Back to school, Thursday, September 1, is fast approaching. If some students are nervous at the idea of finding their classmates, for others, the month of September is an obstacle course. Impossible to pass the gate of the establishment without having a knotted stomach, migraines, even anxiety attacks.
This refusal to go to class is not to be taken lightly. In France, one in five students is anxious about school (PDF document) and “school phobia” affects approximately 1 to 2% of school children, representing 5% of consultations in child psychiatry, according to data collected by Laelia Benoit, child psychiatrist and researcher at Yale University (United States). With the Covid-19 crisis, the phenomenon has grown. The School Phobia Association (APS) has seen the number of its members increase alarmingly since 2019. “We have welcomed 150 people per week since the end of the second confinement until now”, observes Odile Mandagaran, its president. How to deal with the problem if your child is in this situation? Franceinfo asked the question to several specialists.
What is school phobia?
In psychiatry, school phobia results in a “anxious school refusal”. This term refers to “children who, for irrational reasons, refuse to go to school and resist with very strong anxiety or panic reactions when someone tries to force them to do so”, according to the definition of the neuropsychiatrist Julian de Ajuriaguerra in 1974. Most often, this disorder covers “many manifestations such as anxiety, arriving late to class and partial or complete absenteeism”complete Laelia Benoit and Marie Rose Moro, child psychiatrists at La maison de Solenn, in Paris, and co-authors of School phobia, rediscovering the pleasure of learning (ed. Vigot, 2020), with Aurélie Harf.
However, it is important to differentiate school phobia from anxiety, which is much more common. The latter concerns young “stressed before the start of the school year, or by the fact of changing classes”, specifies Laelia Benoit. “These behaviors are frequent and do not cause lasting discomfort for the child, reassure the child psychiatrist. Two or three weeks after the start of the school year, these students no longer have any anxiety.”
With her colleague Marie Rose Moro, they found that the socio-cultural origin of the children was decisive in establishing a good diagnosis. “We talk a lot more about school phobia in Paris than in Seine-Saint-Denis, where the words of school failure and school drop-out come up more often”, explains Marie Rose Moro, referring to a study conducted by Laelia Benoit on the two territories. She deplores this form of “two weights, two measures”.
“When a good student does not go to school, we immediately speak of school phobia, whereas when he is a bad student, no.”
Marie Rose Moro, child psychiatristat franceinfo
What are the causes of school phobia?
They are multiple and also depend on the age of the child. “School phobia is very complexexplains Marie Rose Moro. Either the child cannot consider leaving his house – which happened after the Covid for example -, sor he’s frail, depressed, anxious or worried about what’s going on at home.” According to specialists, the most common cause is school bullying. Half of students with school phobia have been victims of bullying or violence at school, according to an ongoing study of 2,000 parents of students led by Laelia Benoit.
In primary and secondary school, certain disorders can also make life at school more difficult. This is the case of learning disabilities, called “dys” (dyslexic, dyspraxic, etc.), autism spectrum disorders or attention disorders, with or without hyperactivity. This does not mean that a child exposed to these disorders will necessarily develop a school phobia. But these young “are out of step, risk being put aside by other children, being harassed” or having a hard time with their days at school, points out Laelia Benoit.
Finally, anxiety related to results and performance, more present among high school students, can also lead to school phobia. “In this case, we can recommend stopping evaluating the teenager for a while”recommends Marie Rose Moro.
“The French school is performance-oriented and can be very punitive in the way it does things.”
Marie Rose Moro, child psychiatristat franceinfo
What to do to prevent it?
The start of the school year in September is synonymous with change. For anxious children, Marie-Christine Combes Miakinen, Ile-de-France contact person for theSchool Phobia Association, advises preparing for the start of the school year as a family, buying school supplies together. As parents, you have to “try to contain your own anxiety so as not to add to it”.
Laelia Benoit even recommends organizing a sort of “general repetition”. Understand: set an alarm clock, eat breakfast, pack your school bag, go to school with your parents or siblings. Then the child can do a fun family activity.
