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April 2017
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School environments can be stimulating places since they are like daily training camps where children start to get to know and experience many aspects of life and themselves. However, sometimes school turns into a theatre of fears, a source of worries and a real hardship which can cause children and adolescents to develop so called ‘school phobia’.

Separation anxiety, learned fear and insecurity
It is not uncommon that a family has to deal with a child refusing to go to school at some point in their lives. However, there are some situations in which refusing to go to school appears to be accompanied by somewhat obvious discomfort related to a state of anxiety.

Many studies have tried to establish the causes of this problem which makes an ever-growing number of families’ everyday lives very difficult.
According to the most traditional and common diagnostic approach, persistent refusal to go to school simply can be a sign of separation anxiety disorder, a type of childhood disorder (DSM IV). In this context, the disorder is considered to be an expression of separation anxiety, usually concerning the mother.  
However, it is extremely important to note that separation anxiety is usually present and evident in small amounts during the initial period at primary school therefore, in some cases, it would not be right to call it a real form of school phobia. The difference lies in the strength of the anxiety, its ability to habitually and specifically avoid school and how long it lasts. True school phobia is when separation anxiety is shown in relation to attending primary school and there are a few key symptoms that are caused by this phobia. First and foremost there are signs of inadequate anxiety in relation to how mature a child is, as well as refusing to go to school and two other symptoms of agitation, including: 
- feeling bad whenever the individual is away from home;
- worrying about losing people they are close to or being separated from then by unforeseen events;
- fear of being alone;
- refusing to sleep alone;
- nightmares about emotional loss;
- physical symptoms occurring at the thought of having to separate.
Social phobia can bring back separation anxiety when the discomfort occurs before 18 years old and for at least four weeks, compromising the individual’s social and/or school life and other important, personal areas
Suffering from school phobia is not uncommon and often involves families who are not able to encourage an appropriate process of separation or gradually encourage the child to become independent.

However, the core problem which comes from ‘separation anxiety’ does not always seem to be present in other cases, such as those in which there are signs of a conditioned fear of school which follows either real or imagined, unpleasant relationship experiences which may be related to the problem. Further studies and treatments have also shown that this problem is a specific and precious form of social phobia¸ and it is often fuelled and strengthened by the idea that school is a strict and disciplinary place which is made out to be a threatening place by the family or social contexts close to the family.

There are also problems related to insecurity and low self-esteem, especially when changing from primary school to secondary school or from the latter to high school or college, and uncertainty about one’s abilities in new social contexts or dealing with new and more demanding educational requirements.  
School phobia is an ever growing problem in modern society because of the pressure society and families put on young people: on the one hand, families are increasingly more aware of educational performance and their child’s personal growth, whilst schools are continually led by the values of society which are increasingly focused on certification of skills and competencies.
Children who grow up in this context are prone to becoming perfectionists, being very strict and demanding on themselves and not forgiving themselves for making even the smallest of mistakes. This leads onto the children developing a personality which focuses too much on personal results and negative personal aspects, causing gradual and constant devaluation of oneself, which is the reason why children become anxious about school events.

Rational and irrational fear of the causes
School phobia is easier to see in younger children as their anxieties are more obvious, whilst school phobia in adolescents can be seen as a lack of motivation of being lazy.
The onset of symptoms generally occurs suddenly at the beginning of the school year and occasionally there are situations which trigger it or periods of the school year in which sufferers may relapse, such as after being off school for an illness or after school holidays.
Sudden appearances of the problem can be related to specific times during school life, such as arguing with a friend, having problems with a teacher, being ill whilst at school or even not doing homework very well. In these cases, it is important to identify the causes which have triggered the problem so as to be able to find specific solutions and specific, precocious and effective treatment courses.

