school phobia: implications for school health educators
TRANSCRIPT
This article was downloaded by: [North Dakota State University]On: 30 October 2014, At: 18:08Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Health EducationPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/ujhe20
School Phobia: Implications for School Health EducatorsAnna Torrens Salemi a & Kelli McCormack Brown ba Dept. of Community and Family Health , College of Public Health, University of SouthFlorida , 13201 Bruce B. Downs Blvd., MDC 56, Tampa , FL , 33612 E-mail:b Dept. of Community and Family Health , College of Public Health, University of South FLPublished online: 20 Dec 2013.
To cite this article: Anna Torrens Salemi & Kelli McCormack Brown (2003) School Phobia: Implications for School HealthEducators, American Journal of Health Education, 34:4, 199-205, DOI: 10.1080/19325037.2003.10761864
To link to this article: http://dx.doi.org/10.1080/19325037.2003.10761864
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon andshould be independently verified with primary sources of information. Taylor and Francis shall not be liable forany losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of theContent.
This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
--------~198~-------
School Phobia: Implications for School Health Educators
Anna Torrens Salemi and Kelli McCormack Brown
ABSTRACT
This review addresses school phobia, a problem of growing concern among educators. Clear definitions of school phobia have emerged only recently, but differential diagnosis between school phobia and related disorders remains controversial. The public health implications of school phobia are significant. Various school personnel may play key roles in the identification of school phobia. Theoretical explanations of school phobia address the questions regarding whether the phobia is stimulated by something in the school setting, phobia is actually of the school, or is merely a component of the school. The pathology of school phobia can be severe. School health educators need to recognize its symptoms and the profile of those at risk to engage in early intervention. The prevalence of school phobia varies depending on the source. Strategies for early intervention are comprehensive and coordinated and can be integrated into existing frameworks such as the coordinated school health program. Future directions include addressing school phobia from an ecological perspective.
School phobia was first described in 1932 by Broadwin as "consistent absence from school... without a comprehensible reason" (Broadwin, 1932, p.254). "School phobia" is a term frequently used, but often misunderstood (Kearney, Eisen & Silverman, 1995). Literature on school phobia grew out of diverse fields such as psychology, nursing, social work, and pediatrics, all having one common denominator: contact with children. The literature reflects the nature of school phobia and its identification within a school. A number of different personnel within a school, from the bus driver to the principal, could assist in identifying a student with school phobia. It is important for health educators to be aware both of this diversity within the literature and the complex nature of school phobia.
The outcome of school phobia appears
simple, yet is quite serious; the student refuses to attend school. Given that school is 5 days a week, school phobia becomes a daily issue. Problems associated with school phobia are considerable, leading to potentially adverse consequences (Hsia, 1984; Jenni, 1997; King & Bernstein, 2001; Want, 1983). It is important to recognize that school attendance is mandated by law. Schools act in loco parentis, assuming the obligations and responsibilities of preparing students to become productive members of society. Society has expectations for students to complete their education, which amounts to the equivalence of a full-time job for 13 years. School phobia is an issue that requires quick resolve to avoid dismal results.
In this review we summarize the current literature about this disorder. First, the controversy regarding the complicated
definition of school phobia is explored, because an understanding of this controversy is of critical importance. Second, the significance of school phobia as a public health issue is addressed. In addition, a summary of the prevalence rates is included. Third, we review existing theoretical explanations concerning school phobia and their relationship to the school setting. We then describe the pathology of school phobia,
Anna Torrens Salemi, BA., MPH, CHES, is a Doctoral Student in the Dept. of Community and Family Health, College of Public Health, University of South Florida. 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL 33612. kmbrown@hsc. usfedu. Kelli McCormack Brown, PhD, CHES, PASHA is an associate professor, Dept. of Community and Family Health, College of Public Health, University of South FL
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
providing a profile of a typical child/adolescent. We discuss the implications of school phobia for early intervention including some strategies and how they can be incorporated into a coordinated school health program ( CSHP). We conclude with suggestions for future directions regarding strategies and research.
DEFINING SCHOOL PHOBIA Of all of the "internalized" disorders
among youth, the one most subject to controversy is school phobia (Kearney et al., 1995). The reason for this controversy is, in part, due to some confusion about the descriptive terms and definitions used by various researchers. In 1941 "school phobia" was developed as a phrase to describe an "over-dependent mother-child" relationship (Murray, 1998a, p.l). Over time "school phobia" evolved into an umbrella term that covered virtually everything dealing with school absenteeism. School phobia, school refusal, school avoidance, and separation anxiety are terms used interchangeably to report on this phenomenon. Yet the literature suggests that each separate term possesses inherent characteristics that demand differentiation.
