School Phobic Children Research Articles

From Waiting Room to Mother's Lap: Parameters in Testing a Psychotic, School-Phobic Child

In this article, I discuss the challenging experience of testing a child with severe separation anxiety and school refusal, which reached psychotic-level proportions. Unusual parameters are necessary to provide assessments with severely compromised children. In cases such as these, the goal should be to gather as much useful information as possible, paying particular attention to the conditions, which allow testing to take place. Such information will afford clues to the necessary conditions for providing required therapeutic and educational support.

Effect of long-term melatonin administration on school-phobic children and adolescents with sleep disturbances

Melatonin is effective in treating sleep disturbances, which are closely related to school phobia. However, side effects of melatonin in long-term administration have not been examined fully. In the present study melatonin was administered to 30 patients with school phobia (18 females, 12 males; mean age, 14.8 years) who had no physical, psychiatric, or social problems, but had sleep disturbances. Patients were compared with 27 healthy, age-matched controls. No changes in serum 5-S-cysteinyldopa levels, human skin pigmentation, or the state of puberty were observed in either group. Melatonin appeared to lead to improvements in sleep disturbances.

Cognitive‐Behavioral Treatment of School Phobia

To conduct a controlled group outcome investigation of the efficacy of cognitive-behavioral treatment for school phobia. Fifty-six children with school phobia were randomly assigned to 12 weeks of cognitive-behavioral therapy or an attention-placebo control condition. Pre- and posttreatment school attendance, self-reported anxiety and depression, and diagnostic status were compared. Both the experimental and control treatments were equally effective at returning children to school. Both treatments also were effective in reducing children's anxiety and depressive symptoms. Follow-up revealed no differences between groups when the children reentered school the next school year. Overall, results suggest that psychosocial treatments are effective at returning school-phobic children to school and that the highly structured cognitive-behavioral approach may not be superior to more traditional educational and supportive treatment methods.

School Phobia: Patterns of Family Functioning

Seventy-six families of children with school phobia were evaluated with the Family Assessment Measure. Mothers and fathers, as separate groups, rated clinically significant dysfunction in the parent-child relationship in the areas of role performance and values and norms. There were no significant differences between intact and single-parent families on ratings of family dysfunction. There was significantly less family dysfunction as rated by mothers and by children if the child had a diagnosis of pure anxiety disorder compared to families of school phobic children in other diagnostic categories.

Pedigrees, functioning, and psychopathology in families of school phobic children

Family pedigrees of six children with severe school phobia compared with those of a matched group of families of five children with psychiatric disorders showed a clustering of affective and anxiety disorders. Blind and independent family histories and structured interviews of parents and siblings demonstrated higher rates of depressive and anxiety disorders in first-degree relatives of children with school phobia. Parents of children with school phobia described more disturbance in family functioning on the Family Assessment Measure than did parents in the comparison group in the areas of role performance, communication, affective expression, and control.

School phobia: the importance of prompt intervention.

School nurses, teachers, administrators, and child study team members annually are confronted with the recurring problem of how to help school phobic children cope with and resolve the fears and anxieties that beset them. In their efforts to aid the phobic child, school personnel must communicate with concerned parents who oftentimes view the school as the primary source of the problems evidenced by their child. Because of the dearth of literature on school phobia, school personnel frequently are uncertain of the proper approach in dealing with the phobic child and the family. The importance of prompt treatment, and the need for good communication among those concerned with the phobic child, are addressed in this article. The manifestation of this disorder is described and theories and intervention methods are reviewed.

The School Phobic Child and Special Services Providers: Guidelines for Early Identification

Background issues related to the children and youth who have the anxiety disorder known as school phobia are discussed. An approach is offered to assist special services providers with early identification of children who might have this disorder. In this article, the approach is reflected as a set of 25 behavioral indicator guidelines. In addition, an overview of the psychosocial characteristics of school phobia are considered.

Classification and diagnosis of depression in school phobia.

Fifty-one school phobic children, aged nine to fourteen years, were assessed for psychiatric diagnosis; this revealed the presence of two clinically meaningful sub-groups--depressed and residual school phobic. A wide range of symptoms were studied to identify those which might prove useful in diagnosing adult-type depression in childhood and early adolescence, both in terms of frequency of symptoms in the depressed group and the extent of the distinction between the two groups. Eleven such key symptoms were identified and based on these, a formula for diagnosing adult-type depression was evolved. The validity of several different ways of classifying the above cases were explored; these covered: kind of disorder; type of onset; adolescence versus pre-adolescence; and sex of the child. However, on only one dichotomy--depression versus absence of depression--were there many significant discriminants. Affective symptomatology of more recent onset was contrasted with pre-morbid personality traits, usually associated with school phobia. There was no evidence to support the concept of 'masked depression' in childhood.

Psychosocial functioning of school phobics at follow-up

This report of an ex post facto study of seventy-four school-phobic children depicts their psychosocial functioning at intake, at the termination of treatment, and at follow-up, ten to twenty years later, and identifies the variables associated with the current psychosocial functioning of those who followed through and those who did not.

What are the characteristics of school phobic children?

This paper presents a critical review of studies delineating the major characteristics of school phobic children. This work focusses on data relevant to the incidence of school phobia, age, sex, ethnic, religious, and social class backgrounds of these children and their families, birth order, intelligence, and academic achievement, presence and nature of precipitating events leading to phobic episodes and onset of related symptoms, and personality characteristics. There have been few systematic surveys of school phobic children so little is known about these characteristics; much work has produced equivocal results. The only consistent agreement is that school phobic children are typically more dependent, anxious, immature, and depressed than nonphobic children.

