Is your teenager playing sick to get out of going to school? Are they avoiding school more often? If the answer to these questions is yes, your teen might be experiencing school phobia. At Key Healthcare, we provide teen school refusal treatment in Los Angeles. Our team develops comprehensive, individualized treatment plans to ensure your teen is back on track in no time. During treatment, teens will attend individual, group, and family therapy to address all issues related to their condition.
What parents fear more when their teens refuse to go to school is their future. As a parent or guardian, getting help for our teen’s school phobia becomes the top of our priority list. This article further guides you on school phobia, its causes and symptoms, and how to get treatment for your teen.
Understanding High School Phobia
What is school phobia? School phobia may be described as another anxiety issue in teens who fear attending school. They are reluctant to go to school, and the thought of being in school causes them anxiety or distress. It is also known as scolionophobia and affects about 2-5% of school-going kids. School phobia is not as black and white as it may seem. It is a complex syndrome that is influenced by various factors. It is affected by temperament, environmental factors, family situations, and other mental health conditions.
Demographics of School Phobia
According to the Anxiety Disorders Association of America, school phobia affects about 2-5% of all school-going kids.
On average, it presents in kids from 7 years old and affects both boys and girls equally.
The study by the Anxiety Disorders Association of America also showed that 52% of girls participating in the study were more likely to develop school phobia as they entered their pre-pubescent years.
Among the different age sets, school phobia affects 11 to 14-year-olds the most.
Common Symptoms and Behaviors Associated With School Phobia
Your teen may exhibit many symptoms if they have school phobia. These include the following:
- Diarrhea
- Headaches
- Nightmares
- Sweating
- Shaking and tremors
- Vomiting
- Nausea
- Clinginess to you or their caregiver
- Stomachaches
- Going to school only after crying
- Leaving school early and hiding
- Preoccupation with safety at school
- Psychological distress after arriving at school or school-related anxiety
If your teen exhibits any of the symptoms listed, it may be time to seek professional help.
Causes and Triggers of High School Phobia
Your teen may have school phobia due to various factors. The following are some causes of school phobia in teens:
Social Anxiety Disorder
School phobia is not a mental health problem in itself but is associated with social anxiety disorder. It is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it is considered a symptom of anxiety disorder.
Teens with anxiety disorders find it overwhelming to interact with others socially because they feel awkward, unsafe, and out of place. According to research, approximately 40% of high school teens suffer from varying levels of anxiety.
Bullying
Your teen might be refusing to attend school because of bullying. Bullying is one of the most common causes of school phobia, with statistics showing that about 160000 teens skip school because they fear being bullied. This number is concerning because it represents many high school-going teenagers. According to the National Center for Education Statistics, 22% of teens have reported being bullied at least once in school.
Family Issues
Another cause of school phobia is family issues. Family issues may range from
- Divorce
- Financial Instability
- Conflict
- Inadequate Housing
- Food Insecurity
Your teen may not want to attend school because they feel prejudiced because of their family situation. It is not uncommon for teens to be shunned because their parents are going through a divorce or to be looked down upon because of financial instability. To avoid these negative experiences, your teen may avoid school altogether.
Academic Distress
Your teen may be avoiding school because of academic distress. Unfinished assignments and daunting projects are some of the leading reasons why your teen may not want to attend school. As teens grow, the burden placed on them academically also grows. They have much more to do, and this can cause them distress. As a parent or caregiver, you must help your teen with academics to ensure they do not develop academic phobia. You may seek the services of a tutor to help your teen in areas they are struggling with.
Sexual Harassment
Apart from bullying, another major cause of school phobia is sexual harassment. According to a study conducted by the American Association of University Women, data collected showed that 48% of students reported having been sexually harassed or assaulted at least once. The perpetrators of these acts of violence are usually their peers, and this can cause your teen to develop school phobia. According to the same study, 87% of the victims reported negative effects from sexual harassment. Concerning school phobia, a third of the victims reported not wanting to go to school anymore because of the sexual harassment.
Sexual harassment is a serious issue which can carry legal consequences. Ascertaining the cause of school phobia among teens is important to ensure your teen’s safety.
Conflict with Friends and Social Rejection
Social rejection and conflict with friends can be a huge issue for teenagers. The fear of rejection is more intense in teenagers since they want to fit in. If your teenager faces social rejection at school, they may develop school phobia. Some studies suggest that social rejection is processed similarly to physical pain. Social rejection has grown a lot through social media and cancel culture. Many teens are crippled by the thought of being ‘canceled’ and would rather avoid school altogether if they feel socially rejected.
