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Why Johnny Won't Go to School

By Amanda Gardner
HealthDay Reporter

THURSDAY, Oct. 13 (HealthDay News) -- The symptoms aren't often alarming: headache, stomachache, fatigue. But they tend to come on weekdays, specifically when your child should be heading off to school.

Psychologists call it school avoidance, and it can take different forms in many age groups.

Exact numbers are hard to come by, but school avoidance "remains a serious problem," said Alan Hilfer, director of psychology at Maimonides Medical Center in New York City. "We are more attuned to this and more aware of factors possibly affecting school attendance."

School professionals are also able to offer more support nowadays, he said.

Frequently, kids who avoid school are reacting to pressure, either real or perceived.

"There's tremendous pressure . . . in academics, appearance, activities," said Mark Goldstein, a child clinical psychologist in Chicago. "A lot of times kids are just overwhelmed . . . And if a child has a proclivity towards anxiety, especially a genetic predisposition, there's a greater likelihood of anxiety being precipitated."

The full range of school avoidance is a continuum, said Goldstein.

At one end is the younger child experiencing painful yet predictable separation anxiety when going to school for the first time.

At the other extreme, said Goldstein, "There's actually social phobia, which is a much more severe disorder, with some kids refusing to go to school."

And everything in between, "from a child being bullied or picked on in school, [or] kids having anxiety about a particular event in school, such as having to dress for P.E.," said Goldstein. "Sometimes it's as simple as not being prepared for a test or quiz and they consciously or unconsciously suddenly don't want to go to school."

Several studies have detected a rise in school avoidance during middle-school and junior-high years, according to the American Academy of Child and Adolescent Psychiatry, but Hilfer said increased awareness may be skewing the numbers.

Parents trying to discern between legitimate physical complaints and symptoms of school avoidance should start with their child's doctor, experts advise. "If there are no physical factors -- the pediatrician has ruled out anything noteworthy -- and the 'headaches' persist, one can assume some psychogenic issue," said Hilfer. "That is not to say the child doesn't have a headache, it's just what's causing it that needs to be addressed."

Treatments depend both on the reasons for the avoidance and on the age of the child.

Having trouble with school work may indicate a learning disability, which needs to be diagnosed and addressed before the child can feel comfortable in school.

"It's very important to know why they think school is such a horrible place, why they feel like they're failures in school," said Hilfer.

In very young kids scared to leave home and mom, simply talking to the children and gradually exposing them to the new situation -- say, getting dressed and driving by the building without going in -- may assuage anxiety, said Melissa Robinson-Brown, assistant professor of pediatrics and psychiatry at the Mount Sinai Adolescent Health Center in New York City.

Sometimes behavioral interventions aimed at decreasing anxiety may help younger and older kids. This could mean meditation to calm the child, muscle relaxation, hypnotherapy, self-hypnosis or cognitive behavioral therapy (CBT), said Goldstein. In CBT, a therapist helps patients change their negative thought patterns.

In more extreme cases -- say, when a child is bullied by gangs or because of sexual orientation -- school involvement may be necessary. Occasionally, kids have to transfer to another school, Hilfer said.

Kids who have outright social phobia can be "genuinely panicked and literally cannot go to school," Hilfer said.

Again, behavioral interventions may benefit the child. Also, some schools will modify their schedules, letting students sometimes work from home, Hilfer said.

If depression is at the root of the anxiety, parents may need to consider medication, although this is usually less common, Goldstein said.

And, sometimes it's the parents who need to be counseled more than the kids.

"Sometimes I work with parents to lower expectations and take some pressure off the kids," Goldstein said.

More information

The American Academy of Pediatrics has more on school avoidance.

SOURCES: Alan Hilfer, Ph.D., director of psychology, Maimonides Medical Center, New York City; Melissa Robinson-Brown, Ph.D., assistant professor of pediatrics and psychiatry, Mount Sinai Adolescent Health Center, New York City; Mark Goldstein, Ph.D., child clinical psychologist, Chicago

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