By Finlo Rohrer
BBC News Magazine
A school is being asked to apologise to the family of a boy it prosecuted for truancy. The boy was diagnosed as having "school phobia", but what exactly is that?
Most adults can remember days when they vehemently didn't want to go to school.
There would be protestations of illness, and of the danger of passing on an unpleasant disease, before the eventual acceptance that the journey into school was inevitable.
So many might react with scepticism to the idea that there is such a thing as "school phobia".
But, says Nigel Blagg, author of School Phobia and Its Treatment, it is a condition that has been recognised since the 1960s.
"They will experience extreme anxiety. They are off school, typically with their parents' knowledge and approval. And they often have symptoms like tummy aches, head aches and nausea. Some of them suffer severely with depression.
"Any attempts to get them to school, when they are at their worst can lead to quite extreme behaviour - temper tantrums, screaming, kicking. It is very distressing for the adults."
The sceptics might of course want to bracket these children as truants, but, says Mr Blagg, a former local authority educational psychologist who now runs a private practice, they are quite distinct in background and behaviour.
"They are typically well behaved, socially conforming who are usually doing quite well. Normally they come from caring families.
"The truant group are the ones who [miss] school because they want to
often involved in delinquent behaviour."
It is thought the worst ages for school phobia are five to six and 11-14, says Mr Blagg. There are no precise numbers for how many children suffer the condition, but he notes one estimate is that 1% of children will have it at one point during their school careers.
A day at school is not every child's idea of fun
But the diagnosis is not without controversy, and even the term is subject to dispute, says Mr Blagg.
"In the psychological world the preferred term these days is school refusal. [But] school refusal doesn't convey the extreme distress, anxiety and panic, the physical symptoms that these children experience or the fact that it isn't a volitional state."
There is a recognition among psychologists and other education professionals that school phobia/school refusal covers a range of different problems.
Some of the younger sufferers can be diagnosed as having "separation anxiety", leaving them distressed at parting from their parents at the school gate. But some psychologists say this is more about refusal, not phobia - a true school phobic will experience a reaction even if their parents are present.
"Other children could be classified as having a social phobia to do with performance aspects of school - reading out loud or changing for PE," says Mr Blagg.
Other children might be off sick for a prolonged period, fall behind with work and fall out of a routine. Some might simply have changed school and lost friends they relied on to feel secure at school. Still others may have had a single distressing experience.
"More typically what you have is an accumulation of stresses to do with home and school that add up over time and cause the child to be anxious," says Mr Blagg.
PHOBIA OR REFUSAL?
School phobia - irrational fear of school or the school situation
School refusal - Refusal on the part of a child to attend school
Refusal to go to school may be caused by a school phobia but most school refusals due to separation anxiety
In a true school phobia a child will show the phobic reaction even if his or her parents are present
Source: Penguin Dictionary of Psychology
"The avoidance leads to greater problems. They fall behind with school work. They worry what friends will say. The longer they are out the worse the problems get. If they are told they don't have to go they feel fine and the symptoms disappear."
Not only is there disagreement over the name for the condition, but also how to treat it, and whether it exists at all.
Sociologist Prof Frank Furedi, author of Wasted: Why Education Isn't Educating, is not convinced.
"You take an understandable anxiety about going to school and turn it into a disease
Children will internalise it and play the role that's been assigned to them.
"It cultivates the idea that these [exaggerated medically diagnosable] anxieties are normal. You do begin to encourage children to think in these terms."
But even if you do accept that school phobia exists, there can still be disagreement over the best approach to tackling it.
Mr Blagg insists that while educational psychologists, teachers and parents must be sensitive to the child's needs, they must recognise that confrontation and getting the child back to school is necessary.
Stay at home
"They need that very firm handling and confronting them and getting them back to school. You might have to take them to school and escort them [in]."
For those who have been away schools should assign tutors, help them catch up and offer them quiet space to be in while they are adjusting.
