School phobia. The term is now fashionable, and even if figures vary from one study to another, specialists agree that school phobia in France affects between 2 to 5% of schoolchildren. As a more reliable figure, school phobia represents 5 to 8% of the reasons for which child psychiatrists are consulted.

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So, let's ask the question. Is school more frightening than before? To the extent of making our children sick? What is certain is that social expectations of schools have changed. Since Jules Ferry* we have gone from a situation in which most students had to leave school to go to work, to a situation where parents in 2019 now doubt their children could one day match their income levels.
What is school phobia? What does one have to watch out for as a parent, and how do we treat it?

Jules Ferry: French politician who promulgated compulsory school in France at the end of the 19th century.

What is school phobia ?

School phobia can be understood by using the image of a coin. The tail side describes an intense and irrational fear of school. On the other side, it is the avoidance strategies that lead the child to do everything he possibly can to avoid going to school. What happens in this case, is that the more you force the child to go to school, the more he refuses to. Even though they are predominantly eager to learn, and that before "they liked school", children with school phobia live in enormous anguish simply by thinking about the school environment. "I may not be in class, but class is always present in me," a young patient told me recently.

Symptoms of school phobia

The main symptoms of school phobia are easily identifiable:

• The occurrence of this "phobia" appears, in most cases, suddenly (either at the end of holidays or at the beginning of the school year). It is not only caused by a particular or traumatic life event. This is probably the trickiest part for the family and for the student himself: the child refuses school for no apparent or valid reason. When parents give in and allow them to not attend school, the child immediately feels better. Often, he promises to go back the next day, but the scene seems to replay itself indefinitely. In the words of one schoolboy: "But I don’t know why I can’t go to school anymore. Everyone asks when and why it started but I don’t know. It was actually even pretty good before the tsunami began”.

• Difficulties leaving home to go to school.
  A strong emotional response marked by anxiety and panic that increases as we get closer to school. Violent somatic outbursts (tremors, stomach-aches, headaches). The child cries, shouts and begs. We are dealing here with "noisy" symptoms. As parents, it is easy to recognize them.

• Absence of antisocial behaviour. (The child continues his outdoor activities and does not seem anxious during the school holidays).

• Complete school absenteeism.
  We are dealing here with a serious phenomenon that leads to serious consequences for everyone. I’d like to stress that the school phobia issue and "I do not like school" issue are not related. These children love school but are not attend, which is very different.

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Who is affected by school phobia ?

When it hits, school phobia can appear at any age. Nevertheless, two age categories are affected more than others: beginning of primary school, at around 5-6 years of age, and start of adolescence - in 6th grade at 11 years of age, and in 4th grade, when children are 13-14 years old. Warning: a kindergarten child crying to not go to school is not school phobia. In this case, its more about separation anxiety than school anxiety. Similarly, for high school students and students in college demonstrating school phobia, experience proves that it is much rarer.
Furthermore, studies show that girls are as affected as boys, although it appears that boys start to show symptoms earlier. Curiously, youngsters over 16 years of age, of feminine gender, or that are the youngest siblings, demonstrate a less speedy healing process.

Lastly, it seems that intelligent, "serious" students, who have a positive commitment to school, are actually more at risk.

What School Phobia is not

School phobia is unsettling. One mother explains: "I feel completely helpless in this situation. I’ve tried everything, the hard way, the soft way, but nothing helps”. It’s even difficult to pinpoint the correct word to describe the phenomenon: "school phobia", "school anxiety", "refusal to go to school". Why are there so many names to describe a phenomenon that doesn’t change?
The main reason for this is that school phobia is at the crossroads of other events/situations. To understand what makes it different, we must understand things that are similar to school phobia but that are not actually school phobia.

• School phobia is not a learning disability. A learning disorder is a psycho-cognitive dysfunction that refers to school learning abilities. It is currently classified as a mental disorder.
• School phobia is not a refusal to learn. In the refusal of wanting to learn - commonly known as "school dropout", the child continues to go to school but is there without really being there. He no longer has the desire to learn and thus his results plummet. It is not anxiety that is predominant here, but a depressive symptomatology.
• School phobia is not comparable to "truancy". When a child plays truant from school, he hides it from his parents and usually hangs out with other children. In this case it would be a demonstration of risky adolescent behaviour – somewhere between defiance of authority and self-assertion. However, in the case of school phobia, the child does not hide his situation from his parents.
• School phobia is not a phobia. “What!” you would say. And yet, this is what happens often when a phenomenon "comes out" of its original environment - the medico-social one - to becoming popularized in the media. Strictly speaking, a phobia is the irrational fear of a clearly identified object. But concerning school, it is the therapist’s job to shine light on what is actually causing the problem within the global school environment. Is it fear of teachers, other classmates, bad grades, or fear of leaving his parents? The answer here differs depending on each child’s history and journey. This is why the official international classification is "school refusal" and not "school phobia". On this point, I agree with the analysis of Marie-France Le Heuzey, a psychiatrist at Robert Debré hospital in Paris who prefers the term "school break" or "child sickness because of school". This specialist states: "School phobia, like that of an elevator or a plane, does not exist. It is a malapropism. As for school refusal, a term used by Anglo-Saxons, it doesn’t seem appropriate either. The young people I see in consultation do not refuse to go to school, they cannot go, which is different.
  The title of this article is thus clarified: "School phobia" or when the anxiety takes on the face of the school. It’s not so much the school that causes anxiety, but it’s an anxiety that is revealed through school. The school acts here like a magnet which attracts a number of scattered elements, without a direct link between them, which end up forming a big ball of thread which is very difficult to unravel.

