School Phobia Issues Critique - Article Example

Running Head: SCHOOL PHOBIA School Phobia Name Course Lecturer Date Abstract School phobia is a serious psychological disorder affecting about 5% of school going children in both elementary and secondary children. It refers to student refusal to attend school or difficulty to stand school environments. The condition is pervasive and has long-term effects to the child, parents and school systems which include poor academic performance, parental conflicts, diminished peer relationships and emergence of other psychiatric conditions. Due to its impressive co-morbidity, assessment and treatment of school phobia is quite challenging. As a mental disorder a comprehensive and professional therapeutic process might be required. The purpose of this article is to provide a concise understanding of school phobia. It briefly reviews development and causes of school phobia, outlines assessment protocol and finally discusses possible treatment procedures. SCHOOL PHOBIA Introduction A common scenario during admission days in schools is the failure to report by one or two of the registered students. Traditionally, this was termed as truant which is a word derived from the French to denote rogue, naughty child, lazy person, parasite or beggar. However, besides children who miss school due to a range of social factors, there is a subset of those who are found to miss school due to more serious emotional based factors. Earlier scholars such as Baldin (1932) explain this kind of absenteeism could be caused by the need to escape from the real world and attempt to find love. The term school phobia was coined in 1941 and was used to describe a psychoneurotic disorder which features overlapping obsessive and phobic tendencies. By definition, it refers to ‘an anxiety disorder of childhood and adolescence characterized by intense fear of going to schools’ (Kearney and Albano, 2007). Although no specific epidemiological study has been conducted to establish the prevalence of school phobia, it is estimated that more that 5% of the school age population suffer from the disorder. Even so, only about 1% of these are genuinely school phobic as the disorder resembles other forms of psychological disorders affecting children of this age. This article essentially seeks to dissect the concepts underlying school phobia by comprehensively exploring some causes and symptoms that distinguish it from other similar disorders. It will further discuss how the disorder can be detected, risk of failing to treat it and early interventions that can be applied to prevent detrimental effects associated with it. Development and causes of School phobia A number of anxiety disorders have been linked to school phobia. Separation anxiety is the most common anxiety disorder affecting children attending school for the first time. Separation disorder usually occurs when the child perceives going to school as losing a significant others in an environment where they were socialized during their first stages of life. The disorder is commonly perceived to result from diminished control over the environment in which the student is introduced to. The home provides a controllable environment for the child whereby his opinion counts and his voice is heard as opposed to the school where rules have been set to be followed by everyone alike. Besides that, these children have a deep concern about their parents and caregivers and they have constant fear of losing them (Kearney and Albano, 2007). Some children suffering from school phobia have also been found to have social and performance anxieties. They have trouble socializing with teachers and other students and their minds are often preoccupied with what people think about them. In addition, they have high levels of anticipatory anxiety about making presentations and speeches in class as well as participating in sporting activities. Generalization anxiety also plays a major part in development of school phobia. This kind of anxiety occurs when a child is anxious over a number of general situations including uncertainties about the natural environment such as war and disaster. They generally perceive the world as a dangerous place to live in. Children who are depressed are likely to suffer from anxiety phobia. In addition to having heightened difficulty in coping with others, depressed children and adolescents suffer from uncontrolled worry, suicide attempts and suicidal ideations, self-mutilation, indecisiveness, excessive guilt and sleep difficulty. School phobia is also strongly linked to bullying. Children will tend to be reluctant about going to school due to the fear of physical beating, teasing or being left out by others. Aside from the psychological factors causing school phobia, school and community environments significantly contribute to school phobia. Children will more often lack interest in school with high rates of staff and students absenteeism, too much emphasis on competition, negative student-teacher interaction, authoritarian style of management, high levels of discipline levels and larger numbers of underachievers. Parents with mental and lifestyle problems can potentially transmit these to their children and lead to school phobia. Some of these problems include depression, emotional detachment, high levels of conflict and alcohol and substance abuse (Fremont, 2003). Detection and effects of lack of early treatments of school phobia According to Kearney (2001), school phobia is a gradual process that develops with time. The most pronounced symptom which is express refusal to go to school might slowly develop to more notable and serious health problems. Frequent complaints about attending school, excessive worry about parent while in school, absence during special days such as tests and speeches and crying to go home are just a few of the warning signs of potential school phobia. Constant denial for permission to go home and force to go to school advance to physical complications such as headaches, gastrointestinal problems, fainting and nausea. These students have lowered self confidence, lack explanation as to why school is terrifying, become impulsive, lose concentration in class and often find excuses about using school facilities such as toilets. Furthermore, they experience mental sluggishness, tail during competitions, lack initiatives and have poor physical stamina. Severe school phobia may cause a student to stop going to school which ultimately curtail his social and educational development. 18% of these children interrupt compulsory school and 45% are actually not able to complete their high school education. Research indicates about 43% of children with school phobia spend a significant portion of their time attending outpatient or inpatient care. In addition, about 6% of them end up in criminal activities after dropping from school while about 14% have to spend more than 20 years under parental follow up (Kearney and Albano, 2004). A common remedy used by many parents to solve the problem is permanent withdraw of the child from mainstream education and subsequent enrolment into private tuition or home schooling. Fremont (2003) maintains that this leaves the real issues unresolved and they are likely to recur in the future of the individual. For instance, it becomes difficult for the individual to leave home for college or work as he has become overly dependent on family support. Making friends on the same wavelength as other people becomes very difficult for individuals with untreated school phobia. Treatment of school phobia Egan (2010) asserts that early treatment of school phobia is founded upon psychodynamic paradigm. He further suggests that treatment of school phobia should focus on therapeutic examination of unconscious conflicts. This is because most of the physical symptoms of the condition tend to manifest in signs of illness yet they are mere results of psychological distress. Evans et al (2011) suggest a collaborative, multimodal team approach which should essentially include the mental health care professional, school staff, parents and the child. Treatment should also take into account other contributing problems such as parental psychopathology, family