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School Refusal
(School phobia)
- Sex distribution equal
- No clear relationship to social class
- Not truancy
- willful avoidance of school because of more interesting things to do,
usually in company of like minded peers, associated with delinquency
- approx 5% of clinic referrals
- Peaks
- 5-6
- when starting school
- may reflect separation anxiety
- 11-12
- At secondary transfer
- commonest age of presentation
- 14-16
- may be first manifestation of depression or other psychiatric
diagnosis
Cause
- Double Depression with truanting
- Problems at school
- Bullying
- New School
- Peer rejection
- Problems at home
- Last child
- Protective mother
- Neglect / abuse
- Problems with Child
- Phobia
- Depression
- Grieving
- Power
Clinical Features
- Acute anxiety at time of leaving to go to school
- Somatic symptoms
- headache
- nausea
- abdominal pain
- palpitations
- Child may express wish to go to school
School Refusers
- Other emotional symptoms
- Family history of neurosis
- Over-protective parents
- Academic achievements okay
- Small family or youngest
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Truants
- Other antisocial symptoms
- Family history of antisocial behaviour
- Inconsistent discipline
- Poor academic achievement
- Large Family size
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Management
- Recognition and differentiation from other causes of school non-attendance
- e.g. bullying, developmental disorders, learning difficulties
- Exclusion of psychiatric illness
- Behavioural back to school programme usually effective with younger
children. Support for parents and liaison with school
- More chronic problems (esp. secondary school) may need more graded return
involving parents, teachers, education welfare officer and clinic.
- Tuition units may offer half-way house
- Adolescent units if co-morbid psychiatric problems
- Other interventions
- family therapy
- cognitive behavioural approach to anxiety
- social-skills training
- Approximately one third of older cases will have adult problems of social
impairment and withdrawal
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