School phobia further evokes controversy because not all students who refuse to attend school are phobics; some may just not want to attend and should more properly be labeled as truant. More confusion over the terms results because the fourth edition Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not differentiate among these events (Murray, 1998b). The terms are referenced under the headings of social phobia, separation anxiety, and conduct disorder (Murray, 1998b ). Thus, each counselor/psychologist has his or her own way of defining the problems and a consensus has not been reached about the nature of the problems. The issue has been labeled "anxiety-based school refusal" as well as "anxiety-based" and "nonanxiety based school refusal" (Murray, 1998b ). Other counselors/psychologists refute both of these definitions, instead designating school refusal as symptomatic of more
complex issues, such as social phobias (Murray, 1998b). For the purposes of this review, focusing on relevant information for school health educators, school phobia is defined as "anxiety and fear related to being in school" (Murray, 1998b ).
Several studies distinguish between the meaning of separation anxiety and school phobia. Separation anxiety is the term of choice whenever a disproportionate amount of anxiety is associated with a child separated from his or her care giver (i.e., mother) (Lee & Miltenberger, 1996). Often the child fears harm coming to his or her guardian while they are separated. In contrast, school phobia is not tied exclusively to such separation. The key factors that differentiate school phobia and separation anxiety are the "significance of the attachment figure" (i.e., mother), and the "specificity of the anxiety/phobia" (e.g., fearing embarrassment) (Lee & Miltenberger, 1996). School phobia, which can strike at any time during a child's matriculation through school, can result from varying causes, such as an extended illness, geographic relocation or new school, death in the family, trauma at school, or a threat to the child's security (APA Experts, 1997; Jenni, 1997).
PUBLIC HEALTH IMPLICATIONS Negative outcomes associated with
school phobia include poor academic performance, family and peer relationship problems, and poor social and educational development (Last & Strauss, 1990; Want, 1983 ). Long-term effects of untreated or poorly treated cases leave the child further behind developmentally and at risk for school failure and involuntary drop-out (Hsia, 1984; Jenni, 1997). From these outcomes, the detrimental public health implications can be derived.
The two goals of Healthy People (HP) 2010 are to (I) improve quality of life and (2) eliminate health disparities (U.S. Department of Health and Human Services [US-DHHS], 2000). One of the indicators of quality of life is sound physical and mental health (US-DHHS, 2000). Many aspects
,\11/lll 'lorrc11s Salc111i mul Kclli ,\IcC" IIIli< k B""' 11
of health are affected by school phobia, including those in the physical, mental, social, and emotional domains. Ranging from the somatic effects of the phobia on the student to the stress experienced by all parties involved, having school phobia can greatly impact a child's quality of life. Furthermore, if the situation is not resolved, the effects on long-term quality of life could prove devastating. The lack of education or a poor experience within the student's matriculation can reverberate throughout life. The second goal of HP 20 I 0 seeks to eliminate health disparities, which may be partially attributed to issues such as lack of education (US-DHHS, 2000).
Education has been cited as a factor in a longer, healthier life (US-DHHS, 2000). Such a phenomenon is attributed to many factors that are related to having an education, such as literacy and the ability to attain employment. Higher levels of education also increase the possibility of obtaining and interpreting health-related information required to develop positive health behaviors (US-DHHS, 2000). Again, the underlying problems that can arise from an unresolved case of school phobia are discernible. The impact of school phobia may be detrimental, thus prevalence must be considered as well.
PREVALENCE OF SCHOOL PHOBIA An accurate analysis of the prevalence
of school phobia depends on how it is being defined. Because the definition is not consistently used, the reported incidence rates vary. Second, Berry ( 1993) notes a lack of investigations into the incidence of school phobia (Berry, 199 3). Therefore, we hypothesize that the estimates may not be accurate due to the variation in definition and the dearth of available studies.
