Combating school phobia: understanding, identifying and providing support

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School phobia, also known as anxious school refusal, is a reality for many children and teenagers. In many countries, it is estimated to affect 1 to 2% of pupils aged 3 to 18. In France, only the rate of absenteeism is recorded. However, absenteeism encompasses many different realities: school refusal, truancy, expulsion, withdrawal by parents, etc. The Phobie Scolaire association reports that its membership has doubled since the Covid-19 episode.

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School phobia, that intense fear of going to school, is undoubtedly underestimated. It's not simply a whim or a lack of motivation: it's a deep-seated, often uncontrollable anxiety that can lead to partial or total withdrawal from school. And the consequences go far beyond repeated absences: isolation, loss of self-confidence, impact on family life and difficulties reintegrating an educational setting.

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Behind this suffering, there are many causes: separation anxiety, bullying, academic pressure, fear of judgment... Each child experiences this situation differently, making support complex, but essential.

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How can you identify the signs of school phobia? What are its causes and manifestations? And above all, what solutions exist to help children and teenagers overcome this fear and return to school with serenity? In 2023, a team of Inserm researchers led by Laelia Benoit, a child psychiatrist and sociologist at the Centre de recherche en épidémiologie et santé des populations (CESP) in Villejuif, France, published the results of a qualitative study on the subject, conducted among children, teenagers and their parents during the Covid-19 pandemic.

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What is school phobia?

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School phobia, or anxious school refusal, is characterized by a deep, uncontrollable fear of going to school. It's not a simple lack of motivation, nor a deliberate refusal to go to class, but a psychological suffering. The child or teenager concerned often wants to learn, but finds himself paralyzed by an anxiety that makes any presence in the school environment unbearable.

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A fear that goes beyond simple apprehension

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All children can experience stress at school, whether it's at the start of the school year, before an assessment or in the face of relationship difficulties. But in the case of school phobia, the anxiety is persistent and pervasive. It can lead to :

• anxiety attacks as school starts (crying, trembling, abdominal pain, nausea);
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• recurrent physical complaints (headaches, extreme fatigue, palpitations) with no identifiable medical cause;
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• systematic avoidance of school situations, sometimes to the point of dropping out altogether.

A reference tool, the French Classification of Mental Disorders of Children and Adolescents (CFTMEA) gave the following definition in 2012: "manifestation of major anxiety with often panic phenomenon related to school attendance and prohibiting its continuation in the usual forms."
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School phobia vs. truancy: a common confusion

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While school phobia may have been noted as early as the end of the XIXᵉ century, following the introduction of compulsory primary education from age 6 to 13 in 1882, it wasn't defined in the Journal Officiel until 2011. For many years, a pupil's frequent absenteeism was tantamount to truancy: "he skips school".

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It's essential not to confuse school phobia with voluntary absenteeism. A teenager who skips classes to hang out with friends or avoid a subject he or she doesn't like is doing so by choice. They don't usually show intense stress or physical symptoms when they talk about school.

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Conversely, a child suffering from school phobia often wants to be able to return to class, but the anxiety is so great that he or she is unable to do so. The very idea of walking through the school gates can trigger an uncontrollable panic reaction, with attacks sometimes comparable to those of severe anxiety disorders.

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If left untreated, school phobia causes constant distress, even if the child stays at home: the pupil knows that sooner or later he or she will have to go back to school. Even during the school vacations, an anxious child who refuses to go to school remains in distress.

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Recognizing school phobia is the first step towards providing appropriate support, to avoid a spiral of school dropout and isolation.

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Possible causes of school phobia

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School phobia is a complex phenomenon. Multifactorial, it does not necessarily have the same cause for each child concerned. Understanding these causes enables us to put in place appropriate support and treatment strategies.

