Abstract: Most of the children do not like to go to school at some stage. Majority of them cope up with the situation successfully, but some may be suffering from some manifestations that result in school refusal and anxiety.1 A considerable percentage of children and adolescents who avoid school have mental illnesses.3 Sometimes, it results as a product of psychological disorders, that’s when counseling and homoeopathy comes to help.1
School phobia/School Avoidance/School Refusal are terms used to describe children who have a pattern of avoiding or refusing to attend school.2
Many children seem to have untold absences from school to the extent that schools these days are prepared to accept a certain degree of absence without question. Children from such homes who have frequent absences from school are usually those who tend to make the most of minor ailments.1
Most of the children do not like to go to school at some stage. The majority endure this phase and emerge better for having coped successfully. 1 Prevelance can be as high as 28 %.1
Different from truancy, these behaviors occur in approximately 2% of school aged children. Historically called “school phobia”, many researches now prefer to use the terms “school avoidance” or “school refusal.”2
1. Parental attitudes
2. Emotional disturbances
3. Parent—child relationship
4. Attitude of school teacher
5. Rivalry or fear amongst the class fellows
6. Fear of entire school environment
7. Fear of specific situations – like class tests, special subjects, games etc.
8. Unpleasant experience or real or imaginary fear arising at school.
9. Unchecked bullying
10. For gaining parent’s attention
Part of the confusion regarding the term “school phobia” is that the behaviors are not usually considered to be a true phobia. Although some children fear school-related activities (bus ride, reading aloud in class, changing for physical education), some are anxious about home issues or about being separated from a caregiver. Children become anxious for many reasons. “Separation anxiety” typically occurs at about the age of 18 to 24 months. Toddlers will cry, cling and have temper tantrums when they are about to be separated from their caregiver (for daycare or a babysitter, for example). This is normal at this age, but some older children continue to have difficulty separating from caregivers.
Sometimes school-aged children who were previously able to separate from their caregivers will suddenly become anxious and fearful. A recent crisis in the community or the family (such as a death, divorce, financial problems, move, etc.) may cause a child to become fearful or anxious. Some children fear that something terrible will happen at home while they are at school. Children who are struggling in school with academic or social problems may also develop school refusal. Many children have social concerns and may have been teased or bullied at school or on the way to school. Some neighborhoods or schools are unsafe or chaotic.4
Children who have missed a lot of school due to illness or surgery may experience difficulty returning to the classroom routines as well as academic and social demands. Still other children prefer to stay home because they can watch tv, have parental attention, and play rather than work in school. Children and youth who are transitioning (from elementary to middle school, or middle school to high school) may feel very stressed. All of these factors may lead to the development of school refusal/avoidance. Additionally, many children avoid or refuse school for a combination of reasons, further complicating treatment.5
If untreated, chronic school refusal or avoidance may result in more than family distress. Academic deterioration, poor peer relationships, school or legal conflicts, work or college avoidance, panic attacks, agoraphobia and adult psychological or psychiatric disorders may result.2
In general, children who refuse to attend or avoid school stay in close contact with their parents or caregivers, and are frequently (although not always) anxious and fearful. They may become very upset or ill when forced to go to school. Truants may be distinguished from this group by their antisocial or delinquent behaviors, their lack of anxiety about missing school, and the fact that they are not in contact with parents or caregivers when they are avoiding school.2
Some of the indications may be:-
• Child might remain disconnected with the studies for longer durations.
• Child may feel anxious maximum of the times at the hour of going to school.
• The child may make one or the other excuses not to attend the school.
• Child remain distracted from parents and family.
• Child having difficulty to learn.
• Emotional difficulties
• Behavioral disorders
PROGNOSTICALLY favorable factors include:
• Acute onset of symptoms
• Younger age at symptom onset
• Less time spent absent from school
• Early diagnosis and treatment
• Lower psychiatric morbidity
• Lesser extent of avoidance3
• If the child is being bullied at school, then parents may have to intervene on child’s behalf.
• If the reason for childs’s refusal to go to school is because he fears separation from the mother or he parents, then certainly parents should not take the easy way out by allowing the child to stay at home. As it will increase the dependency and fear more, instead asking a school friend to accompany the child would be a better step.
• the fears of child must be allayed, and in no case the child should be allowed to stay at home. The child and sometimes the parents also may need the psychotherapy and need to be addressed.
Treatment depends upon the causes, which can be difficult to determine. Many children may have started to avoid school for one reason (e.g., fear of being disciplined by a teacher, feeling socially inadequate) but are now staying home for another reason (e.g., access to video games, lack of academic pressure, etc.). several treatment plans may need to be tried. Helping the child to relax, develop better coping skills, improve social skills, using a contract, and helping the parents with parenting or family issues are all examples of possible treatments.
1. Baryta carb: Loss of memory, mental weakness. Fear and cowardice. Inattention to studies. Confusion. Child can not remember and learn, hence shirks from going to school. Aversion to strangers, aversion to play.1
2. Anacardium: Fear of examination in students. Impaired memory, depression and irritability. Disposition to laugh at serious things, and maintains a seriousness when anything laughable occurs. Fixed ideas. Absence of ideas. Brain fag, absent mindedness.1
3. Aethusa cynapium: Incapacity to think, confused, loss of comprehension, as if a barrier between the senses and external objects. Idiocy. Great anxiety and restlessness, followed by violent pains in head and abdomen. Breain fag. Bad humour, irritability. Inability to tolerate milk.1
The large number of adolescents who leave school without graduating underlines the need for political action. The symptoms of school avoidance have to be taken very seriously in this context. The school system is confronted with the challenge to identify such students rapidly and initiate measures for their reintegration.3 The situation can be controlled well with the help of psychotherapy, motivational management and homoeopathic treatment.4
1. The Problem Child by Dr. A.K. Gupta
2. http://www.ldonline.org/article/5907/ -1998
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822958/ –
4. Martin, M. and Waltham-Greenwood, C. (1995). Solve your child’s school related problems. New York: Harper Perennial (School phobia, pp. 208-213).
5. Paige, L.Z. (1993). The identification and treatment of school phobia. Silver Spring, MD: National Association of School Psychologists.
About the authors:
Dr Prasoon Choudhary, Head of Department of Paediatrics, Homoeopathy University, Jaipur.
Dr Riya Kumar, B. H. M. S. – Lord Mahavira Homoeopathic Medical College and Hospital, LudhianaM.D. (Hom.) – Paediatrics (ongoing) -Homoeopathy University, Jaipur.