Most studies estimate the proportion of students with school phobia in the United States to be 1-8% of the school-age population (Berry, 1993; Ceria, 1997; Lee & Miltenberger, 1996). Last and Strauss ( 1990) refer to school phobia as a "relatively widespread disturbance," with a prevalence rate among the general population of school-age
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
children at I o/o and among clinically referred children between 3 to 8o/o (Last & Strauss, I990, p.3I ). Jenni (!997) puts the prevalence rate into perspective by estimating that if a person were to walk into a middle school, he or she would find between one and five students with the problem (Jenni, I997).
From a comparative perspective, Jenni (!997) points out that school phobia is more prevalent in highly competitive societies such as Japan, where it is estimated to occur in 3I to 52% of middle school students (Jenni, I997). Although in the United States the numbers are not as high as Japan's, even an estimate of I o/o is sufficient to demand more attention.
THEORETICAL EXPLANATIONS FOR SCHOOL PHOBIA
Two theoretical explanations have been used to better understand the cause of school phobia. Kearney et al. (!995) poses these explanations as the questions "Is school phobia actually a phobia?" and "Is school phobia actually a fear of school?" The first question can be addressed by conceptualizing school phobia within the categories of social and specific phobias. According to DSM-IV, social phobias are characterized by a fear and avoidance of social situations in which the individual may become embarrassed (American Psychiatric Association, I994). Specific phobia can be defined as "fear of some object or situation that incites excessive, irrational, specific and avoidant behavior-provoking nature"(Kearney et al., I995, p.70). School phobia, depending on the surrounding factors, may warrant a diagnosis of social phobia or specific phobia. Unfortunately, there is a lack of studies in this area preventing an analysis determining the levels of fear invoked in such students (Kearney et a!., 1995). Rather, studies have predominantly centered around diagnosis, anxiety scales, and case studies.
The second question, "Is school phobia actually a fear of school?" threatens traditional school phobia explanations that typically center around the institution of
school as the stimulus of fear. The school itself represents a variety of components (students, teachers, cafeteria, etc.), so that, once a diagnosis of school phobia is made, the stimulus of the phobia may still remain unknown (Kearney eta!., 1995). It could be possible that school phobia is related to tactile items within the school. For example, a student may have a fear of entering the cafeteria or the library. On the other hand, other individuals may suffer general social fears that manifest in school (Kearney et al., 1995). The complexities of the stimuli present difficulties when a counselor or other school professional tries to determine appropriate plans of action. For example, if the counselor is trying to use desensitization techniques, yet is unaware of the exact source of fear, the efforts may be too nonspecific to be effective (Kearney et a!., 1995). Certainly, these theoretical questions are significant and complex enough to justify the availability of applicable information for school health educators, counselors, psychologists, teachers, and other school personnel.
PATHOLOGY OF SCHOOL PHOBIA School phobia can be triggered by a
variety of stimuli, such as an embarrassing situation, confrontation with a bully, a disagreement with a teacher, or some other traumatic event (Kohn, 1999; Mayo Clinic, 1999). However, to understand the pathology of school phobia, it is necessary to examine the onset of the phobia. Researchers agree about the general times of onset-at the beginning of formal education, at the transition to middle school or junior high, or at the end of compulsory education (Berry, 1993). School phobia may begin with a stimulus, followed by a course of events, though each case is unique. After the stimulus event occurs, the primary caregiver may hear complaints of stomach aches. The child may feel dizziness, nausea, and feverishness (Berry, 1993). The parent subsequently may permit him or her to stay home. By allowing the child to stay home, however, the parent unknowingly enables the school phobia behavior (University of
Pittsburg, 1990). As the starting hour of school passes, the child's symptoms may begin to subside. The symptoms often intensify on Sunday evenings, Monday mornings, and following a vacation (Berry, 1993). This pattern may continue each day depending on the severity of the case.
School phobia has been categorized into a myriad of subtypes and categories. For a detailed history of the development of these subtypes, the reader is referred to Kearney's text School Refusal Behavior in Youth (Kearney, 2001). Generally, school phobia is divided into two categories: an acute onset (Type I, acute) and a more severe, persistent case (Type II, chronic) (Kearney, 2001 ; Pilkington & Piersal, 1991 ). Students with acute school phobia are absent anywhere from 2 weeks to 1 year of school (Kearney, 2001). The acute condition is more easily resolved and is usually related to a type of separation anxiety. Moreover, the severe form (Type II, chronic) occurs less frequently but, if not properly resolved, can have detrimental short- and long-term consequences if not properly resolved (Last & Strauss, 1990; Pilkington & Piersal, 1991.) The severe form is likely to intensify with stronger physical ailments and more adamant refusals to attend school. Students with chronic school phobia are absent for longer than 1 year of school (Kearney, 2001).