Mental Health Issues
If your teen struggles with depression, anxiety, Post-Traumatic Stress Disorder (PTSD), and other mental health conditions, they may develop school phobia. Teens with depression may avoid school since they want to be alone to deal with their mental health issues.
Adolescent PTSD is also a common trigger for high school anxiety. It may be caused by events that took place within the school or perpetrated by their peers. Teens struggling with PTSD want to avoid the triggering events and would rather stay away from school.
Impact of High School Phobia on Teens
High school phobia can negatively affect your teen’s life. These effects include academic, social, economic, and physical effects. The following are some of the impacts of school phobia on your teen’s life:
- Strained social connections. When your teen develops high school phobia, they will likely lose emotional connections to their peers. School phobia negatively affects your teen’s ability to build and maintain friendships, impacting their social life. Long absences from school occasioned by school phobia and the fragility of teen friendships likely contribute to the breakdown of your teen’s interpersonal relationships.
- Academic underperformance. Teens with school phobia may miss a considerable number of hours of school. This means they learn less than their peers and are likelier to underperform in tests and exams.
- Deteriorated physical and mental well-being. Your teen may have exhibited physical symptoms if they suffer from school phobia. These symptoms include
- Stomach aches
- Headaches
- Vomiting
- Sweating
- Nausea
If these symptoms persist, they can negatively affect your teen’s overall well-being.
Diagnosis and Assessment of High School Phobia
School refusal is not listed as a condition under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This means there are no standard diagnostic criteria since it is closely associated with other anxiety disorders. However, a genuine phobia can be diagnosed by assessing several factors to ascertain its root cause.
When diagnosing school phobia, a health provider may ask your teen some of the following questions during a diagnostic interview:
- What symptoms does your teen experience?
- When do the symptoms appear?
- How long do the symptoms last?
- What specific events trigger the onset of the symptoms?
- What helps the symptoms go away?
- What makes your teen afraid of school?
- Your teen’s medical history.
Effective High School Phobia Treatment Options
If your teen has scolionophobia, you may need to seek professional help. At Key Healthcare, we offer a wide range of services for teens with mental health issues in LA . We use several evidence-based treatment options coupled with holistic approaches to ensure effective treatment of your teen’s mental health issues.
Our services include the Teen Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP) for young adults, and Teen Residential Treatment Center (RTC). These services are tailored to your teen’s needs and vary depending on the severity of your teen’s mental health issues.
If your teen has a school phobia, we may employ the use of the following forms of therapy:
Cognitive Behavioral Therapy (CBT)
Teen CBT is an evidence-based psychotherapy treatment developed to help teens identify and change negative behavioral patterns. It is an effective tool for treating various mental health conditions such as anxiety, depression, and Post-Traumatic Stress Disorder, among others. CBT is based on the idea that feelings, thoughts, and behaviors are connected. If your teen can control or change one aspect of their life, it will affect the others.
CBT for school phobia can help your teen identify why they fear going to school and work to change that thought. When using cognitive behavior therapy techniques, teens identify maladaptive or destructive behavioral patterns, hence can focus on appropriate emotional responses to that fear.
How CBT for Teens Works
CBT uses its structure to help teens change negative behavioral patterns. It involves a hands-on approach from the therapist who helps your teen set attainable goals at the beginning of a session. When these goals are reached, your teen will be rewarded for achieving them. CBT may involve a lot of homework assignments, which are assessed at the beginning of the next session. Goal-setting and positive reinforcement help your teen’s brain associate positive behavioral patterns with a reward, making them more likely to maintain positivity.
Techniques and Strategies Used in CBT
CBT utilizes several techniques to help your teen overcome school phobia. These techniques include the following:
- Cognitive restructuring. This is the first step of CBT. It involves helping your teen identify negative thought patterns.
- Guided discovery. It is a technique used in CBT where your teen is guided toward a divergent viewpoint. They are guided from a perspective that suggests school is a scary place to a point where they are reassured that school is safe and they should not fear it.
- Journaling. During CBT, your teen will be asked to journal their feelings. Writing down how they feel acts as an outlet for negative emotions.
- Behavioral experiments. Behavioral experiments in CBT are used to help your teen alleviate their anxiety. Your teen may be asked to predict the outcome of a scenario that would normally make them anxious. If their prediction were catastrophic, their worry would be alleviated when they see it was wrong.
- Relaxation and stress management. CBT utilizes deep breathing exercises, imagery, and relaxation techniques to help your teen alleviate their anxiety about school.
