December 30, 2015 / Dr Yesheswini Kamaraju - Child and Adolescent Psychiatrist
As a parent you would panic, when your child suddenly comes up to you saying “I don’t want to go to school”. Does this happen because the child is stubborn, pampered or overprotected. This is a common scenario that many child experts come across in their day to day clinical practice. I would like to illustrate a case scenario describing a child’s struggles settling down at school.
An 8 year old girl accompanied by her mother, presented for an evaluation of her behavior, on request by her school teacher. The girl is reported to be a bright, enthusiastic and social child who participates in a myriad of activities at school. Mother reported recent changes in her “behaviour pattern”. She cries almost on a daily basis before going to school and has to be forced to get dressed and pack her school bag. There were occasions, where the father had to drag the child out of the car and leave her at the school gate.
School staff report that the child refuses to enter the classroom and insists on her mother waiting at school. Although she seemed to settle down with mother waiting on school premises, resistance to enter school gate, incessant crying and refusal to attend school irrespective of rewards prompted this evaluation.
At home, she reportedly is playful, happy and loves to spend time with her friends in the evening. Parents used to prepare her to attend school the previous day by discussing at length, reassuring and promising rewards at the end of the day. She apparently would be comfortable at home till she gets ready to school the next morning.
The school counsellor intervened and has picked up the child at the gate on several occasions. She was slowly sent into the classroom and there have been no reports of crying while she was at the classroom. However, during recess time, she insists on talking to her mother and requests her to take her home as she is uncomfortable at school. On couple of occasions, the mother had picked her up early from school.
Recently, the mother has been getting calls from the class teacher about her “odd behavior” where she is putting erasers in her nose. On one occasion, she had to be taken to an ENT doctor to remove eraser from her nose.
After receiving feedback from the school counselor and teachers it is very evident that the child has been making consistent efforts to get away from school. We started therapy sessions for the parents and the child in order to address her school issues. Parent strategies for separation anxiety that were implemented:
In addition to working on parental anxiety, the following management strategies at school were suggested:
Separation anxiety disorder is excessive anxiety exhibited by children and adolescents which is beyond the child’s developmental level and which persists more than 4 weeks requiring professional help.
80% of children with separation anxiety disorder develop school phobia. As per western statistics 4-5% of the children and adolescents develop separation anxiety disorder. Anxiety regarding separation mostly in the form of stranger anxiety starts around 8 months of age and peaks between 10-18 months of age. Most children gradually outgrow separation anxiety as they grow older. However, some children and adolescents continue to exhibit excessive anxiety concerning separation from home or from those to whom they are attached.
The symptoms of separation anxiety such as clingy behavior, fear of being alone, and refusal to do things that require separation, sleep disturbances and social withdrawal in some cases.
Aggressive behavior can be seen in children or adolescents in certain situations when forced to separate from the attached person or home. Children display somatic symptoms (physical complaints like stomach aches, headaches, vomiting etc.) due to underlying fear of separation. The anxiety can be severe and persistent, interfering with the functioning of the child/adolescent in their interpersonal relationships, academic functioning and social behavior.