Jenni ( 1997) carefully describes the type of panic experienced by students with severe cases of school phobia: "There is a sense of the body being out of one's control. Those afflicted may experience faintness, heart palpitations, shortness of breath, dizziness, nausea, loss of control, the desperate need to escape, and a sense of impending doom that includes the belief that one is about to die or go insane" (p.211 ).
The more severe cases generally occur during adolescence and include the previously described panic attack (Jenni, 1997). One of the hallmark behaviors, according to Pilkington and Piersel (1991), is failure to remain in school despite pressure or threats of punishments from parents, teachers, and school administrators. Most
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
professionals who have dealt with cases of school phobia agree that if untreated, the phobic condition can have a permanent and adverse effect on the youth's social and emotional development (Want, 1983). Likewise, untreated school phobia has the potential to affect school performance, academic achievement, and learning.
PROFILE OF A CHILD WITH SCHOOL PHOBIA
Schools have commonly viewed and placed students who are absent from school because of school phobia in the same category as truant students, yet it is important to differentiate the two. The signs of school phobia are not difficult to discern, yet without knowing the profile of vulnerable students, school personnel can easily miss them (Kohn, 1999). Knowledgeable school personnel are key for early identification of youth with school phobia to enable prompt treatment. It cannot be assumed that school phobia will go away on its own or that a parent or pediatrician will identify it (Want, 1983).
Want ( 1983) describes five common characteristics of students with school phobia: anxiety, willfulness, dependency, depression, and unrealistic self-image (Want, 1983). Anxiety is the most distinguishing feature of a child with school phobia. Willfulness (the manipulation of authority figures) is not as common, whereas dependency (reliance on a parent for support and protection) is readily seen. Depression can arise from school phobia and may be situational. An unrealistic self-image is common in adolescents with school phobia and is indicative of a "hypersensitivity to threats to self-image" (Want, 1983).Although these characteristics may be observed in truant students, they occur more frequently among students with school phobia.
Until the onset of the disorder, students are generally average to excellent students who enjoy school and rarely pose a behavioral problem in class (Jenni, 1997). Youth who later develop school phobia may seem "hypervigilant, with an overactive danger alarm" (Jenni, 1997, p.209). Jenni (1997)
suggests three coexisting conditions that are central to the onset of panic disorders such as school phobia: (a) a genetic predisposition to anxiety, (b) a threatening loss event, and (c) an internal physical experience that appears catastrophic to the individual (Jenni, 1997).
Another theory on the profile of students with school phobia hypothesizes that the child will have at least one parent who is highly anxious ( Cerio, 1997). This proposition is consistent with Jenni's theory of being predisposed genetically to anxiety (Jenni, 1997). Such information about the parent is pertinent in gaining a better understanding of the child. The chosen treatment method should contain a child-family component (Cerio, 1997). When one parent is highly anxious but not included in the treatment, he or she could potentially reinforce the phobic behavior, inadvertently enabling and preventing a prompt return to a normal setting.
Lee and Miltenberger ( 1996) refer to the typical child with school phobia as being "from a higher socio-economic background, male and having post-pubertal onset of symptoms" (p.475). It is generally agreed that students with school phobia excel academically prior to absenteeism, as they may be achievement-oriented students who set high standards for themselves, and who may pressure themselves and fear imperfection (Kearney, 2001; University of Pittsburg, 1990). It seems ironic that these students develop such strong aversions to school. As an example, in competitive societies such as Japan school phobia has increased over the last two decades. It has become such an issue in Japan that the United Nations Committee on the Rights of the Child stated in its concluding observations, Article 43, that the State of Japan should "take further steps to combat excessive stress and school phobia" (United Nations Committee on the Rights of the Child, 1999, p.4).
IMPLICATIONS FOR SCHOOL HEALTH EDUCATORS
Youth spend more time in school than anywhere else outside the home. This pre-
1\111111 Ji>ITL'II> S11lnui 1111d Kcllt ,\,hCol/1/tld.: llwl\ '11
sents a compelling reason why early intervention efforts for school phobia should be implemented. School personnel should be knowledgeable and provide stress-free school environments conducive to allowing students to feel comfortable in and connected to their school setting. School personnel must be able to identify students with school phobia early to minimize the trauma that can result, including peripheral impact on learning and academic achievement (Want, 1983) . School personnel should develop guidelines for identifying students with school phobia, which should decrease the number of students in school who are inappropriately categorized as truant. Prevention programs for school phobia are nonexistent, and treatment facilities are limited. Prevention techniques usually focus on preventing a relapse of the behavior, not the initial onset (Kearney, 2001). Emphasis on early intervention provides the best option for successful resolution of school phobia.