Would you help an arachnophobe by plonking a spider in their hand?
But there are some advocates of home schooling who believe that rather than being a psychological aberration requiring a cure, the symptoms of school phobia may simply indicate that the child is best educated away from the school, at home.
Ann Newstead, a spokesperson for the home tuition charity Education Otherwise, says school phobia is a "very real condition".
"I see a lot of families where they are in that situation - you only have to meet the children and families to see that it's not a made up condition. It's genuine. Not sending your child to school is something parents can be prosecuted for. You don't risk prosecution lightly."
"You wouldn't dream of forcing an adult to engage in an environment that wasn't beneficial to them. So why do we think it's ok to treat children in this way?"
But aren't children more malleable? Doesn't keeping them back from school indulge their fear rather than tackle the problem?
"I agree with the tackling but not the forcing of it. That's like treating someone who is scared of spiders by putting a spider in their hand. You tackle these things gradually, help someone to overcome a phobia and home education is a way of doing that."
More generally, many schools seek to make some of the changes for children less stressful, for example working on acclimatisation for children moving up to secondary school.
But Prof Furedi does not believe that such a sensitive treatment is necessarily always helpful.
"Kids going from primary school to secondary school often get transitional counselling.
"If you tell them enough times this is an extremely difficult, painful step, you make the kids more anxious."
Below is a selection of your comments.
This article was a helpful insight into the incidence and traits of school phobia. Having been school phobic myself, at ages 11 and 15, I support the argument that it is a real condition. From personal experience, I can say that how the school phobia develops depends on how the parent(s) handle their child's extreme anxiety and how they attempt to tackle the problem.
Victoria Murray, Bristol, England
My daughter went through almost a year of refusal/separation anxiety aged 9 - it was ghastly because on top of worrying about your child there are all the social humiliations of being watched and judged by friends and peers as you literally peel your child's fingers off the classroom doorframe and drag them screaming in to class and then run as their teacher holds them to stop them running after you. I am not exaggerating here at all. I spent many hours crying because it was so stressful. It is hard to feel like you're being so cruel to your child forcing them to go when they are so unhappy but I knew I had to be strong. Friends were very supportive of my morning battle but those parents who didn't know me or my daughter were obviously contemptuous of this 'badly behaved child'. It took a long 6 months to get her back into going to school happily and now she is in year 6 and doing well but if she is under the weather she relapses a little and I have to persuade her to go in (not that she 'loses it' any more but I live in fear that she will). We are a balanced, well educated family with happy, well behaved and well mannered children with hobbies and interests not truants. Luckily for me the teachers, my friends and her friends were all really supportive and helped us come out the other side. The school was very flexible and let her be reclusive when she felt the need and eased her back in to the day by allowing her to help look after the kindergarten children if she couldn't face her classroom. Thus she wasn't allowed to escape school but school bent the rules to help her cope by being accommodating. She was also allowed to ring me at break time for reassurance that I was at home and would collect her at end of school if she was worried. I don't know if it is a diagnosable condition but it certainly isn't voluntary nor 'wilful'. She used to get even more distressed by her behaviour which, of course, snowballed the anxiety even more in a vicious circle. Any parent going through this has my sympathy - it is truly hard. When faced with your child completely hysterical, beyond reason and in danger of doing real harm to themselves and to you and any other adult trying to help them in to school is a nightmare that stays with you for life - I still want to cry and indeed am shedding tears while I write this.
