
• Use a car pool or include a peer to accompany the child.
• Read books which encourage the expression of feelings and teach coping skills such as Kelly Bear Feelings. Role play situations and discuss various ways to relate to others.
• Provide play dates with classmates to encourage friendships.
• Attend school related activities.
• Reassure the child that the family will be safe through hugs, kind words and positive notes.
• Teach the child relaxation techniques (see Helping Children Cope with Worries).
• Deal constructively with family concerns and parenting issues, perhaps with the assistance of a mental health professional.

The goal is to have the child return to school and attend class daily. In the best case scenario, the student's confidence and enjoyment of school will increase when a plan is implemented and changes are made. However, if the school phobia is extreme, a therapist or psychiatrist's assistance may be necessary.