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School Phobia - School Refusal Treatment, Not Wanting to Go To School

Abstract: School phobia is an anxiety disorder. Children refuse to go to school basically because of fears (fear of seperation, generalised fears) or depression. Refusal to go to school can be trated by a combination of psychotherapy, educational counseling and medication.

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School Phobia - School Refusal Treatment, Not Wanting to Go To School

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Question(s): 
Written by: Dr. Martin Winkler
First version: 22 Jul 2008.
Latest revision: 01 Aug 2008.

What should I do with children not wanting to go to school, give advice om school refusal treatment.

Answer:

When children or adolescents do not want to go to school, this may have various reasons. The 20th conference of the American Anxiety Disorder Association suggests a combined treatment.

Children who refuse to go to school often are diagnosed with anxiety disorders like the so called fear of seperation, depression or the combination of both disorders. This may require educational counseling, cognitive orientated psychotherapy and/or medication.

Medication is not applied at the beginning of the therapy. Only when psychotherapy turns out to not be sufficient, or the children don't go to school during a long period, medicational treatment with antidepressants should be considered.

For children with severe generalised fears or fear of seperation respectively depression, so called SSRIs (=Selective serotonin reuptake inhibitors) could be an option. But recently these medicaments have been very disputed. They are not accredited as a treatment for school phobia, but under professional control and included in a combined psychotherapy and educational counseling/family therapy they can be an effective help. Benzodiazepine or other medicines that relieve anxiety (that are used to some extent for adults) should not be applied on children.

The participation and cooperation of the parents is of course inalienable, which is a big challenge for the family. If everybody (children, parents and school) works together, the children with these disorders can be helped effectively.

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