I think Prof Furedi totally misses what happens in "school phobia". I had this condition as a child, and hate the name too. But it was definitely far more than "an understandable anxiety about going to school". It was a gradual build up of things which included depression and bullying, as well as the normal anxieties and hormones of the teenage years. What adults seem to forget is the extreme pressure on teenagers to fit in. Never again in life are you thrown into a building with several thousand other people your age, of differing backgrounds and expected to get along. The fact is that many kids don't take to this environment, and why on earth would anyone expect them to? When an adult comes across a group of teenagers on a street corner, or in a park, their immediate reaction is fear. Yet the sensitive, bookish, small teenager - who is far more likely to be their target both physically and emotionally - is forced by law to be contained in a building with huge groups of teenagers, all day every day, for what feels like a lifetime. At this same time they are also under pressure from exams and studying, as well as general family and growing up stresses. It's inevitable that at some point most kids will suffer a crisis point, where they can't cope with all those pressures. If this happens in the adult world, people go off sick with stress or depression, often for months. If there is bullying in the workplace, an adult will feel no issue with suing for damages. Yet with a child, it's expected that they should be able to cope emotionally with anything at all.
Thirty years of teaching in inner city schools has shown me that as soon as a "syndrome" is named, you can be sure that you'll have a rash of 'diagnosed' sufferers within a few weeks. (Tourettes for example). Even if "School phobia" is real; and the pupil who have been prosecuted is a sufferer.. Why should the school apologise? Presumably the evidence of non-attendance was real and provable. The "syndrome" is a circumstance that can be considered by the court. The school is right to pursue truants, their only evidence is attendance records.
Bill Thorpe, Manchester
As a parent of a 15 year old girl I can confirm that I do believe this exist. My daughter has something similar to this due to bullies. She was bullied two years ago and we put her in a new school. Every morning, even now, we have to fight with her. She ask every day am I running a fever, can I stay home. Then all the way to school are text saying, her head hurts, her throat hurts, she is going to pass out and so on. I have seen her shaking in the morning not wanting to go to school and her dad and I feel completely helpless. She is also a very good kid in every other way, and I know she wants to do well in school. Hopefully this is something that more studies are done on which can offer parents help. My daughter does see a therapist, and takes anti depressants, but these are of little help.
Nicole Humphreys, Manchester, England
Having experienced the symptoms described in this article when I was about 10 or 11, I certainly believe this condition exists. I had a long period at that age where I would get nausea in school, extremely anxious, and indeed this anxiety would be fed even more by a fear of actually throwing up, so a real Catch 22! It eventually built up to a level where I felt physically sick at the thought of going to school at all. I have to stress that here that I was normally very happy in school, plenty of friends, not bullied, and very much missed school when i was home 'sick' (and bored!). It wasn't a particularly stressful time in my life otherwise - no big exams etc. at that age. Home life was also very happy, and my parents were supportive and genuinely just concerned. I still can't really pin down a reason for those symptoms coming on, it just seemed to happen quite suddenly. My parents thought for ages I was physically ill, but eventually got in touch with a child psychologist who essentially (as far as I remember) helped me to get over the anxiety and control the 'sick' feeling, and got me going back to school gradually. Whatever he did, it seemed to work, I didn't have any more major episodes like that as I grew older. So I would advocate more patience and understanding of what I think is a very real psychological condition in some children, rather than simply dismissing it as truancy.
Brian McHugh, Edinburgh, U.K.
Yes, phobias exist in school settings, but I don't think that there is actually a school phobia. The reason why the profile of all these school phobiasts are "well behaved, socially conforming...." is for the simple fact that they are suck ups that probably get whatever they want, and their mommies and daddies cradle their kids until their out of college. I think everybody at some point or for a period of time didn't want to go to school. This was probably because we had to deal with something we didn't want to, like: giving a speech, a bully, or maybe getting up too early. These fears or anxieties are normal for everybody. Being afraid of a public institution is just another way to label something else we want to have as an excuse to coddle our kids.
This is ridiculous. There is always a name for anything that makes us as adults uncomfortable. I am a teacher and i have dealt with children who don't want to come to school, one is now okay as he realised nobody was going to put up with his nonsense. The other left the school as he was very good at manipulating his mother who just did whatever her children wanted. We need to stop labelling children and helping them to come up with excuses. I am sure when they grow up with no qualifications and become yet again another burden on society we will think of another psychological condition to excuse. The problem with the west, too many excuses for bad and manipulative behaviour!!