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In this article published on the Inserm website in connection with the above-mentioned study, Laelia Benoit mentions the following recurring situations:

• In primary school, the pupil is absent either because of somatic symptoms, or because of a rare or chronic medical problem. Usually, the child manages to return to school in a "normal" way after two years of follow-up.
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• Middle and high school students confronted with an anxious refusal to attend school report depressive disorders, social phobia, gender identity issues and a difficult school environment. While some of them manage to slowly recover thanks to intensive support, others see their situation deteriorate, sometimes to the point of dropping out of school altogether. 

In the same study, almost half of the 1,328 students who refused to attend school had been victims of harassment, insults or threats. It is also the awareness of differences, whether identified or not, that sometimes leads to this school phobia: disability, precociousness, learning difficulties, autism spectrum disorders...

However, Nicolas Gauvrit, author of the Psy comic Dans la tête des HPI, published by Les Arènes, would explain that a high-potential child is no more likely than any other to be bullied, to suffer from school phobia, to be depressed, and so on. On the other hand, Antoine Olivier, teacher and educational consultant, stresses that the role of school in triggering anxious school refusal in high-potential pupils is often underestimated.

The fact is, the education system doesn't necessarily meet children's needs, and while some children can live with it, not all of them can. If a child doesn't like it, he or she may reject schooling, especially traditional schooling.
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Individual factors that can lead to school phobia

Without being exhaustive, here are a few anxieties noted in patients, schoolchildren, college students or high school students suffering from school phobia:
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• Separation anxiety is an excessive fear of being far from home or parents. Often seen in young children, it can also affect middle-schoolers.
  
  
• Performance anxiety is the intense fear of failure or of not living up to expectations. It can lead to excessive pressure being exerted on the pupil, even if the parents don't exert any. It is, of course, exacerbated if parents place enormous importance on grades. Continuous assessment linked to the bac reform in 2020 and the way files are selected on Parcoursup keep this pressure constant for many months.
  
  
• Anticipatory anxiety manifests itself as unspeakable anguish when we have to project ourselves into an uncertain future. It can be combined with performance anxiety. It is exacerbated by the fact that students have to choose their final orientation (option choice) earlier and earlier. They are afraid of not being able to branch out.
  
  
• Social anxiety coincides with fear of social interaction or peer judgment. It makes it difficult to participate in class or integrate into groups.
  
  
• Undiagnosed learning disorders (dyslexia, ADHD...), as mentioned by Aurélie Harf in this episode of the podcast Les Adultes de Demain, who refers to school phobia as the burn-out of young people, can lead to increased frustration and anxiety in the face of academic demands.

The MSD Manual Manual also points to a history of anxiety or depressive disorders, i.e. a personal predisposition to anxiety or depression, as increasing the risk of developing school phobia. Other sources also mention the child's temperament: shy, introverted children are more likely to suffer from school refusal.
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External factors causing school phobia

The triggering of a school phobia results from the interaction of multiple factors, some linked to the individual, others in connection with his or her environment. Thus, the following phenomena can contribute to triggering school refusal:
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• School bullying: repeated experiences of bullying or violence at school can lead to intense fear of returning to the classroom.
  
  
• Major changes: events such as moving house, changing schools or family upheavals (divorce, death) that can destabilize the child, as described in this article published on Santé Publique France.
  
  
• Academic pressure: as we saw earlier, high expectations on the part of parents and/or the school can accentuate performance anxiety in the student.
  
  
• A tense family climate: family conflicts or a lack of emotional support can exacerbate school-related stress.
  
  
• Exposure to toxic social interactions: whether in person or online, harmful relationships can contribute to the development of depression, more common in adolescence, and school phobia. The advent of social networking has only accentuated this phenomenon.