The anxiety which accompanies moments of school phobia is intense and often reaches its peak when the sufferer has to leave the house to go to school. Younger children become very agitated and let themselves be overcome with panic, protesting and pleading with parents that they will go to school tomorrow. When it gets this far, children may get aggressive, lock themselves in their rooms or hide and, being completely overtaken by an intense and irrational fear, they are trapped in an emotional whirlwind, thus parents cannot intervene in order to rationally persuade the child to calm down.
If children in this state are forced to go to school, they might isolate or hide themselves, cry for a long time or even try to escape to go and wander or attempt to return home, since they consider home to be the only place that is truly safe. 
Slightly older children, aged 5-7, tend to use more sophisticated defence mechanisms to make their anxiety less obvious, thus they often show signs of somatisation, which can consist of headaches, abdominal pain, vomiting, weakness and even a temperature. In this case, physical symptoms tend to go away naturally during the weekend and nearing the holidays.

When the idea of having to go to school is removed and parents allow their child to stay at home, the calmness fuels model behaviour, such as being very cooperative and sometimes even attempting to explain the behaviour about refusing to go to school. Children’s fears are sometimes related to specific facts which create anxiety, whilst, in other cases, it is not possible to find an explanation, thus the inability to justify the strong, negative emotions, which may reappear punctually the following morning, dominates.
A prolonged absence from school can become another reason behind rational justification of the fear of going back to school, since the sufferer may think he/she is too far behind with work therefore he/she cannot reach the same levels as his/her peers.
In reality, school phobia is often accompanied by very diligent studying at home: young children and teenagers suffering from this problem do not mind studying at home and they often work very hard so that a long absence from school does not affect their performance on returning. However, this does not take away from the fact that a long absence from school tends to generate a secondary problem of insecurity about the sufferers knowledge of the modules studied at school.

The family structure which can encourage the problem
Common features of the family context which seem to fuel the problem have been identified in numerous cases of school phobia.
Openly anxious and phobic mothers tend to force their fears on their children and can make their children think that they need to be protected at all times.
Hyper-protection often appears to be strongly connected to the mothers’ insecurities, which intrudes on the children’s lives, creates a feeling of security and fuels this rigid closeness to the mother.
The father is usually not very reassuring, weak or absent for various reasons (for example, work, family problems or death) and this means there is no fundamental, reassuring model or, for males, a figure of security.
Another common feature, usually intertwined with those listed up until now, is the family educational regime which may be tolerant and forgiving and thus very different from some school environments. It is not uncommon that some teachers, who have to keep a loud class under control for hours, need to raise their voices or reprimand children and this may intimidate some fearful children or those who are not used to such a strict regime at home. When school phobia in the result of an unhealthy relationship between mother and child and the child being spoilt at home, this is called induced school phobia.
On the other hand, when school phobia is the result of negative school experiences, this is called acute school phobia, whilst other cases one speaks of mixed forms called chronic school phobia.

Dealing with the problem
In order to help children and adolescents who show signs of school phobia, one must consider the causes which provoked this phobia in depth.
It is very important that the treatment carried out by a professional considers the child’s personality, the problems there might be within the family, especially if there has been a death in the family, and the latest occurrences to do with school.
With desensitisation treatment, it is possible to get the child to return to school without forcing them by gradually preparing them for the event. At the same time, work on positive parenting should be carried out in order to support the return to school and so that the parent(s) do not accidently cause the fear to come back.
The main aim of professional treatment for school phobia must be to encourage the suffering child to go back to school by constructing a common front and providing him/her with a unique message which tells him/her that he/she needs to go back to school and that he/she can do it. It is also important to establish times when the child is listened to, about his/her needs and progress. Sometimes it is also necessary to inform the teachers and school of the problem so that when the child goes back, he/she is more protected, even though the aim is to get him/her to develop skills to adapt in controversial environments by developing basic social and relationship skills which will be useful for his/her whole life. This will also prevent future problems to do with social or professional discomfort. 
After having fulfilled the first objective, it is necessary to work on reinforcing the child’s self-esteem, both in terms of school life and relationships, improving communication skills and dealing with unforeseen events and problems at school, so as to prevent future relapses.


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