The long-term outcomes of school phobia are typically poor if not properly addressed. Most of the research has been conducted only in clinical settings, therefore the usefulness of such data is limited (Jenni, 1997). Early studies revealed poor outcomes, such as continued absenteeism and mental disorder (Jenni, 1997). Studies conducted on outpatient treatment proved more successful (Jenni, 1997). School phobia did not predict mental disorders in adulthood, except a slight prediction for agoraphobia (lenni, 1997). The current literature does not reveal any relationships with gangactivity, suicide, or other risk behaviors among youth with school phobia.
Within school systems health educators need definitive approaches for managing school phobia. School health personnel should be educated so that they understand that students with school phobia are not willfully avoiding school (lenni, 1997). Sensitivity toward the student and his or her situation is necessary to avoid negative relationships.
Jenni ( 1997) and Want ( 1983) offer different steps to build strong strategies within
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
\111111 lUl l !"·' .'>ulmu untll\dil \/, ( <'111/CI< ~ /i/(111 11
schools for resolving school phobia. Want (1983) outlines a 1 0-step strategy that is comprehensive and involves a school intervention team, family involvement, therapy, and the development of an individualized plan for the student (Table 1). This
approach is practical, refrains from the use of a psychoanalytical intervention, and is compatible with the CSHP, utilizing a similar component structure.
school, the family, and the child. This model emphasizes "depathologizing" school phobia and emphasizing the manageability of the phobia. Such an effort maintains that school is the best location for treatment and that patience is required (Jenni, 1997). The
Jenni's ( 1997) suggestions also focus on a collaborative model that involves the
Table 1. Existing Strategies and Early Intervention Within Coordinated School Health Program (CSHPJ
CSHP Component & Suggested Integration
Health Education • Curriculum includes a focus on emotional. mental. and social health • School phobia introduced within existing relevant programs such as bullying prevention, peer mediation. or stress management
School Health Services • Provide access to health care services • Treatment of physical ailments related to school phobia within school setting-student does not have to leave school
Counseling, Psychological, and Social Services • Provides assessment and services • Assist in identification of students with school phobia • Coordinate treatment of student
Healthy School Environment • Promote school connectedness • Provide safe. friendly, and healthy environment at school
Family and Community Involvement • Key to successful treatment of school phobia by providing reinforcement through a comprehensive approach • Resources and support available to students, family, and school personnel • Network with community resources such as coalitions that direct people to resources available. Likewise. raise awareness within these coalitions regarding school phobia.
Existing Strategies & Suggestions
• Have child keep track of progress (Jenni, 1999) • Increase awareness of school phobia among staff through in-service training
• Limit student complaints {Want. 1983)
• Organize a school team-include parents. teachers. administrators, and student {Want I 983) • Assess family configuration {Want 1983) • Develop a plan {Want 1983) • Arrange student transportation to school {Want I 983) • Select a team member to provide limited counseling for students/parents {Want I 983)
• Allow students to maintain contact with their friendsstudents are typically humiliated by this phobia {Jenni, I 999) • Make child aware of scheduled changes; relapse occurs easily {Jenni, I 999)
Parents • Parents must play a role in resolving problem {Jenni, I 999) • Parents must keep positive outlook {Jenni. I 999) • Involve parents in everything {Want I 983) • Encourage parents to seek counseling/therapy for selves and child {Want, I 983)
Teachers • Keep teachers informed and explain that there may be a temporary suspension of focus on students academic progress (Jenni. I 999) • Prepare teachers for students return {Want, I 983) • Do not allow home schooling! {Want I 983)
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
main goal of both strategies is the prompt return to school of the child with school phobia (Jenni, 1997; Want, 1983).Allowing the child to miss school days only reinforces the school phobia behavior.
The emphasis of both strategies is a "team -oriented approach" that includes not only the student, parents, and counselors, but also the administrators and teachers (Table 1) (Jenni, 1997; Want, 1983). Any strategies implemented in schools must be flexible, comprehensive, and coordinated. Integration of such strategies into a CSHP seems a positive next step providing the necessary framework for early intervention. Although it may prove difficult to address school phobia from every component of the CSHP, it is worthwhile to consider structuring interventions within the framework.
