By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“SCHOOL PHOBIA” BEST TREATED BY ENFORCING SCHOOL ATTENDANCE

Question: My son is in the second grade, and unlike last year, he does not want to go to school. Every morning he says his stomach hurts and he feels like vomiting. If I let him stay home, he seems just fine by noon and plays around the house all the rest of the day. When I force him to go to school, he comes home in a very bad mood and says he hated everything he did all day. What should I do?

Answer: What you describe sounds very much like a phenomenon known as "school phobia." Even though your first reaction might be to laugh at this term, it's actually a legitimate psychological problem, and as many as four percent of American children suffer from it at some time in their lives.

Let me first define this condition. School phobia is a type of separation anxiety that is caused by a child's fear of leaving home and spending the day in school. It typically causes physical symptoms, such as stomachaches, headaches, nausea, vomiting, diarrhea, tiredness and dizziness. These symptoms appear in the morning when the child is getting ready to leave the house for school. The symptoms may disappear by 10, well after school has started. The symptoms often disappear entirely on weekends.

It’s important to realize that school phobia is not the same thing as fear of taking a test or fear of participating in some school activity. If a child experiences anxiety about a test that he or she is unprepared for, that's realistic and normal apprehension. School phobia is a more severe, more extreme type of anxiety.

I would suggest that you take your son to a pediatrician or family physician to have his symptoms evaluated. If the doctor finds no physical cause for the symptoms, he or she will probably make a diagnosis of school phobia and suggest that your son return to school.

Going through this diagnostic process and then returning to school is enough to cure many children. However, in cases where the symptoms don’t improve or start again, psychological help may be sought. Sometimes, mental health professionals recommend desensitization treatment. This is when the parent accompanies the child to school. At first, the parent sits in the classroom with the child, then later moves to the hallway outside the classroom. Eventually the parent moves down the hall and then begins leaving the school building for longer and longer periods of time. Some therapists also recommend additional treatments, such as one-to-one counseling for the child or family counseling.

If your son is diagnosed with school phobia, he should not be allowed to stay out of school, regardless of the other treatments that he might be receiving. In general, we get over our fears best by facing them directly. That’s why, in most cases, if the child is required to go to school for two straight weeks, the symptoms of school phobia will become dramatically improved.

Unfortunately, many parents let their children with school phobia stay home, and this only makes the symptoms worse. In general, the longer a child stays home, the harder it will be for him or her to return.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.