Many children at some time in their school career are challenged by anxiety. 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 carer, 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.
How Does 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 organised 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 diarrhoea.
Other children may have experienced stressful events.
Possible triggers for school phobia include:
1. Being bullied.
2. Starting school for the first time.
3. Moving to a new area and having to start at a new school and make new friends or just changing schools.
4. Being off school for a long time through illness or because of a holiday.
5. Bereavement (of a person or pet).
6. Feeling threatened by the arrival of a new baby.
7. Having a traumatic experience such as being abused, being raped, having witnessed a tragic event.
8. Problems at home such as a member of the family being very ill.
9. Problems at home such as marital rows, separation and divorce.
10. Violence in the home or any kind of abuse; of the child or of another parent.
11. Not having good friends (or any friends at all).
12. Being unpopular, being chosen last for teams and feeling a physical failure (in games and gymnastics).
13. Feeling an academic failure.
14. Fearing panic attacks when traveling to school or while in school.
(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:
· Reassure your child. Tell her that she will be fine once she has got over the part she dreads.
· Explain that her fears are brought on by thoughts that are not true thoughts: she is reacting to normal things in an extreme way.
· Tell her she is brave for going to school. Although her friends find it easy, she has a private battle she has to fight every school day.
· Tell her you are proud of her for being so brave.
· Tell her you love her.
· Keep to the same routine. Make life boring for your child so that she has less to be anxious about (no surprise trips out). Make her go to bed and get up at the same time every day (even on weekends) so that she has some secure framework to live around.
· Find things that your child can look forward to each day.
· Encourage your child to find things she can enjoy in the school day.
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
Pupils suffer 'school phobia' as term starts
Tracy McVeigh, chief reporter
The Observer, Sunday September 7 2008
For tens of thousands of English and Welsh schoolchildren the start of the new school term this month will be so traumatic that it will make them ill. Doctors and psychologists are seeing a 'significant' increase in the numbers of children suffering from a condition dubbed 'school phobia' and are bracing themselves as children are most at risk of developing the condition at the start of the school year.
School phobia is already estimated to affect one in every 20 children and now experts believe the trend towards bigger schools in the UK, particularly in England, an increase in childhood obesity and bullying, is making the medically recognised condition far worse.
The condition - also known as 'school refusal' - can, if left untreated, bring on physical symptoms such as vomiting, headaches, fatigue and panic attacks and sufferers run the risk of carrying anxiety phobias into adulthood.
Mark, 14, developed school phobia when he moved from his Wiltshire primary school into a large London suburban comprehensive. It took 18 months for him to be diagnosed, during which time his mother was threatened with being taken to court over his 'truancy'.
'It's like you are just frozen,' explained Mark. 'I felt allergic to the building. I didn't want to kill myself or anything, but I didn't want to go to school. It's like you just can't, my legs wouldn't work and it made me sick.'
Dr Nigel Blagg, a psychologist and author of School Phobia and its Treatment, said: 'The saddest thing about children going undiagnosed was that the phobia can lead to lifelong problems. All the evidence shows that the best way to deal with this is to get the child back to school and routine as quickly as is possible.'