By Hugh C. McBride

For most students, summer’s end could best be described as a time of wistful resignation and back-to-school jitters. A small percentage of children and adolescents, though, find the start of the academic year literally terrifying.

Experts estimate that about 1 percent of students suffer from a fear so extreme and so debilitating that it renders them incapable of leaving the house and entering the classroom. First identified in the early 1940s, school phobia – which is also sometimes referred to as “school refusal” or “didaskaleinophobia” – presents with symptoms similar to those of agoraphobia (fear of public or unfamiliar places), panic disorder, and separation anxiety.

“It’s generally a problem that’s anxiety-based, where a child gets anxious at the idea of going to school. It may manifest itself in a physical way, stomach pains, leg pains,” John Sargent, director of child and adolescent psychiatry at Houston’s Ben Taub General Hospital, said in an Aug. 24, 2008 article in the Houston Chronicle.

“Generally, the child’s fear is real, and the symptoms are real,” Sargent told Chronicle staff writer Jennifer Radcliffe.

About the Disorder
School phobia can affect any student at any age. But according to the American Academy of Child & Adolescent Psychiatry (AACAP), the disorder is most common in youth ages 5 to 7 and 11 to 14 – students who may be experiencing anxiety related to transitioning out of elementary school or into high school.

“These children may suffer from a paralyzing fear of leaving the safety of their parents and home,” the AACAP website reports. “The [children’s] panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.”

According to the Phobics Awareness website, school phobia in younger sufferers is thought to be more closely aligned with separation anxiety (fear of leaving the child’s primary caregiver), while older students are more likely to be experiencing a form of social phobia or performance-based anxiety disorder.

To some people, school phobia looks a lot like laziness; for example, some uninformed online commenters have implied that cases of school phobia are actually nothing more than spoiled children with naïve or accommodating parents. But experts such as Marie Hartwell-Walker know that the disorder can produce intense emotions and behaviors similar to those experienced by individuals who have encountered intimidating animals or survived life-threatening events.

“For some kids, going to school is like confronting a vicious dog every day,” Hartwell-Walker wrote in an article on the PsychCentral website. “School is a place where they can’t succeed, where they feel badly about themselves, where they constantly fall short of adult and peer expectations. … Day after day, year after year, they are thrown into the situation they fear most. And day after day, year after year, the fear is reinforced.”

Signs & Symptoms
The most obvious sign of school phobia is a child’s adamant refusal to attend class. But just as obvious is the fact that not every student who wants to stay home is suffering from this psychological condition. The following symptoms and warning signs may indicate that a child or adolescent is suffering from a true school phobia:

  • Flu-like symptoms – As school time nears, some children will suffer from exhaustion, headaches, stomachaches, and nausea, and will need to make many trips to the restroom.
  • Panic-like symptoms – Some who suffer from school phobia will begin shaking; their pulse will race, and they will begin to perspire excessively.
  • Sleep problems – Some school-phobic children will be unable to sleep the night before school, some will develop a fear of the dark (or of being alone in their rooms), and others may have nightmares about going to school.
  • Inappropriate behaviors – Children with a school phobia may throw what looks like a “temper tantrum” when told to get ready for school; they also may become defiant or express anger, fear, or sadness. At the opposite end of the behavioral spectrum, some phobic students will be overly “clingy,” remaining close to their caregivers at all times, and expressing fear about the caregivers’ health and safety in their absence.

Though a phobia can occur at any time, the following stressful situations could contribute to a students’ fear of going to school:

  • Family issues – A death in the family, a divorce, a recent move, or other unsettling events can cause a child to become overly fixated on home life and unwilling to face the “abandonment” that he feels when leaving to attend school.
  • Peer issues – A student who is harassed, teased, or bullied may turn her fear of her tormentors into a generalized inability to attend school at all.
  • Academic issues – Low-achieving students may be overcome by their continued failure, while straight-A students may become paralyzed by the fear of even the slightest falter.

Treatment & Recovery
Because school phobia often occurs in conjunction with (or as a result of) another psychological condition, and because it is often accompanied by behaviors and physical symptoms that mirror those of other disorders, quick diagnosis and prompt treatment are often difficult to come by.

The first obstacle to treatment involves ascertaining whether the child’s refusal to attend school is indicative of a phobia, or is instead merely the result of a dislike for being in the classroom. One way to differentiate between these two states, advises Bettina E. Bernstein, DO, is to observe the child’s attitude when he stays home from school. “The truant student generally brags to others (peers) about not attending school,” Bernstein wrote on the eMedicineHealth website, “whereas the student with school refusal, because of anxiety or fear, tends to be embarrassed or ashamed at his or her inability to attend school.”

For students who display symptoms consistent with school phobia, the first step is to make an appointment with the child’s physician for a complete medical examination (to rule out any underlying medical causes that may be behind the reluctance to attend school).

Once any physical anomalies are addressed, steps can be taken to treat the fears and anxieties that comprise the child’s phobias. In her article in the Oct. 15, 2003 edition of the journal American Family Physician, Dr. Wanda P. Fremont listed the following options:

  • Educational-support therapy
  • Cognitive-behavioral therapy
  • Parent-teacher interventions
  • A combination of therapy and medication
  • Intensive psychotherapy

Bernstein reported a positive prognosis for school-phobic children who receive treatment, citing studies that found more than eight of 10 formerly phobic students were still in school one year after they underwent therapy.