School phobia in adolescents: we take stock

With Stephan Valentin, doctor in psychology and author of “School phobia – Understanding to act” (Enrick B Editions)

Phobia or school refusal: definition

Before looking specifically at the school phobia in adolescence, it is good to dwell on the term used and what it designates.

The most recognized definition of school refusal is that of neuropsychiatrist Julian de Ajuriaguerra, established in 1974: “ These are children or adolescents who, for irrational reasons, refuse to go to school and resist with very strong anxiety reactions or anguish if they are forced to go“. Earlier, in 1969, the psychiatrist Ian Berg evoked for his part a ” great difficulty in attending school, [un] severe emotional upheaval; [une] absence of antisocial disorders; [des] parents aware “.

“We can speak of school phobia to designate this disease, as we can speak of school refusal. It is a choice according to the specialist or the author, underlines Stephan Valentin, doctor in psychology and author of a book on the subject. More and more specialists are criticizing the term school phobia, because, according to them, it wouldn’t really be a phobia. First, research has shown that the child or adolescent would not be afraid of a specific object (school). First of all, it would beapprehension about social or evaluation situations related to school. The place “school” therefore does not necessarily represent the phobic object and the cause of the anxiety is not always related to schooling, as in the case of bullying. In this sense, the term anxious school refusal is perhaps more accurate.

In adolescents, this school-related anxiety does not begin abruptly with a refusal to go to school overnight, but in stages. Gradually, school, college, high school or even faculty (university) becomes a source of major suffering and anxiety.

Stephan Valentin also specifies that school phobia is not not to be confused with skipping school, out of dislike or disgust with the school system. “Most often, children or teenagers who suffer from school refusals like school“, but it is the anxiety that this generates that pushes them to desert its benches.

Entering college or high school: sensitive moments

“Most authors estimate that 5% of students have this disorder. There are three frequency peaks”, explains Stephan Valentin:

  • 5 to 7 years old: entering primary school.
  • 11 years old: going to college – entering 6th grade.
  • And 15 years old: going to high school – entering 2nde.

“So it’s not necessarily about adolescence per se, but rather sensitive moments in the child’s life, which refer to a new stage of schooling or to a change of cycle”, says the doctor of psychology.

Entering a new school also represents a “at risk” period of school phobia, because of the changes that this implies (places, circle of friends, school pressure and challenges for the future…). Note that school phobia can also occur at any time during the child’s schooling. “It all depends on the factors in the child’s life for it to occur.“, emphasizes Stephan Valentin.

School refusal: what are the signs and symptoms in adolescents?

It is not always easy to detect a school phobia in a teenager, because the appearance of school refusal does not happen suddenly, as in a younger child. During teenagehood, “the onset of school phobia is usually more progressive and insidious“, says Stephan Valentin. School disengagement will go crescendo, if nothing is done to stop it.

“For example, the teenager no longer attends classes in certain subjects, such as sports or French, or does not take part in a test. The mornings, before leaving for college or high school, often become more conflicting with the parents, because the adolescent does not want to get up anymore, he lies in bed or he begins to complain of pain. Being late for school becomes a habit. So these are not not right away whole days that the teenager misses school, but hours, and this rather sporadically“, says Stephan Valentin.

Visits to the infirmary may also become increasingly numerous and frequent, but the parents are not always informed. We should add that pivotal periods, such as the end of the weekend or holidays, can be particularly difficult times for the teenager, and that his anxious behavior at these times should give rise to suspicion.

Somatic disorders to watch out for

As in young children, anxious school refusal can cause various somatic symptoms (stomach ache, vomiting, diarrhoea, headache, abdominal pain, etc.). If school phobia may well be the cause, “it is always advisable to see a doctor for rule out organic disease“, recalls Stephan Valentin. The doctor of psychology points out that a depressive episode, a separation anxietypanic disorder, school inhibition or an obligation to help parents in their work can also cause such symptoms.

School refusal in adolescence: what are the causes?