Within the eight components of the CSHP, the following can work collaboratively to address school phobia: health education, health services, counseling, psychological services, social services, healthy school environment, and family involvement (Table 1) (Allensworth & Kolbe, 1987) . Health education emphasizes a planned curriculum that addresses the physical, mental, emotional, and social aspects of health. Within this component, early intervention of school phobia could be addressed within existing programs
il
for students. These may include bullying prevention, peer mediation, and stress management.
School health services would involve treating the physical ailments that arise in serious cases of school phobia. As opposed to sending the student home, which is detrimental to the student, students who get a "stomach ache" due to school phobia can be seen at the school clinic. Due to the collaborative nature of the CSHP, health services would be aware of the student's problem, thus allowing care without sending him or her home (Tyson, 1999).
Counseling and psychological and social services are central to proper identification and treatment of the child with school phobia (Allensworth & Kolbe, 1987). Services could be provided to students in school, and social service staff could coordinate outside treatment if necessary. All the elements important to successful treatment of the child with school phobia would be communicated through the CSHP model, enabling continuous monitoring. An example is through the component of promoting a healthy school environment. The school must be a physically healthy and safe place for learning (Resnicow & Allensworth, 1996). Based on the nature of school phobia, it can prove difficult to identify the stimulus of the phobia (e.g., a bully);
\1111<1 fOIICII' ''>llft ' l/11 tllltf 1\c//i ,\1£( tlllllll<k /!JOI\ ' 11
therefore, communication among all school personnel is necessary in targeting such behaviors and providing early intervention (Resnicow & Allensworth, 1996).
Finally, a key component to resolving school phobia within the CSHP model is family and community involvement. It is critical that family members are involved in all steps of caring for a child with school phobia. Issues of transportation, therapy, and parental support are essential to overcoming the phobia. Resources must be available to allow students, school personnel, and family members the necessary support for sufficient and prompt care (Tyson, 1999). Table 2 provides a detailed list of available resources for students, school personnel, and parents.
FUTURE DIRECTIONS In conclusion, intervention programs
can be instrumental in the treatment of students with school phobia. To date, the research conducted is predominantly intervention based as opposed to prevention focused. Although many highly publicized teen problems (e.g., teen pregnancy, substance abuse) have a myriad of prevention programs in place, programs focused on preventing school phobia do not exist. Such a lack is understandable due to the individualistic nature of school phobia. Feasible
Table 2. Available Resources on School Phobia !t ;r ·~ .... ·!J,,
Resources Availability
When Children Refuse School. Graywind Publications Inc. . The Psychological Corp .. 2000. A Cognitive Behavioral Therapy Approach ISBN: 0-12784-468-6 (Parent Workbook). 2000. By Christopher A. Kearney & Anne Marie Albano.
When Kids Say No to School: Helping Children at Risk Harold Shaw Publishers. ISBN: 0-87788-406-4 of Failure, Refusal, or Dropping Out fl998). By Elaine K. McEwan.
The Identification and Treatment of School Phobia. The National Association of School Psychologists. ISBN: 0-932955-f1993) . By Leslie Zeldin Paige. 08-8; Publication no. 6503
The Child Anxiety Network (offers a list of centers. http://www. childanxiety. net/Directory _of _providers. htm clinics. and professionals)
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4
, \/IIIII !OI/CIIo S11ln111 <11/cl 1\c/Ji .\l,( 'o/1/I<Hk lJJ0\\'11
strategies include early identification and intervention. Within the literature on
school phobia, emphasis is placed on involving many team members in working on a resolve to the student's phobia. While en
couraging this coordinated approach, the literature still suggests this process functions
as a microcosm. Students do not attend school in a mi
crocosm. Students comprise one component within this complex and dynamic system we refer to as school. Schools are composed of multiple parts, within com
munities, which mesh together creating an individual school climate. In light of this,
we suggest that strategies for managing
school phobia move beyond the microcosm of the school. An ecological perspective to managing school phobia entails not just the student, family, and school personnel, but it moves beyond that, taking into account peer relationships, teacher-student rela
tionships, school climate, school connectedness, and community factors.