Reliability and validity of the revised fear survey schedule for children (FSSC-R)

In this study, the validation of a Revised Fear Survey Schedule for Children (FSSC-R) is detailed. Psychometric properties of the scale are reported for two normal samples and one clinical sample of school-phobic children. Initial analyses indicate that the FSSC-R possesses high internal consistency, high test-retest reliability and acceptable stability over time. Further, it adequately discriminates between normal and clinical samples, has acceptable convergent and discriminant validity and possesses a meaningful factor structure. The potential clinical utility of the scale is discussed, and important social and developmental issues affecting the development and expression of fear in children are addressed.

School Phobic Children at Work

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School Phobic Children at Work

Seventy-one school phobic children seen at a child guidance clinic were followed up after they had passed school leaving age. Their record in work and further education was compared with the length of time they were off school, whether or not they returned to school, and the occurrence of further psychiatric treatment after discharge from the clinic. It was found that whether or not the child returned to school and the length of time he was off school had no relationship to future performance at work or in further education. A significantly larger number of children receiving further psychiatric treatment after discharge from the clinic failed to reach their potential in work or further education. Adequate treatment of the underlying conditions appears to be more important than returning the child to school.

Treatment of paranoid depressives and depressive school phobic children.

Treatment of paranoid depressives and depressive school phobic children.

EKG Effects of Imipramine Treatment in Children

Their are increasing reports of serious side effects in children with clinical use of imipramine in high doses. Our analysis of the EKG effects of imipramine in 25 hyperactive and 8 school phobic children suggests that children on a dose of imipramine of 3.5 mg/kg or more are likely to show an increase in PR interval of .02 seconds or more and that such increases are more likely to occur in patients with a small pretreatment PR interval. In 7 children the PR interval prolongation was above the rate-corrected norm. EKG monitoring seems desirable in children maintained on imipramine dose of 3.5 mg/kg or more.

EKG Effects of Imipramine Treatment in Children

There are increasing reports of serious side effects in children with clinical use of imipramine in high doses. Our analysis of the EKG effects of imipramine in 25 hyperactive and 8 school phobic children suggests that children on a dose of imipramine of 3.5 mg/kg or more are likely to show an increase in PR interval of .02 seconds or more and that such increases are more likely to occur in patients with a small pretreatment PR interval. In 7 children the PR interval prolongation was above the rate-corrected norm. EKG monitoring seems desirable in children maintained on imipramine dose of 3.5 mg/kg or more.

The use of natural consequences and a make-up period to eliminate school phobic behavior: A case study

The school-phobic behavior of a seven-year-old male was modified through implementing a program characterized by maximum parental involvement, restructing of natural consequences, and the use of a make-up period. Full-time school attendance was achieved on the sixteenth day of the program. The advantages of using school personnel as monitors and not as disciplinarians of the school-phobic child's behavior are discussed.

School phobia in the children of agoraphobic women.

As part of a survey of agoraphobic women in the general population, it was found that school phobia occurred in their children to a greater extent than would be expected. The average incidence in children aged 11 to 15 was 14 per cent. The women with school phobic children had had school phobia themselves to an undue extent.

Pharmacotherapy and Management of Pathological Separation Anxiety

In the history of child psychiatry, pharmacological intervention has followed practice established with adults. This approach is eminently rational because of the reluctance to administer to developing organisms compounds whose effects are not well known in mature humans. Thus, after antipsychotic, antidepressant, and stimulant drugs were found to have valuable properties in adults, they were tried among similar, child, clinical groups. Though the use of imipramine in school-phobic children followed its use in agoraphobic adults (Klein, 1964; Klein & Fink, 1962), its first application was derived from inferences regarding relationships of psychopathology rather than from strict, therapeutic empiricism. The syndrome of agoraphobia was clearly identified long ago, but until recently had received relatively little clinical attention. Agoraphobic adults experience sudden, unexplained, panic attacks and are unable to travel independently. They are typically women. One, Freudian theory posits that the symptoms are due to an unconscious, anxiety-provoking, prostitution wish: the women's phobic avoidance of the outside world prevents the activation of an incompletely repressed wish to be a streetwalker. Fortuitously, Klein discovered that imipramine blocked agoraphobes' apparently spontaneous panic attacks. Double-blind, placebo-controlled studies confirmed this clinical finding (Klein, 1964). Applying an ethological concept to the panic anxiety of agoraphobes, Klein postulated that these patients suffered from a disruption of a normal biological process responsible for the regulation of anxiety triggered by separation. This notion was stimulated by the observation that a large proportion of the patients had a childhood history of severe separation anxiety and that their

Sulpiride in school phobia.

Sulpiride was administered to 21 children with school phobia. All had shown some depressive symptoms in addition and had been treated by nonpharmacological measures. 13 of them returned to school within a few days and depressive symptoms disappeared eventually (the recovered group). In 3, behaviour at home returned to their premorbid status, but school refusal persisted (the improved group). In the remaining 5, no improvement was observed. In comparison to the present writer's previous experience with imipramine and benzodiazepines, the response to sulpiride in school-phobic children is more rapid and remarkable.