The combination of these factors varies according to each individual. It requires a personalized approach to identify the specific causes and propose appropriate care and schooling arrangements.
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Identifying the signs of school phobia

School phobia is not always obvious. Unlike simple apprehension or the occasional urge to stay at home, it often expresses itself through physical and emotional symptoms that can fool parents and teachers alike. A child suffering from school phobia doesn't choose to avoid school out of pleasure, but out of a real inability to cope.
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Physical symptoms: the body speaks

One of the first signs of school phobia is the appearance of somatic complaints, which mainly occur on school days and may disappear at weekends or during the vacations. These symptoms include

• recurrent stomach aches, which can feel like cramps;
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• persistent headaches with no identifiable medical cause;
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• anxiety-related nausea or vomiting, often on waking;
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• intense fatigue frequently associated with sleep disorders;
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• palpitations, cold sweats, tetany attacks, signs of latent anxiety attacks.

These symptoms are frequently interpreted as temporary illnesses, but when they recur regularly for no apparent medical reason, they can be a signal of deep-rooted school-related stress.

On the Internet, in books, you'll find testimonials on the subject of anxious school refusal. The physical pain is real, and is sometimes associated with a real pathology, which may be benign. Above all, it is amplified by the psychic pain.
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Emotional symptoms: invisible distress

A child or teenager with a school phobia expresses great psychological suffering, which can take different forms:

• anxiety attacks, uncontrollable crying, inability to move (tetany), absence (the child isolates himself as if in a bubble) at the thought of having to go to class;
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• increased irritability, refusal to talk about school or anger at discussions about it;
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• sleep disorders, including difficulty falling asleep or school-related nightmares;
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• depressive manifestations, loss of interest in usual activities and isolation;
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• a feeling of inferiority, an excessive fear of failing or being judged.

These signals are all the more worrying in that they can develop into childhood or adolescent depression if the situation persists without care.
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Escape behavior: a categorical refusal of school

A child suffering from school phobia uses avoidance strategies, sometimes subtle, to avoid going to school:

• He multiplies the excuses for staying home ("I'm too tired", "I have a stomachache", "I have a migraine").
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• He constantly negotiates with parents to avoid school, with attempts at compromise ("I'm going tomorrow, but not today").
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• He feels bad in class and ends up in the infirmary, school life, etc., triggering the call to parents.
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• He gradually isolates himself, refuses to see his classmates outside of school.
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• He displays excessive dependence on his parents, and is anxious about being separated from them.
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• He suddenly refuses to go to school, following a period of latent anxiety.
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How can you tell school phobia from a simple refusal to go to class?

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A child who shows no interest in school will take advantage of his free time to be active and seek out leisure activities. 

On the other hand, a child with a school phobia is generally suffering, withdrawn into himself. Of course, he's relieved not to have to go to class, but his malaise hasn't disappeared. He's not satisfied with this situation. 

On the other hand, just because a child or teenager can't make it to class doesn't mean they can't make it to sports training. It all depends on the cause of the anxious school refusal.

If he suffers from performance anxiety linked to school, playing soccer will not be a problem and will even do him good. Such a situation can leave parents distraught and distort the analysis of the problem. In the case of social anxiety, the situation is different: any activity requiring social interaction may prove difficult.
 

The importance of a professional diagnosis

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Anxious school refusal is a complex disorder that cannot be resolved simply by forcing the child to return to school. Appropriate treatment begins with a professional diagnosis. This will enable us to identify the underlying causes and adopt the best strategy for supporting the child and his family.
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When should you consult a professional?

If you recognize your child's symptoms in those described above, consult a health professional (doctor, psychologist, child psychiatrist) as soon as possible to make a diagnosis. Don't hesitate to contact the school medical service, if the school has one. Staff are increasingly trained to detect and support children suffering from school phobia. 

Anxious school refusal is a distress that requires specific support. Once the diagnosis has been made, if you haven't already done so, alert the school so that educational adjustments can be made. 

It's important not to trivialize the symptoms, to say "he'll get over it", or to force him to the point of damaging his physical and mental health. If treatment takes too long, the child risks dropping out of school. 

