By Shakila Bano
The brave man is not he who does not feel afraid, but he who conquers that fear. Nelson Mandela
American Psychiatric Association defines fear as a negative emotion toward a real or imagined danger that threatens an individual’s life, personality, or values, including goals and principles. Some fears are innate, like fear of heights and fear from louder sounds, while some of the others are fears from specific objects or situations, termed as phobias. One such common phobia is experienced by school-age children all over the world, i.e. school phobia, the topic that we will discuss further
There are a lot of reasons for choosing the topic School phobia. It is my common observation that whenever I see a child going to school, he/she cries a lot and refuses going to school. I question myself that what is the reason behind this behavior? Is this because of children’s own choice? What could be done to solve this issue? We can work on it, only if we could be aware of the causes behind it. Moreover, this writing will create awareness among the readers which could be an initial step towards preventing school phobia in children. The another reason is making third world countries acceptance towards psychological illnesses and importance of their treatments because third world countries have less acceptance towards psychological disorders and people hide the disorders in fear of stigmatization but giving less importance to these issues is much dangerous then the physical disorders. There are a lot of therapies for school phobia children but our society is blind towards psychological therapies. I want parents to know that why their children have school phobias and what is their role in maintaining their child’s school attendance. I want to explain different therapies to parents for their children to get rid of this phobia instead of making their children agree by punishing them.
The term school phobia was first used in 1941 to identify children who were failing to attend school because attendance causes emotional distress and anxiety. In Great Britain and as of the early 2000 in Unites States, the term school refusal is referred. Kearney, (2008) defines school phobia as “School phobia is a broad term that encompasses a child motivated refusal to attend or remain at school, or a clear and apparent difficulty in doing so. Different factors are responsible for school refusal including genetic deposition, the home environment, the school environment and social pressures. Learning theories have also impact on school phobia such as social re enforcing and modeling. (King; Ollendick & Tonge, 1995). According to the DSM-III-R, social phobia, involves a fear or humiliation or embarrassment while at school, in addition to fears about the school in general. (Phelps, Cox, & Bajorek, 1992).
The prevalence of school refusal behavior is difficult to estimate, due to discrepancy in how school phobia is defined and lack of any national reporting; however researchers have estimated that approximately 40% to 50% of school age children have school refusal behavior. (Fremont, 2003). The boys and girls both are equally involved in school phobia but it more common in ages 5 and 8 and 10 and 15.(Fremont &Hayne,2001). Many people misdiagnose school refusal with school truancy that’s why the actual prevalence of school phobia varies from one source to another. The school phobia was in approximately 50 percent of school age children. (Kearney et al., 1995).In Pakistan fears and anxiety disorders have high prevalence. (Mirza and Jinkens, 2004).Based on data from six studies, the authors found the overall prevalence of anxiety and depression disorders to be 34%with boys of 36% and girls of 43%. (Mirza and Jinkens, 2004).
Causes of school phobia in children
There are many social, emotional and psychological factors contributing to school phobia in children. Kearney, (2008) also explains that refusal often results from anxiety produced either by the separation from the major attachment figure or from fear of aversion situation at school, such as bullying or an oral presentation. School phobia can also result from positive reinforcement, or rewards, such as access to television, video games, or simply attention that is received outside the school. Some of the major psycho-social determinants common in our country are discussed below.
Firstly, the main cause behind school phobia is separation anxiety. The children become worried of their mothers and care givers being separated from their family therefore they fail to adapt to this separation. (Kearney et al., 1995). They think that something bad will happen to the parents when we will go to school-leaving our parents alone. Enmeshed relationship to mother are those where the two persons are unable to function as they typically should when away from one another. ( Kearney, Eisen, Silverman, 1995). These children mostly complain about attending school. In the early morning they start crying or kicking. It reminds me of my neighbor Ali. He studies in class one and every morning he cries in a loud voice with complain of stomach ache and he says that he will not go to school. His mother always punishes him to make him to go to school.
Performance Anxiety and Depression
Secondly, school phobia is caused by different anxieties such as performance anxiety, social anxiety and it can be caused by depression. The school fear may arise from class tests, examinations, giving speeches, class performances as well as from sports performances. In these types of situations children get worry about being embarrassed. Performance anxieties remind me of my friend Suzan’s little sister’s story. My friend always talks about her little sister Anne. She starts avoiding behavior towards school when the speech competition gets nearer. She counts the days and feels fear from speech and when two days gets left for competition she stays at bed complaining headaches and refuses to go to school. Some children become uncomfortable in social interactions and interaction with teachers and peers. In a number of situations anxiety and depression are factors of school phobia. (Bernstein et al, 2001).According to (Kearney and Albano 2004),”The most common diagnoses for youth with school refusal are Separation Anxiety Disorder (22.4%), Generalized Anxiety Disorder (10.5%), Oppositional Defiant Disorder (8.4%), Depression (4.9%), Specific phobia (4.2%), Social Anxiety Disorder (3.5%), and Conduct Disorder (2.8%)”.