So, it is therapy’s job to help unravel all of this in order to find out what this anxiety about school really is.

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School Phobia evolution

As it is the case for most psychological demonstrations in adolescence, school phobia evolves as follows:

• A third of cases evolves towards marked psychological disorders such as anxiety disorders, depression or a personality disorder.
• A third of cases recovers very favourably.
• A third of cases recovers but continue to have troubles in social or professional integration. The risks of social marginalization and delinquency increase.

From my experience as a therapist, it's about staying positive. On one hand, early management significantly improves the course of the disorder. On the other hand, an attentive and loving home environment is crucial. By that, I mean parents who trust their children ("I know you do not do it on purpose, I believe you, we will help you") and those who are ready to question themselves ("Do you think we're putting too much pressure on you regarding your grades? ")

How to treat School Phobia

The first warning signs warrant an appointment with a psychologist. Talking to teachers and taking part in the various educational meetings when necessary, are integral part of the psychologist’s job. The treatment is based on:

• Individual psychotherapy with variable duration, but that tends to be medium-long term.
• Possibly coupled with family therapy or parental guidance, where parents question their educational strategies.

In the most difficult cases, a significant change is crucial in the healing process: it can be a change of school environment, a move, hospitalization, or the whole family balance being called into question. Institutional care may be considered after 6 months if treatment in private practice fails.

School Phobia and Expatriation

An expatriation context for the child is not in itself a factor that promotes the appearance of school phobia. Nevertheless, from my experience, it’s important to note that the school has a particular role here. As a first step into the community, International (French) schools abroad have a pivotal role in the life of students and their parents, surely more important than the “local” school back at home. A 4th grade pupil from a French school in a country in Africa tells us: "First of all, we all live in the same residence, my maths teacher is my neighbour and my Senior Education Advisor comes to have tea at home with my mother. It's weird to start with. I have the impression that there are no barriers between school life and the outside life. " This teenager suddenly developed school phobia. An interview between the youngster and his parents shed light on a dysfunctional parent-child relationship. Here is an excerpt:

• the young man addressing his parents: "You don’t even say hello to me anymore. The first thing you ask me is what grade I got at school. And then you talk to me all the time about my future. But I don’t know what I want to do later“
• the psychologist: "I have the impression you think that if you get a bad grade like a C, it's as if your parents loved you at a “C” level and if you get an A+ grade then they love you accordingly".
• the young man: "Yes, that's it, they love me more when I get good grades. And then you know, my father works a lot, he's always traveling."
• the mother: "It's not exactly that, but we’ve tried everything. It's our role to ensure you do well in school for your future."
• the psychologist: "Do you feel like you're failing in your parenting role when your child gets a bad grade? "
• the mother: "Oh yes, times are hard, the economic sector is not at its best. I feel like a bad mother. »

It took time to understand the relationship. Therapeutic work was carried out with the teenager on his ambivalence towards his parents: wanting to please them by succeeding in school versus opposing the parents insidiously by not going to school anymore. The young man was able to express his desire to return to France, to his small village. It was also noted that the uncertainty concerning a return or not to France was, for him, a great source of anxiety. On the parental side, we worked on the feeling of guilt. The child was able to understand that the importance his parents were giving to school matters was, clumsily but fundamentally, a proof of love. Once the parents' personal anxieties regarding school, and anxieties stemming from their own schooling were taken out of the equation, the pressure related to schooling was somewhat lessened. Everyone relaxed. The youngster went back to his class and now flourishes in hospitality studies. On their side, the parents are focusing on supporting their child, and giving him the weapons to be happy in life rather than "policing" his grades.

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Etienne Duménil specialises in school and educational questions, but also in children’s and adolescents’ psychological difficulties. He has been an expatriate himself and consults at his office or by video-consultation on the Eutelmed platform. He speaks French.

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www.psy95.paris

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