Spotting these signs early enables effective action to be taken. It's better to be sure of a diagnosis, even if you're wrong, than to let a situation get bogged down. School phobia is not inevitable: with the right treatment, children can regain their self-confidence and gradually re-engage with school.
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Which specialists to meet?

When faced with an anxious school refusal, it's important not to be left alone, and to surround yourself with competent professionals, both for the child and for the parents. Specialists who can help include : 

• psychologists specializing in childhood and adolescence: they help identify the emotional and cognitive factors linked to school anxiety;
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• child psychiatrists: in cases of severe anxiety disorders, they can make a clinical diagnosis and offer therapeutic support, sometimes in conjunction with appropriate treatments;
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• guidance counselors or specialized teachers: they can suggest pedagogical adaptations and help families implement alternative solutions.

The school doctor may be able to help you set up an adapted timetable within the framework of a PAI (individualized reception project). Your child may also benefit from specific arrangements for exams such as the brevet or baccalauréat (third time, special technical, material or human conditions, etc.).
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In-depth assessment for personalized care

Every child is unique, and the causes of school phobia may vary. A thorough assessment helps to :

• identify triggering factors, with the help, among others, of assessments (psychometric, personality...) ;
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• measure theintensity of anxiety and its impact on daily life;
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• establish an individualized support plan, with therapeutic follow-up, school accommodations and family adjustments if necessary.
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The earlier a diagnosis is made, the more effective support can be put in place and lasting school dropout avoided.
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Support strategies for parents and teachers

A child suffering from school phobia needs first and foremostan understanding and reassuring environment, both at home and at school. The aim is not to force them back into the classroom at all costs, but to help them rediscover a calmer relationship with learning and the school environment.
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Recommendations for parents

• Offer active listening, understanding and benevolence
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  The child needs to feel that his fears are heard and taken seriously. Encouraging him to express his anxiety without minimizing his emotions is essential. Saying "There's nothing to be afraid of" or "You've got to go like everyone else" can be counterproductive. Conversely, an approach such as "I can see that school is stressing you out a lot. Can you tell me what you're most afraid of?" can open up a dialogue and help you find solutions together.
  
  
• To offer psychological support
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  Follow-up with a psychologist or child psychiatrist is generally necessary to work on anxiety and develop appropriate strategies. Some approaches, such as cognitive-behavioral therapy (CBT), work well in helping children modify their negative thoughts about school and gradually regain confidence.
  
  
• To maintain a reassuring routine
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  Even in the event of temporary non-schooling, it is advisable to preserve a stable daily structure. Regular schedules for getting up, eating, activities and sleeping enable the child to maintain landmarks. It also prevents disorganization, which would make returning to school even more difficult.
  
  
• To collaborate with the school
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  A constant dialogue with teachers and management allows you to find solutions adapted to the child's specific situation, such as :
  
  • adaptation of the timetable (gradual return, half-days);
  • implementing strategies to make the child feel secure on arrival and during the day;
  • the drastic reduction of sources of stress (imposed oral exposures, evaluations... he'll come back to this in due course).
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Tips for teachers

Although class sizes generally make it difficult to adapt precisely to each student's needs, the ideal is :
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• Creating a caring and secure environment
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  Children suffering from school phobia often dread the judgment of others. A welcoming, inclusive classroom atmosphere, with awareness of the needs of anxious students, can help allay their fears.
  
  
• Adapting academic expectations
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  Some children need alternative assessment modalities (oral instead of written, adapted checks (e.g.: succeeding in handing in 1 exercise out of 3, without being graded, then with only the successful exercise graded, etc.)) so as not to be paralyzed by performance anxiety. The priority is to encourage progress without increasing pressure.
  