Exposure Therapy
Exposure therapy can be an effective tool for treating your teen’s school phobia. It involves systematic techniques that gradually expose your teen to situations that make them anxious. The goal of exposure therapy is to simulate a distressing activity in a safe and secure environment. When done right, your teen’s school phobia will reduce, and their quality of life will increase.
An example of exposure therapy is showing your teen images or videos of their school environment to see how they react. Your teen will be coached to ensure they do not respond adversely to the stimulus. These gradual exposure techniques can reduce your teen’s anxiety.
Types of Exposure Therapy
Exposure therapy can be done in several ways. These include the following:
- In vivo exposure. This exposure therapy will expose your teen to what they fear about school. It is done gradually to ensure no adverse effects. At first, the therapist will ask your teen to imagine a situation that causes them distress. Your teen will always be guided through the process to make them feel safe and comfortable. Once imagery is finished, it may graduate to images, videos, and the real thing.
- Applied muscle tension. This type of exposure therapy is similar to in vivo exposure. The therapist will ask your teen to imagine a scary situation while tensing their muscles up. This prevents fainting. Tensed muscles elevate blood pressure and make the scary feeling more intense.
- Virtual reality exposure. VR exposure is done through the use of technology to simulate real-world events. It allows your teen to interact with the stimuli more effectively and have control over the situation.
- Systematic desensitization. This type of exposure therapy involves facing the stimuli, followed by relaxation techniques. It teaches your teen how to calm themselves down when faced with anxiety-inducing situations.
Exposure therapy is effective in treating a variety of conditions, including the following:
- Phobias, including school phobia
- Social anxiety disorder
- Panic disorders
- PTSD
- Obsessive Compulsive Disorder (OCD)
- General anxiety
Alternative Therapeutic Approaches
Key Healthcare offers the following alternative therapeutic approaches for teens with school phobia:
Art Therapy
Imagine your teen being able to control their anxiety and negative emotions through painting or sculpting. Art therapy can be beneficial in stress reduction and emotional regulation, useful skills for teens with school phobia. Art therapy for teens uses art as an outlet for complicated emotions such as anxiety. At Key Healthcare, your teen may engage in art during individual or group sessions where a therapist will guide them on various activities. Your teen will learn painting, sketching, doodling, sculpting, and collage-making to help them release negative emotions. They will also engage in art analysis, where they can express how a specific piece of art makes them feel.
Art therapy can be beneficial in increasing self-expression, improving coping mechanisms, identity exploration, and stress reduction.
Music Therapy
Music has been used as a tool to alleviate anxiety for millennia. When combined with evidence-based therapy approaches, music therapy can be beneficial in helping teens overcome their fears. Your teen will acquire skills like music production, songwriting, and playing instruments.
During teen music therapy at Key Healthcare, your teen will be guided to let go of negative emotions and flow with the beat of the music. A curated treatment plan will assess your teen’s musical taste to ensure the music curated for them reduces their anxiety. Music therapy can benefit teens with school phobia as it helps them regulate their emotions, improves their communication skills, reduces stress, and encourages self-expression.
Surf Therapy
A closed setting may not always be the best option for teens with school phobia. Surf or ocean therapy is an approach developed for teens who have trouble regulating stress, anxiety, or PTSD. If your teen’s school phobia is caused by anxiety or PTSD, they may benefit from surf therapy.
During teen surf therapy, our surf therapist, Chanelle Catuogno, will guide your teen to hit the waves and control their emotions. Surfing is fun but requires a lot of focus and concentration. Teens who engage in surf therapy have reported feeling happier after each session and are ready to face any challenge.
Surf therapy is beneficial for teens with school phobia since it increases self-sufficiency, improves social skills, develops mindfulness, and reduces anxiety.
Medication as an Adjunct
Pharmacological interventions combined with CBT have been proven to be effective in treating school phobia. Since school phobia is considered a symptom of an underlying mental health condition, your teen may be prescribed different medications depending on the root cause of the phobia. Commonly prescribed medicines for school phobia include the following:
Selective Serotonin Reuptake Inhibitors (SSRIs) – If the underlying cause of your teen’s school phobia is depression, SSRIs are the best option. They are antidepressants for teens and reduce serotonin reuptake in the bloodstream and make your teen happier for longer. However, SSRIs may worsen depression symptoms.
Propranolol – This medication is prescribed to mask anxiety symptoms. It may be beneficial for your teen if the cause of their school phobia is anxiety. It reduces symptoms like sweating and heart racing. Neuroleptics can also be used in cases where the cause of school phobia is separation anxiety.
