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
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
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
At one end is the younger child experiencing painful yet
predictable separation anxiety when going to school for the first
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
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
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,
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,
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.
The American Academy of Pediatrics has more on
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