  
• Train educational staff
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  Training in school anxiety management and support strategies could help teachers better understand these students and intervene appropriately. It would also enable them to recognize the signs of school phobia and know how to react, not only in the organization of school time, but also in the dialogue with parents and the child.
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At académie level, there is not necessarily a specific referent for school phobia. On the other hand, there are people who specialize in learning disabilities, precociousness, autism spectrum disorders and the fight against dropping out of school.
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Possible adjustments to facilitate the return to school

There is no single answer, whether in terms of the care provided by healthcare professionals or the arrangements that can be made to maintain links with school. Solutions must be adapted to the pace and needs of each child. A gradual, supervised return to school is often preferable to a sudden resumption, which is rarely effective.
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You may consider, after discussion with your child, health professionals, or even the educational team, the use of :
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• From alternative
  Some approaches, such asMontessori and, more generally, active pedagogies, can better meet the needs of children suffering from school anxiety. The emphasis on autonomy, respect for individual rhythm and absence of competition can be more reassuring than a conventional school system.
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At our bilingual Esclaibes International Schools, our teaching teams pay particular attention to student well-being," explains co-founder Marie Robert. In fact, well-being is one of the pillars of the schools' pedagogical project, combined with an active teaching approach. Our teachers create a reassuring, stimulating and caring environment. Our schools place self-fulfilment and self-confidence at the heart of their educational project. They aim for personalized student follow-up, made possible thanks to the tools used and small class sizes, in order to meet the specific needs of each child."
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• A lighter schedule
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  A return to part-time schooling (a few hours a day or some days a week) can help the child gently regain confidence. The aim is to avoid a total rejection of school by gradually exposing the child to this environment.
  
  
• Temporary distance schooling
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  In some cases, home instruction (IEF) or support via online educational platforms can be a transitional solution. This enables the child to maintain a link with learning while reducing the anxiety associated with physical presence in the classroom. It is also possible to combine a face-to-face timetable at the school for certain subjects with distance learning for other areas of learning.
  
  
• Specific support at
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  If the child returns to the classroom, it may be useful to set up specific facilities :
  
  • a school referent (teacher or psychologist) available in the event of an anxiety attack;
  • a quiet space where children can go if they feel too much stress;
  • gradual introduction of social interactions (do not force group activities immediately).
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Resources and assistance available

For families faced with school phobia, there are several resources available to support their child:

• specialized associations such asPhobie Scolaire, which offers links to a wide range of resources: don't hesitate to get in touch;
• support groups on networks, in particular but not only, to exchange ideas with other parents and children in similar situations;
• numerous online resources and books providing valuable information and testimonials.

You can listen to :

• the podcast "School phobia: what can you do?
• France Culture's 4-part documentary series LSD, " Jeunesse, le mal de vivre ";
• the "Adults of Tomorrow" podcast episode on teenage malaise with Anne-Claire de Pracomtal, co-founder of I am Strong ; 

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You can read : 

• La phobie scolaire, retrouver le plaisir d'apprendre, by Aurélie Harf and Laelia Benoit, Vigot, 2020 ;
• Comprendre pour agir : la phobie scolaire (3ᵉ édition), Stephan Valentin, Enrick b. éditions, 2019 ;
• and of course, all the related books on bullying, neuroatypia, etc.
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School phobia is a complex challenge requiring an empathetic, multidisciplinary approach. By understanding its origins, identifying its manifestations at an early stage and implementing appropriate strategies, it is possible to help children overcome this anxiety and return to school, or at least to learning, with serenity.

The aim of Esclaibes international schools in Paris, Clichy and Marseille is to provide a caring environment, respectful of each student's pace and based on active teaching methods, so that students can play an active role in their learning and make it meaningful. Our teams do everything in their power to promote a calmer, more motivating school experience.

And if there were three key points to remember to help a child or teenager combat school phobia, they would be : 

• School phobia can't be solved overnight, and forcing a child to return to class unprepared is likely to make the situation worse.
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• Caring support, psychological follow-up and adapted school arrangements are the keys to helping the child regain balance and overcome anxiety. This sometimes requires family adaptation.
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• The most important thing is to listen, understand and support the child at his or her own pace, to help him or her rebuild a peaceful relationship with school.

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