Bullying and fear associated with school and teacher’s punishment
Moreover, school phobia can be brought on by school environment. This can include bullying by other students. In these types of situations the school should be aware about these incidents and take proper action. (Kahn 1968). Teacher’s punishment and any fear associated with school such as fear from school bus also lead to school phobia. I mostly see small children crying by looking at their school bus and get hide from the bus. When their mothers force them to sit in bus they close their eyes looking at the bus and cry a lot. In a 2003 study, almost 90% of children and adolescents who had features of both “anxious school refusal” and “truant school refusal” had at least one psychiatric disorder. (Egger, Costello, and Angold 2003). It has also been found that 75% of mothers who have children with school phobia also suffered from school phobia themselves (Phelps, et al., 1992).
Impacts of school phobia on children and their families
The school refusal is frequently associated with severe depression and school failure. The short-term consequences include poor academic performance, problems with peer relationship and family difficulties. Long term results include increase risk for psychiatric illness and employment difficulties. The children suffer from autonomic, muscular and gastrointestinal disorders when they feel fear from schools. They suffer from dizziness, shakiness, palpitations and chest pain. In addition they also experience gastrointestinal pain, nausea, vomiting and diarrhea. The swear anxiety may lead to joint pain and back pain. The families also get suffer from refusal behavior of their children as it creates conflicts and strained relationship as result of their routine disruption. They stay at home with their children and cannot go for work that’s why the income also gets affected.
To reintroduce a child to a school there should be collaborative approach of parents, peers and school teachers. There are many strategies available for school phobia. Cognitive behavior strategies are one of them. These strategies help in reducing symptoms of depression and anxiety as well as modify irrational thoughts related to school. (Henye et al., 2001).They includes relaxation training, cognitive structuring, and exposure based practices. Parent teachers’ interventions play an important role in enhancing children behavior. They include clinical sessions with parents and consultations with school personals .Parents should follow behavior management strategies such as positive reinforcing for maintaining school attendance, decreasing positive reinforcement for staying at home. Parents should ignore such complaints in the morning which has no medical basis. Those children who have death of loved ones or whose parents are going through divorce should give supportive counseling. According to Elliott (1999), for more successful treatment of a child the child should brought back to school as soon as possible. Systemic desensitization is a technique that can be used for eliciting children negative feelings for school and turns child into non anxiety producing stimuli. The child’s return to school should be done in steps so the child should not be overwhelmed. This treatment involves school psychologist along with parents and teachers. In first step psychologist should assist the child in developing fear and avoidance hierarchy and tell child to list all items in relation to fear. (Phelps, 1992).
Systemic desensitization can occur in two ways. Imaginary can help the child in overcome the fears listed in fear hierarchy. One method is visualizing different situations to a child and teaching him relaxation techniques while imaginary is going on. These strategies teach the child to calm their fears. Another method is systemic desensitization through vivo in which child is exposed to fearful environment and slowly guided up the hierarchy by psychologist until the child has de sensitized to fearful setting. (Last, Hansen, Franco, 1998).In addition, educational support therapies are more important in which children are given information about phobias and other anxiety disorders that can help them distinguish their own fears and understand nature of them. Emotional and behavioral problems in phobia can be minimized by soothing and gentle communication of teachers.
In conclusion of the study, school phobia is a serious issue and taking it into consideration is very important, there are many underlying factors behind school phobia. It develops due to separation anxiety, performance anxieties, and depression, bullying and fears regarding school environment. When a child experiences school phobia he suffers physically, socially and emotionally. The early management can control on the phobic behavior of a child which includes different strategies and therapies such as cognitive behavior therapy, systemic desensitization, and relaxation techniques and positive reinforcements. There should be collaborative approach of parents, teachers, and psychologists in terms of bringing a child to normal from school phobia. The third world countries should give importance to treatment of anxiety issues of their children instead of thinking that referring a child to a child psychologist is wastage of time. Children are future stars and supporting them in every step of their life can brighten their future.
The contributor is a BScN student at the Aga Khan University, Karachi.