School Phobia

Suffolk Cogntive-Behavioral
Director: Mark Sisti, PhD
Approximately 2%-3% of all children and/or adolescents suffer from “school phobia”. School phobia is a poorly defined term which refers to a student who is avoiding going to school because of fear. But often students labeled as school phobic, may actually have a variety of different types of mood and/or behavioral problems. Not all cases of refusal to attend school are related to anxiety problems (phobias) or other mood disorders. Other more common and complicatedconduct disorders are also responsible for many cases of school refusal. Conduct disordered students may avoid school but they also avoid coming home and demonstrate a larger pattern of rule breaking behavior. This fact sheet will focus only on anxiety and mood related attendance problems.
Major Characteristics
The primary characteristic of school phobia is of course avoidance of school. School refusal is usually the result of either a separation anxiety problem or social anxiety. Behavioral symptoms may include a pattern of difficulty separating from those to whom the child is most attached (as in the case of a separation anxiety problem) or avoiding social situations in which performance demands are placed on the student (as in the case of social phobia). Physical symptoms can include difficulties sleeping, headaches, nausea, vomiting, panic attacks, appetite changes, etc.
Cognitive Characteristics
There are also several cognitive characteristics of school phobia, these include, fearful thoughts about some type of harm coming to either themselves, their parents, family or friends, if they are away from these individuals (separation anxiety). Examples include believing burglars could break into the home, catastrophes such as fires killing loved ones, or anticipating they or someone else will get very sick or panicked etc. For socially phobic children, fears center more around beliefs about being unable to meet the expectations and demands of peers or teachers, e.g. being rejected by classmates, failing a test, being embarrassed in public, etc. These images and ideas may also be present in nightmares. Often younger students may be unable to identify or express their fears clearly and sometimes not at all.
Behavioral Characteristics 
Behavioral characteristics are primarily different forms of avoidance. Avoidance is an attempt to reduce the anxiety, physical distress and panic attacks that occur when in school, away from parents, or under performance pressure. Some children may refuse to separate from their parents even when sleeping. Unfortunately, avoidance never helps the student to learn how to cope, and instead weakens academic, social and emotional coping skills. A small percentage of students may have temper tantrums, usually when parents try to force the child to leave them and attend school.
How common is it?
School phobia occurs in approximately 2%-3% of children and is approximately equally distributed among girls and boys. There are usually three times in a child’s academic career that this problem begins. The most common is at five or six when beginning school, the second, when a child changes schools such as when leaving elementary school, and the third, late into high school when school is soon no longer mandatory. Often school avoidance with this oldest group has more to do with social phobia and/or conduct disorders than separation-anxiety problems.
As with most anxiety disorders, the cause of school phobia is a combination of genetics and environment. A fair amount of evidence now indicates that anxiety disorders often have a biological or genetic basis which predisposes a person to develop anxiety problems.

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