School Phobia

What is it?

  • School phobia (fo-b-uh) is when your child is very nervous and refuses to go to school. It is also called school avoidance (uh-voy-dunts). A phobia is a strong fear of something for no obvious reason. Phobias can cause very bad anxiety or panic attacks. School phobias are common when children start school between 5 to 7 years of age. But, adolescents (teenagers) can also have school phobia. School phobia sometimes starts after a child has been absent from school for a vacation or an illness.

  • This fear of going to school can be very stressful for your child and for you. But, school phobia can be treated successfully. School phobia can cause anxiety or depression later in life.

Causes:

One of the reasons why your child may have school phobia is that your child may be afraid to be separated from you. This is called separation (sep-uh-ra-shun) anxiety. Also, if you are upset about being separated from your child, your child might start to fear going to school. Causes can also be related to home and school.

  • Home Causes:

    • Illness, accident or death of a family member.

    • Divorce.

    • New baby.

    • Family move.

  • School Causes:

    • Fear of mean teachers or other students.

    • Fear of undressing or showering in front of other people for gym class.

Signs and Symptoms:

  • Your child may cry to stay home when it is time for school. You may be unable to get your child to leave the house to go to school. He may run away from the school and return home when he is forced to go to school. Your child may have a panic attack with sweating, dizziness, racing heart, vomiting, diarrhea, or shaking. School phobia may get in the way of your child's normal activities.

  • Your child may have headaches, upset stomach, diarrhea (die-uh-ree-uh) (watery BM), or body aches when he thinks about school. Your child may be sad and not want to be around others. He may be unable to pay attention to work or play.

Care:

  • Medicines: The following are some types of medicines your child may need.

    • Anti-Anxiety Medicine: This medicine may be given to help your child feel less nervous. It may be given by IV, as a shot, or by mouth.

    • Anti-Depressants: This medicine is given to lessen or to prevent the symptoms of depression. Many children with school phobia also have depression so your child may need anti-depressant medicine. It is given by mouth.

    • Anti-Convulsant (kun-vull-sunt): This medicine is usually given to control seizures. But, it may also be used to lessen violent behavior, aggression, or irritability. This medicine may also help control your child's mood swings. It is given by IV, as a shot, or by mouth.

    • Anti-Psychotics (si-kaw-tiks): This medicine is usually given to lessen the symptoms of psychosis or severe (very bad) agitation. Anti-psychotics are given as a shot, by mouth, or as a suppository in the anus (rear-end).

    • Anti-Parkinson's: This medicine is used to control muscle stiffness, twitches and restlessness caused by anti-psychotic medicine. It is given by mouth or sometimes as a shot.

    • Mood Stabilizer (sta-buh-li-zer): Your child may seem very happy one moment, then very angry the next. This medicine is given to control these mood swings. It is given by mouth.

    • Psychostimulant (si-ko-stim-u-lunt): This medicine is given to help your child pay attention and concentrate better. It can also help improve his energy. It is given by mouth.

    • Sedatives (seh-duh-tivs)-Hypnotics (hip-nah-tiks): This medicine may be given to help your child feel calmer. It is often used to help your child sleep better at night. It is given by mouth. It may also be given by IV, as a shot, or in the anus (rear end).

  • Care Settings:

    • Intensive Outpatient Program: This is when your child comes to the hospital or clinic for 1 to 3 hours of treatment. This program is usually 2 to 5 times a week for a short period of time.

    • Outpatient Program: This is when your child meets with a therapist once a week or less. Appointments are one hour long or shorter. He may meet one-to-one with the therapist. Or, he might meet with his therapist in a group. He may have few or many scheduled appointments over time.

  • Caregivers:

    • Psychiatrist (si-ki-uh-trist): This is a medical doctor who works in the area of mental health. The psychiatrist is in charge of ordering your child's medicine. You may work closely with this doctor and other caregivers.

    • Therapist: This is a caregiver that works closely with your child during treatment. This person may be a doctor, psychologist (si-kall-o-jist), nurse, mental health counselor, or social worker.