Incorporating existing strategies into frameworks such as the CSHP is one example of how we can start to move forward
with an ecological approach. School phobia research must move in
new directions in the future. New research reveals the impact that outside factors have on students and their success in school. Obtaining education is likewise an important factor in living a healthy and productive life. Issues such as bullying, violence, school connectedness, and community all play roles in how a student experiences school. Furthermore, relationships among students and school personnel should be examined in light of school phobia. Although most of the research has focused on family dynamics, there is a lack of fo cus on school dynamics, especially between students and staff. Future research on school phobia should take these factors into
consideration and explore associations among these factors.
REFERENCES Allensworth, D. D., & Kolbe, L. J. ( 1987). The
comprehensive school health program: Exploring an expanded concept. Journal of School
Health, 57, 409-412.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Dis
orders (4th ed.). Washington, DC: American
Psychiatric Association. APA Experts. (1997). Psychologists offer
back to school tips to parents: resiliency, the "first day," school phobias and homework. Re
trieved October 1998 from ericps.ed. uiuc.edu/
npin/pnews/pnew897f.html Berry, G. L. (1993). The school phobic child
and the counselor: identifying, understanding, and helping. Education, 114, 37-45.
Broadwin, I. T. ( 1932). A contribution to the
study of truancy. American Journal of Orthop
sychiatry, 2, 253-259. Cerio, /. ( 1997). School phobia: a family sys
tems approach. Elementary School Guidance &
Counseling, 31 , 180-191. Hsia, H. ( 1984 ). Structural and strategic ap
proach to school phobia/school refusal. Psychol
ogy in the Schools, 21, 360-367. lenni, C. B. ( 1997). School phobia: how
home-school collaboration can tame this frightful dragon. School Counselor, 44, 206-217.
Kearney, C. A. (2001). School refusal behav
ior in youth. Washington, DC: American Psycho
logical Association. Kearney, C. A., Eisen, A. R., & Silverman, W.
K. (1995). The legend and myth of school phobia. School Psychology Quarterly, 10, 65-85.
King, N.J., & Bernstein, G. A. (200 I). School refusal in children and adolescents: A review
of the past ten years. Journal of the American
Academy of Child and Adolescent Psychiatry,40,
197-205. Kohn, M. F. (1999). School phobia. Parents
Magazine, 71, 122-124.
Last, C. G., & Strauss, C. C. (1990) . School refusal in anxiety-disordered children and ado
lescents. Journal of the American Academy of
Child and Adolescent Psychiatry, 29, 31-36. Lee, M. I., & Miltenberger, R. G. (1996).
School refusal behavior: classification, assess
ment, and treatment issues. Education and
Treatment of Children, 19, 47 4-486.
Mayo Clinic. (1999) . School Avoidance. Retrieved October 29, 1999, from http:/ I
www. ma yo h ea I th . o rg/ m ayo/9609 I h tm/ school_p.htm
Murray B. (1998a). School phobias hold
many children back. APA Monitor. Retrieved October 29, 1999, from http:/ /www.apa.org/
monitor/sep97 I define.html
Murray B. (1998b). How do psychologists define "school phobia? APA Monitor. Retrieved October 29, 1999, from http:/ /www.apa.org/ monitor/sep97 /define.html
Pilkington, C. L., & Piersal, W. C. (1991 ).
School phobia: A critical analysis of the separation anxiety theory and the alternative
conceptualization. Psychology in the Schools, 28,
290-303. Resnicow, K., & Allensworth, D. (1996) .
Conducting a comprehensive school health program. Journal of School Health, 66, 59-63.
Tyson, H. ( 1999). A load off teachers' back.
Phi Delta Kappan, 80, K1-K8. United Nations Committee of the Rights of
the Child. (1999). DRAFT Concluding observations of the Committee on the Rights of the Child: Japan. Retrieved on October 29, 1999, from http://www.un.gov
University of Pittsburgh. (1990). The only thing they have to fear is school itself. Growth
and Development, 1, 1-2. U.S. Department of Health and Human Ser
vices. Healthy People 2010 (2nd ed.) . Washing
ton, DC: U.S. Government Printing Office, November 2000.
Want,/. H. (1983) . School based interven
tion strategies for school phobia: a ten step "common sense" approach. Pointer, 27, 27-32.
Dow
nloa
ded
by [
Nor
th D
akot
a St
ate
Uni
vers
ity]
at 1
8:09
30
Oct
ober
201
4