dysfunction and cormorbid psychiatric problems. Since school phobia is a complex condition with a large number of co-morbidities, it is recommended that physicians engage in a comprehensive assessment and evaluation procedures in order to pave way for proper treatment. Sufficient time is imperative during this process if accurate assessment and effective interventions are to be achieved. According to Evans et al (2011) evaluation should begin by conducting interviews with the child and the parents as well. Issues to be factored during the interviews include history of the onset of the condition, physical examination, medical history of the child, mental status, substance abuse history, associated stressors and peer relationships. Collaboration and consultation with school staff is also fundamental during assessment and management of the condition. School personnel can avail crucial information such as psychoeducational evaluation, report cards and attendance records which could also aid in assessment. A number of general approaches have been developed and effectively applied to remedy all the causes of school phobia. One of the long standing behavioural strategies that have been used to deal with anxiety based fear that is beyond actual stimuli is systematic desensitization. According to Corey et al (2011) children with school phobia experience anxiety that is far much beyond what they identify as reasonable. Thus, systematic desensitization seeks to develop a fear-producing stimulus hierarchy which basically identifies fear aspects causing school phobia and systematically pairs them with deep muscle progressive relaxation training. Egan (2010) points out that working the child gradually into his hierarchy of fear and training him on how to regulate responses towards the fear will foster a sense of control over his fears thus allow him to return to school. Exposure based therapy is yet another treatment strategy applied on school phobic children. The key concept underlying exposure based therapy is the idea of habituation which occurs when the child undergoes prolonged exposure to fear or anxiety that provokes stimuli. The ultimate goal of this strategy is to extinguish fear response to attending school by familiarizing or socializing the child with the feared objects such as school bathrooms, gym class, teachers or hallways. Essentially, the child should be allowed to spend more time in the school as this will gradually stimulate his re-entry back to school. Flooding, a form of exposure therapy, works under the principle of respondent conditioning or classical conditioning. This conditioning usually causes the patient to change his behaviour towards the negative stimuli. For instance, the child is exposed to an environment where his phobia is at its worst and as such he will attempt to overcome the fear through relaxation which is actually a psychologically-proven technique. Modelling therapy has been particularly effective for adolescents who have problems with the social aspects of the school environment. The principle behind this therapy is based on the social learning theory which proposes that showing the child non-fearful behaviour during anxiety provoking situations enables them to develop repertoire of response that allows them to withstand such provoking situations. The non-fearful behaviours can be presented in a number of ways including participant modelling, live modelling and video modelling where the child observes others modelling non-anxious behaviours and later tries to imitate or perform the behaviours in the presence of the therapist. Gutierrez-Maldonado et al (2009) terms this as a “seeing and doing” approach that is less structured or formal and produces immediate feedback. Albano and Kendall (2002) underscores the use of cognitive behavioural therapy (CBT) in the treatment of school phobia. This model assumes that the child perceives attending school as threatening to himself, his family or caregiver and thus feels lack of control over the situation by attending school. The child assumes that by remaining at home the problem will be avoided which will ultimately eliminate his anxiety. CBT has five main components: relapse prevention plans, exposure methods, cognitive restructuring, somatic management skill training and psychoeducation. Whereas all these components have been proven effective, the most appropriate one for children and adolescents is cognitive restructuring. Is involved equipping the individual will maladaptive techniques for instance allowing him to identify self statements that result in anxiety and providing him with counter statements that are positive. This results to cognitive distortion of the root causes of anxiety. The ability to function in a social context can be enhanced through application of certain skills and techniques. This can be provided through training programs that generally build positive development constructs such as promotion of clear and positive identity, self-efficacy, spirituality, moral competence, self-determination, resilience and bonding. In addition, engaging the child in social skills groups enables them to identify their social behaviours through the feedback of others. Having an adult coach for the child is also an effective way of orienting the child into social contexts. Conclusion School phobia is indeed a persistent social problem that is gradually taking root in the contemporary society. The condition mostly affects children who are joining school for their first time and teenagers joining high school. Early detection of the condition is especially important due to its potential detrimental effects which include social alienation of the individual and permanent school drop outs. As such it is imperative for parents and teachers to be keen on notable warning signs which include reluctance to attend school, constant health complications and crying to go home. Treatment of school phobia is complex due to co-morbidity which a significantly large number of other related conditions. For this reason therefore, a comprehensive assessment which involves school staff, parents, the child and physician is required in order to conduct an accurate treatment. Several interventions which are primarily behavioural based have been developed to combat school phobia and they include exposure therapy, cognitive behavioural therapy, modelling therapy and social skill training. Even with these strategies, early detection and subsequent intervention of school phobia is the key to successful outcomes. References Albano, A. and Kendall, P. (2002). Cognitive behavioural therapy for children and adolescents with anxiety disorders; clinical research advances. International review of psychiatry, Volume 14, P, 129-134. Corey, G., Corey, M., & Callanan, P. (2011). Issues and Ethics in The Helping Profession (8th ed.). Egan, G. (2010). The Skilled Helper Model. A Problem-Management and Opportunity- Development Approach to Helping (9thed.). Belmont, CA: Brooks/Cole, Cengage Learning. Evans, D., Hearn, M., Uhlemann, M., & Ivey, A. (2011).Essential Interviewing: A Programmed Approach to Effective Communication. International Edition (8thed.). Chapter 7, 12 Fremont, W. (2003). School refusal in children and adolescents. American Family Physician, Volume 68, p. 555– 561. Gutierrez-Maldonado, J., Magallon-Neri, E., Rus-Calafell, M. and Penaloza-Salazar, C. (2009). Virtual reality exposure therapy for school phobia. Anuario de Psicologia, Volume 40, Issue 2, no. 223-236. Ivey, A., Ivey, M., Zalaquett, C., & Quirk, K. (2012).Essentials of Intentional Interviewing: Counseling in a Multicultural World, International Edition (2nded.).(including DVD and CourseMate). Belmont, CA: Brooks/Cole, Cengage Learning. Kearney, C. & Albano, A. (2004). The functional profiles of school refusal behavior: Diagnostic aspects. Behavior Modification, Volume 28, p. 147–161. Kearney, C. & Albano, A. (2007). When children refuse school: A cognitive- behavioral therapy approach: Therapist guide. San Antonio, TX: The Psychological Corporation. Kearney, C. (2001). School refusal behavior in youth: A functional approach to assessment and treatment. Washington, DC: American Psychological Association. Read More