  • Types of Therapeutic Sessions:

    • Couples Therapy: When you and your significant other meet with a caregiver to talk about how to cope with your child's illness. Your significant other may be your spouse (husband or wife), or a boyfriend or girlfriend.

    • Family Meetings: Caregivers meet with you, your child, and your family. Caregivers can help your family understand your child's illness and learn better ways to react to a child with school phobia.

    • Group Therapy: A series of meetings that your child goes to with other children who have school phobia. During these meetings, the children and staff talk together about ways to cope with school phobia.

    • Individual Therapy: A time for your child to meet alone with his therapist. They will talk about how to cope with school phobia and how your child can feel better about himself.

  • Types of Therapy Approaches:Behavioral Modification (mah-dih-fih-k-shun)

    • connects specific behaviors (ways of acting) with specific consequences (results). This therapy rewards good behavior. For example, if your child refuses to go to school, he does not get a reward such as having ice cream after dinner.

    • Cognitive Therapy helps make your child aware of how he sees things. He may have trouble seeing the good in things around him. He is more likely to feel depressed, sad or angry. Cognitive therapy teaches your child to learn how he can see things in a more positive way.

    • Distraction is a way of focusing your child's attention on something other than sad feelings. He may play games, watch TV, or take a walk. He can also visit with friends, paint and write things down. Using planned activities helps to manage your child's feelings. It may help him to relax and start feeling better about himself and his life.

    • Exposure/Desensitization (d-sen-tuh-ti-za-shun) Therapy. Exposure therapy helps your child face his fears in a safe setting. Caregivers are there to support and help him. After he has practiced ways to decrease fear and anxiety he will be better able to handle his fears when he is alone. Desensitization is when caregivers help your child face fear a little at a time. This is taught in a supportive and safe setting.

    • Play Therapy: With the help of the caregiver, your child works out his fears and anxieties through play.

    • Relaxation is another way to focus your childs attention on something other than his feelings. For instance, good smells may change your child's mood and help him relax. Good smells may also help his brain make special chemicals called endorphins (n-door-fins). Endorphins are a natural body chemical that can decrease bad feelings and pain. For example, he may listen to music or take a bath with aromatherapy (uh-ro-muh-thair-uh-p) oils. Candles, massage oils, and scented bubble baths are ways that smells can be used.

Patient Rights:

  • Release of Information Form: This is a legal paper letting caregivers share information with those listed on this form. A parent or legal guardian must sign this form. No information can be released to persons outside the hospital unless this form is signed.

  • Right to Privacy: Information that you and your child share with caregivers is kept private among caregivers. They will not share information with others without your permission.

Coping:

Accepting that your child has school phobia is hard. Your child's school phobia may make you feel angry, sad, or frightened. These feelings are normal. Talk to your child's caregiver, family, or friends about your feelings. Caregivers will talk with you about how things are at home. Your caregiver can help your family better understand how to react to a child with school phobia. Ask your health care provider if they know about books that you can read. Reading about your child's illness might help you better understand it. You can also call or write one of the following national organizations for more information.

  • American Academy of Child and Adolescent Psychiatry
    3615 Wisconsin Avenue NW
    Washington, DC 20016
    Phone: 1-202-966-7300
    Web Address: http://www.aacap.org
  • American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village, IL 60007-1098
    Phone: 1-847-434-4000
    Web Address: http://www.aap.org
  • Anxiety Disorders Association of America (ADAA)
    8730 Georgia Avenue, Suite 600
    Silver Spring, MD 20910
    Phone: 1-240-485-1001
    Web Address: http://www.adaa.org
  • National Institute of Mental Health (NIMH), Public Information & Communication Branch
    6001 Executive Boulevard, Room 8184, MSC 9663
    Bethesda, MD 20892-9663
    Phone: 1-301-443-4513
    Phone: 1-866-615-6464
    Web Address: http://www.nimh.nih.gov/

Care Agreement

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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