School phobia

Abstract

Pediatricians and other primary care providers are in an ideal position to prevent, to diagnose and to treat children with school refusal. Detection requires recognition of high risk situations, and delineation of possible reality factors or environmental hazards. The physician will find school refusal associated with perceived or actual physical illness, debility, or vulnerability, family stresses including illnesses and marital problems, over-protective mother-child interaction patterns, and previous difficulties in achieving mother-child independence and separation. Confirming the diagnosis depends on interview with family members. Positive indicators are dysfunctional patterns of family communication, parental emphasis on illness, and manipulative behavior on the part of the child. Data from the school on absenteeism need to be supplemented by the school's observations of individual achievement and ability measures, grades, and teacher observations of peer and adult interaction. Treatment techniques center around returning the child to school by involving the child, the family, and the school in this process. Specific counseling techniques and principles aim to recognize each individual's feelings and to stress the active role of the parents in solving problems together. Follow-up is based upon assessment of clearly understood short-term and long-term goals. Referral should be rare, and should not be undertaken before proper evaluation has been completed. Making a referral "stick" depends greatly upon the degree of rapport and trust which has been established with the family. In most school refusal cases, management by the pediatrician or primary physician can be a rewarding, stimulating experience which provides a high degree of parent and physician satisfaction.