School Avoidance From the Point of View of Child and Adolescent Psychiatry

Abstract

Many preventive and therapeutic interventions are now available, but the existing measures need to be better coordinated, and more effort needs to be directed to the early recognition and treatment of school-avoiding behavior. Physicians should consider the possibility of mental illness. Rather than writing sick notes or prescribing mother-child treatments at health resorts, which rather tend to sustain the problem, they should refer patients promptly to a child and adolescent psychiatrist.

Practitioner Review: School refusal: developments in conceptualisation and treatment since 2000

“…Thus, Burke and Silverman () differentiate between separation anxiety and school phobia, a term they use to describe a fear of school. In contrast, Knollman, Knoll, Reissner, Metzelaars, and Hebebrand () differentiate between school anxiety (where fearfulness is associated with the school environment) and school phobia (which they see as being a consequence of separation anxiety). However, given that school environments are very social settings, some presentations may be more accurately described as reflecting social anxiety, involving intense distress in response to public situations (Beidel, ).…”

“…A significant development this century has been increased awareness of the role that school environments play in the development of school refusal (Knollman et al., ). Understanding that a student may be refusing school in order to avoid an aversive experience necessitates identification of particular school‐based factors that are contributing to the problem (Havik et al., ).…”

“…() reported that 29% of their waiting list controls demonstrated a clinical improvement in attendance. However, there are likely to be important factors in the persistence of the problem after treatment such as its severity, the age of onset and the speed of response once a problem is identified (Knollman et al., ). Treatment is likely to be less effective in cases where the refusal has persisted for more than 2 years (Kearney & Tillotson, ) and there is some evidence that future employment, or education several years after treatment, is less likely where the child presents with social phobia or learning difficulties (McShane, Walter, & Rey, ).…”

The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness

“…Five to 10% of German school students are absent from school to a substantial extent (>5 times unexcused absence/ school year) (4,5). School absenteeism that is accompanied by psychiatric symptoms is defined as school avoiding behavior (6)(7)(8). All these factors contribute to the need to evaluate effective treatment strategies.…”

How Can We Prevent School Avoidance and Behavior Problems in Preschool Children?

“…"School avoidance" is an umbrella term covering a wide variety of collections of symptoms that need different interventions-a fact taken into account in this study (5), in that all patients were recruited from a specialized outpatient clinical service for schoolavoiding behavior. The same work group discussed this topic extensively in a review article published several years ago (10).…”