Some children suffering from school phobia have also been found to have social and performance anxieties. They have trouble socializing with teachers and other students and their minds are often preoccupied with what people think about them. In addition, they have high levels of anticipatory anxiety about making presentations and speeches in class as well as participating in sporting activities. Generalization anxiety also plays a major part in development of school phobia. This kind of anxiety occurs when a child is anxious over a number of general situations including uncertainties about the natural environment such as war and disaster.

They generally perceive the world as a dangerous place to live in. Children who are depressed are likely to suffer from anxiety phobia. In addition to having heightened difficulty in coping with others, depressed children and adolescents suffer from uncontrolled worry, suicide attempts and suicidal ideations, self-mutilation, indecisiveness, excessive guilt and sleep difficulty. School phobia is also strongly linked to bullying. Children will tend to be reluctant about going to school due to the fear of physical beating, teasing or being left out by others.

Aside from the psychological factors causing school phobia, school and community environments significantly contribute to school phobia. Children will more often lack interest in school with high rates of staff and students absenteeism, too much emphasis on competition, negative student-teacher interaction, authoritarian style of management, high levels of discipline levels and larger numbers of underachievers. Parents with mental and lifestyle problems can potentially transmit these to their children and lead to school phobia.

Some of these problems include depression, emotional detachment, high levels of conflict and alcohol and substance abuse (Fremont, 2003). Detection and effects of lack of early treatments of school phobia According to Kearney (2001), school phobia is a gradual process that develops with time. The most pronounced symptom which is express refusal to go to school might slowly develop to more notable and serious health problems. Frequent complaints about attending school, excessive worry about parent while in school, absence during special days such as tests and speeches and crying to go home are just a few of the warning signs of potential school phobia.

Constant denial for permission to go home and force to go to school advance to physical complications such as headaches, gastrointestinal problems, fainting and nausea. These students have lowered self confidence, lack explanation as to why school is terrifying, become impulsive, lose concentration in class and often find excuses about using school facilities such as toilets. Furthermore, they experience mental sluggishness, tail during competitions, lack initiatives and have poor physical stamina.

Severe school phobia may cause a student to stop going to school which ultimately curtail his social and educational development. 18% of these children interrupt compulsory school and 45% are actually not able to complete their high school education. Research indicates about 43% of children with school phobia spend a significant portion of their time attending outpatient or inpatient care. In addition, about 6% of them end up in criminal activities after dropping from school while about 14% have to spend more than 20 years under parental follow up (Kearney and Albano, 2004).

A common remedy used by many parents to solve the problem is permanent withdraw of the child from mainstream education and subsequent enrolment into private tuition or home schooling. Fremont (2003) maintains that this leaves the real issues unresolved and they are likely to recur in the future of the individual. For instance, it becomes difficult for the individual to leave home for college or work as he has become overly dependent on family support. Making friends on the same wavelength as other people becomes very difficult for individuals with untreated school phobia.

Read More