Another advice given by the child psychiatrist: coordinate with friends and show up in front of the establishment half an hour before the start of class. Parents of students and children can thus discuss their holidays and take the time to “retaming”. A way of “transform the school into a warmer place where it is fun to meet and hear from each other”emphasizes Laelia Benoit.
What are the signs that can alert you?
Before getting to school phobia, parents (or teachers) can detect signs of anxiety, such as lateness in class, absences, frequent visits to the infirmary or headaches or stomach aches. . “Especially in the little onesemphasizes Laelia Benoit, who find it difficult to say that they are afraid or that they are anxious.”
It is important to track the frequency of these symptoms. In cases of school phobia, they are repeated on Sunday evenings, Monday mornings or at the end of the school holidays, a few days before the return to school. Generally, peaks are observed after the All Saints and Christmas holidays.
What if your child refuses to go to school?
The first thing to do is to make an appointment with your general practitioner to check that there is no health problem (problem of sight, anemia…). Parents can also request an appointment with the teacher and an assessment with a speech therapist. Once these leads have been ruled out, Laelia Benoit also recommends discussing with the child, “even make suggestions to him, because he himself may not have understood” where does the problem come from.
In the event of repeated absences or the student’s inability to go to school, Marie-Christine Combes Miakinen recommends covering these absences with medical certificates. And to avoid forcing it at all costs.
“It’s like a burnout at work. We’re not going to force the adult to attend the management committee every Monday.”
Marie-Christine Combes Miakinen, from the School Phobia Associationat franceinfo
You also need to create “a triangle between the education pole, the health pole and the family pole, with the child in the middle”advocates the referent of the APS. And if the parents feel that the dialogue is difficult with the school, she advises them “to go and talk to the educational team accompanied by an elected parent. You also have to identify who is the ally, the person with whom the current flows best.”
How and by whom do you get help?
At first, parents can use children’s literature or cartoons and animated films. There are also associations that allow them to be referred according to the problem encountered by their child.
If the anxieties or the phobia are installed, do not hesitate to consult a child psychiatrist who knows the question well, or a practitioner who offers behavioral therapies such as sophrology, meditation, art therapy… Anything that can help the child better identify his emotions and express them.
However, obtaining a consultation reimbursed by Social Security or in the public sector can be difficult. In medico-psychological centers (CMP), the minimum waiting period is six months, according to a Senate report published in January 2020. In the liberal sector, on prescription from the attending physician, sessions with a psychologist, referenced on the directory of the Monpsy scheme, can be reimbursed, up to a limit of eight per year. But not all practitioners have adhered to this system. Finding a child psychiatrist can also be complicated, as 14 departments do not have one, the Senate report reveals.
On the side of the parents too, the need for support can be felt. “To protect the family unit, the best thing is to get help” by consulting yourself or by contacting an association, insists the president of APS, Odile Mandagaran.
“School phobia is a real tsunami that takes the whole family away. Overnight, everything collapses. Parents feel judged, made to feel guilty.”
Odile Mandagaran, president of the School Phobia Associationat franceinfo
What are the possible alternatives if your child no longer wants to go to school?
To find the most suitable solution, you have to see “the child before the student”, recalls Marie-Christine Combes Miakinen. And thus reflect in a concerted way on what will suit him best. If the child categorically refuses to continue his education in a classic course, or if he is in too much pain to do so, it is possible to follow distance learning courses with the Cned. The educational support system at the hospital or at school (Apadhe) allows a gradual return to class. But it remains underutilized. According to Marie Rose Moro, 3 to 4% of cases of school phobia end in hospitalization.
There are also alternatives such as the “care-studies” course (reserved for adolescents and young adults), which allows total or partial hospitalization while following an education. But in the context of psychiatric care, this option is only available in 26 structures in France. Another option is the second chance school, a free training course for young people aged 16 to 25 who have dropped out of school.
Finally, parents can turn to specialized, private schools. But these solutions represent a significant budget for families. The APS has estimated the excess cost at 300 euros per month for households with a child affected by school phobia.