Support Systems and Collaborative Approaches
A strong support system can differentiate between successful recovery and rejection of school refusal treatment. As a parent or caregiver, you should recognize the importance of parental support in school phobia treatment. Caregiver involvement helps your teen feel loved, secure, and willing to receive treatment. Your teen feels supported through the journey to recovery.
The Role of Parents and Caregivers
As a parent or caregiver, your involvement in your teen’s treatment is paramount. It is important for your teen to have at least one adult they can trust with them as they receive school phobia treatment. You can get involved in your child’s treatment in the following ways:
- Make an effort to understand the reasons why they refuse to go to school. Teens are more likely to accept help when they feel understood. As a parent or caregiver, you need to make an effort to understand your teen’s point of view. They are not refusing to attend school for no reason. Chat with them about the issue in an understanding and empathetic way to ensure they are open. Use open-ended questions to gather as much information as possible and actively listen to their plight.
- Be supportive and reassuring. When your teen is undergoing treatment, be supportive and reassure them. Tell them how much you love them and support their decision to receive treatment or to face their fear of school.
- Setting clear boundaries. As a parent or guardian, you need to tell your teen that staying at home is not an option. Be firm with this decision to ensure your teen understands the importance of attending school. Be empathetic with them but reinforce the decision to ensure they attend school.
- Slowly work your child up to going back to school. Expecting your teen to attend school for a full day may be unrealistic as they exhibit school phobia symptoms. Try the scaffolding approach, where you slowly reintroduce them to the school. This can be important for teens whose school phobia is caused by bullying, sexual harassment, or PTSD.
- Communicate with teachers and the school about the issue. It would help if you communicated with the school about the issue to prevent stigmatization of your child. Effective communication will also allow teachers to adjust and treat your child with the necessary care. The school may also make special accommodations for them when you communicate the severity of the issue with the school.
Peer Support Programs and Initiatives
Peer support programs and support groups are important in helping teens with school phobia overcome their fear. Support groups are comprised of teens experiencing the same situations as your teen. A support group will help your teen feel seen, understood, and less lonely. They can learn how others cope with school phobia and what changes they can make to conquer their fear.
Support groups also provide a social connection or safety net. Support groups are designed to promote inclusion and acceptance to allow teens to feel safe and supported by the group. They also offer supportive friendships that can be relied on during the worst times.
School Collaboration and Accommodations
A collaboration between parents, teachers, and therapists creates an opportunity for early detection and treatment of anxiety disorders and, by extension, school phobia. Parents can report any signs of school phobia to teachers or school psychologists so that they can intervene when appropriate. If your teen has scolionophobia, it is important to get as much help as you can get.
Schools can be at the forefront of helping teens with school phobia by providing academic accommodations such as 504 accommodations or Individualized Education Plans (IEP). It can be difficult to persuade the school to provide IEP for your teen, but with strong advocacy, schools can make necessary accommodations to cater to teens with scolionophobia.
Alternative Education Options
If your teen has severe school phobia, you can explore alternative educational options like homeschooling or online schooling. Due to the COVID-19 pandemic, schools were able to embrace technology in the learning process. Now, teens can join classes at home to avoid missing important information. If the school you have enrolled your teen in allows for online classes, you can opt for this learning model as your teen receives treatment.
Another alternative is homeschooling. It is a more complex model as it requires you or another adult to take full-time responsibility for teaching your teen at home. It also requires different reporting standards depending on the State in which you live.
Homeschooling has its advantages and disadvantages. The pros of homeschooling include:
- It protects your teen from dangerous situations such as bullying or sexual harassment.
- It allows your teen to focus on studying rather than actively avoiding school.
- It relieves the stress of going to school.
- Fosters a strong relationship between you and your teen.
- Prioritizes your teen’s mental health.
- Prioritizes your teen’s current needs.
However, homeschooling has its disadvantages. Disadvantages of homeschooling include the following:
- Homeschooling reinforces avoidance behavior.
- Due to other commitments such as work, parents may be ineffective homeschoolers.
- Due to the lack of a homeschool curriculum and varying reporting standards by State, teens may learn very little from homeschooling.
Conclusion
School phobia can be caused by a variety of factors. These factors include family issues, bullying, sexual harassment, PTSD, and other mental health issues. As parents or caregivers, you should seek help if your teen gets anxious about going to school. Try to ascertain the root cause of the issue to determine the appropriate intervention strategy. You are responsible for ensuring your teen receives professional help to reduce the impact of school phobia on their lives.
Frequently Asked Questions
Program length depends on your teen’s needs and rate of recovery. Typically, programs run for 12-20 weeks but may continue for up to 6 months.
The most common challenges teens face after returning to school include stigmatization, trouble fitting in, and catching up in academics.
