Anxiety
In my psychiatric practice I saw a disturbing trend this spring. I had at least a half dozen school-aged patients come for evaluations after being referred by school psychologists. These kids had all missed multiple days of school (as many as 22!). Most were in danger of failing and their parents were frantic. Most of the children wanted to switch schools or get an at-home education.
Child and adolescent psychiatrists call this alarming phenomenon “School Phobia” or “School Avoidance”. While I had worked with isolated cases of school phobia over the years, never in my more than ten years of treating patients had I seen so many cases in such a short period of time.
School phobia broadly refers to children who refuse or resist going to school for any reason. I will briefly discuss the most common causes in my practice and give some general warning signs that parents can look for to indicate a need to get help and prevent a crisis situation at the end of the school year.
The three broad areas that have caused the majority of school phobias that I have treated have been: Anxiety, depression and learning problems. Often two or three of these are present together in the same child.
I am going to focus on anxiety (nervousness, worry) in this article because it’s by far the most common cause of school refusal. Students often avoid school because they are afraid of having panic attacks when they are away from home. Some kids have Social Anxiety Disorder and are afraid to be in groups of people. With Social Anxiety kids often have unrealistic fears that others are laughing at them or talking about them.
Two other anxiety disorders that frequently contribute to absence from school are Separation Anxiety Disorder (particularly in elementary students) and Obsessive-Compulsive Disorder (OCD). With Separation Anxiety, the children find it nearly impossible to separate from their parents due to worry that harm will come to them or their parents if they are apart. Children with OCD can have so many compulsive rituals that it takes hours to leave the house. Alternatively, kids with OCD can be fearful that they might perform an unwanted compulsion while at school (for example, they might worry that they might yell in class). It should be noted, that kids with OCD usually have irrational fears that they will do something wrong, when in reality, these kids would never actually perform these feared behaviors.
Here are some concerning signs that parents should look for as the school year progresses.
- A child makes frequent excuses to miss school
- Significant changes in a child’s eating or sleeping habits
- Withdrawal from friends and family
- Increased physical complaints (especially stomachaches/
If these signs are present, or things just don’t feel right with your child, start by talking to teachers and school counselors/psychologists. They will help you decide if you need further assistance from a professional therapist or psychiatrist so that you can avoid trying to solve the problem when your child has already fallen behind.
We all want our children to reach their full potential and enjoy life while doing so. School and social life seems to get progressively more challenging for kids to navigate. The best general advice I can give to parents and other caregivers is to know your kids and trust your instincts. Parenting is the most important responsibility that exists. If something isn’t right, jump on it and don’t be afraid to talk to others and get help early in the year. For more information, visit http://www.drfeinbergmd.com.
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