Abstract

School phobia is not a separate diagnosis, but a clinical entity that includes anxiety and avoidance behaviour related to either going to or staying in school, which may appear at any time during education. In most cases it is a manifestation of separation or social anxiety, although refusal to attend school may also be related to other emotional disorders in children and adolescents, such as generalized anxiety disorder, panic disorder or depression. Besides disrupting the normal functioning of a family, school phobia has serious negative consequences on a child’s education and social relations, and as such may be a very complicated childhood disorder. In differential diagnosis it is important to differentiate school phobia from truancy, antisocial behaviour (stealing, lying, etc.) and engaging in fun activities. Early treatment is important in order to minimize the child’s falling behind in school, losing contact with other children and getting extra attention from parents by staying at home. Treatment requires a multidisciplinary approach that includes the cooperation of a psychiatrist and/or psychologist, parents, school staff, a physician and social services in case of long-term absence from school or dysfunctional family surroundings. A multimodal treatment approach combining various techniques is required: the psychoeducation of parents, individual psychotherapy (psychoanalytic or cognitive-behavioural), group therapy and family psychotherapy depending on the severity and causes of the disorder. In severe cases that do not respond to psychotherapy, antidepressant and anxiolytic medications can be prescribed. This paper presents recent findings on school phobia and treatment with cognitive-behavioural therapy, and one clinical case.