Some children and adolescents are more likely to develop school refusal: “Ihe child or adolescent at risk of developing school phobia is often described as fearful, with a great need to feel safe”, notes Stephan Valentin, who adds that this child or adolescent can also present “difficulties adapting to changes and separating from their parents from an early age”.

note that that separation anxiety can resurface due to traumatic or badly experienced events by the child (death, separation or divorce of parents, moving, etc.). “For example, if a parent is sick or in mental distress, the child or adolescent may consciously or unconsciously feel responsible for protecting the parent by staying at home. illustrates Stephan Valentin.

Other factors external to the family and home can occur, or even combine, such as:

  • situations of school harassmentwith incessant mockery and humiliation (which can continue outside of school time, via social networks);
  • conflicts between classmates;
  • of the learning disabilities (dys: dyslexiadyspraxia, dyscalculia, dysorthography…) or attention (ADHD);
  • a boredom in a teenager high intellectual potential (HPI);
  • performance anxiety, for example due to possible family pressure around school results;
  • other psychological disorders (generalized anxiety disorder, social phobia, depression, anorexia or bulimia…).

Specialist, psychologist, psychiatrist: who to consult in case of school refusal in teenagers?

If we can first knock on the door of the office of the doctor or adolescent pediatricianthe ideal is quickly consult a specialist, either a psychiatrist or a child psychiatrist. Because, in addition to clearly establishing the diagnosis, these professionals will know how to set up a therapy adapted to the adolescent, identify the cause or causes of this school phobia, and work with him around solutions to get out of it, in particular by reinforcing of self-esteem. It should be noted that it is advisable to set up this psychological and therapeutic follow-up as soon as possible, in order to avoid the isolation and complete dropout of the teenager.

In fact, it is preferable to reformulate this idea: to the verb “to want”, we will prefer the verb “to be able”, more appropriate in view of the situation of the adolescent. “We will see as parents that the teenager can no longer go to school. I say “may”, because the desire is there, but the teenager feels incapacitated to go to schoolsays Stephan Valentin. Even walking past the school can cause, in some cases, a panic attack. So when the teenager refuses to go to class, it is important to act, because the longer we wait, the more difficult it can be for the teenager to return to school.

There is therefore no question of forcing the child to go to school, college or high school, at the risk of being completely counter productive. Via the family doctor, or directly by searching for resources on the Internet about school phobia (via the association school-phobia.org for example), parents will be able to find specialists for “take care of the teenager and if possible the family, because the teenager’s school refusal represents suffering for the whole family“, warns Stephan Valentin.

The association phobia-scolaire.org has a nice formula to sum up the attitude to adopt as a parent of a child suffering from school phobia: “Think the child is a CHILD before being a STUDENT“. Kindness and understanding are therefore, initially, the key words.

“It is with the specialist that we will find the best therapy or treatment to help the teenager, insists Stephan Valentin. As a parent, it is above all a question of understanding that it is a disease and that it is not because he is lazy or of bad will that the child does not go to the school. It is therefore a question, first, of recognizing that their child is sick and that he needs help”.

It should also be emphasized that, for a therapy to work fully, it is better that it be included in a global collaboration between the family, the educational team and the therapist. Therapies work best if a relationship of trust is tied between these three different actors gravitating around the child, at least according to the association School Phobia.

Arrangements to avoid school drop-out

Note that there are also measures to put in place so that the teenager suffering from anxious school refusal does not completely cut ties with school. There is, in particular, the individualized reception plan (PAI), which is to be put in place with the educational teams and the head of the establishment, and which allows, for example, the suspension of grades or certain subjects for a determined period. The teenager can thus keep one foot in the establishment, without spending all his days there.

distance education can also be a solution, at least in the short term, to maintain a rhythm and learning habits. However, only to be considered full-time if the anxious school refusal is already well established, otherwise there is a risk of isolating the adolescent a little more and further complicating the return to class. in situ.

In short, the idea is to find approaches to move towards a gradual return to school, for example part-time at first. Eventually, try to resume normal schooling.

School phobia in adolescents: we take stock