Unlike separation anxiety, school anxiety does not diminish at school arrival. Judith Kaufman, PhD, professor and Director of School Psychology Training at Fairleigh Dickinson University in Teaneck, New Jersey says school anxiety is fairly common and can be triggered by a single issue or a combination of factors.

Some children are reluctant to leave home because they're fearful something might happen to a family member in their absence. "A parent who is chronically ill or undergoing medical procedures can also be triggers," Kaufman explains. "Teachers, exams, challenging social relationships, making threats or promises to others that cannot be lived up to are additional reasons."

Having a focal anxiety toward something frightening such as spiders, snakes, germs, even vomit, send kids running, too. Others are just anxious in general about a wide range of issues including school.

Learning why a child refuses school is the first step toward correcting the problem but it may take some doing, warns Kaufman. "The reason for school refusal may not be obvious and parents will need to gather information from teachers, lunchroom aides, classmates, or other caregivers in order to understand what's going on inside their child's head," the expert explains. "It's important to look for patterns of behavior, but it's even more important to involve the child in a non-judgmental conversation-regardless of her age-in order to learn what her experience is."

It's not unusual for a child to be clueless about the source of the problem. "Some kids are mindful. Others need encouragement," observes Kaufman. "If the child is able, encourage her to jot down instances when he feels badly along with details about the feelings. Keeping a record can provide insight for both parent and child."

Regardless of the causes, school phobias are debilitating and should be treated with the help of professionals. Untreated school anxiety can lead to complete refusal to attend school--a condition known as School Refusal Syndrome. Children who miss school for extended periods of time are at risk for developing serious educational or social problems in the short term and adult panic disorder in the long term.

Saying Yes to School

Establishing a plan the parent can live with and consistently maintain is key. "It's all right to use reinforcement if that helps get the child to school," advises Kaufman."Try having a helpful relative take your child to school or send him there with a friend. Collaborating with school personnel may have a good result. A friendly teacher who can greet a child at the school's entrance can be a welcome sight for a nervous child."

According to Kaufman, treatment varies depending on the magnitude of the problem. "Typically, if school refusal is a recurrent issue--as opposed to a single situation--it is important to take advantage of professional help. The school psychologist or counselor may be able to help negotiate the school day and teach relaxation strategies."

Another good resource is your pediatrician's office. "Your child's doctor should be able to recommend a clinical psychologist who can teach your child coping skills and better ways to problem solve," says Kaufman adding that family collaboration is another essential element in successful recovery. "School refusal is tough on the parents, too." 

In extreme cases-it's estimated that one in 100 children suffer from school refusal syndrome--medication plus therapy usually resolves the problem. Kaufman cautions parents that medication alone does not change behavior. "Some parents resort to meds as a 'magic bullet' thinking it might be easier than working through therapy," the expert admits. "Meds will provide short term relief but therapy is necessary for long term gains."

Interview with Judith Kaufman, PhD, professor and Director of School Psychology Training at Fairleigh Dickinson University in New Jersey.

The Journal of the American Academy of Child and Adult Psychiatry. Article: School Refusal and Psychiatric Disorders. A Community Study

The Chicago School of Professional Psychology