Introduction

A strict teacher in school, fear of punishment or fear of low grades has made us to make excuses for avoiding school. But at the same time green playgrounds, sports tournaments, rock competitions have made us want to go school even more. Teenage is the time when a teenager finds himself most comfortable amongst his peers because at this time all of them are sailing in the same boat and teenagers think that they can be better understood only by their peers. If at this point of time a teenager starts avoiding school it is a matter of suspicion and one should really look at the underlying causes as there can be some serious causes attached to it.

What is school avoidance?

Making excuses for not going to school or for missing a test is quite common and is normal if these excuses are made once in awhile. But when a teenager starts making excuses for not going to school on a regular basis it is thing to worry about. If a teenager misses school for more than one week because of a physical illness or symptom, and whose clinical picture is inconsistent with serious illness, then it should be suspected of having primary or secondary emotional factors that contribute to the absence.

In such cases parents and teachers need to be vigilant enough to know that if a teenager is missing school is for the genuine reasons or there are some emotional causes attached to it. A teacher can be the sole and primary guiding light in such situations because these things first come under their notice. Investigation of absences may show a pattern, such as missing morning classes or missing the same days at the beginning or end of the week. School avoidance should be suspected in children who are consistently absent in spite of parents' and professionals' attempts to encourage school attendance.

Why do teenagers avoid school?

There can be many reasons associated with avoiding school. They can range from fear of bad grades, bullying by peers, different sexual orientation, sexual abuse or any underlying psychological cause. Let’s have a look over the causes one by one:

• School avoidance in adolescents may not be a new thing but in some cases small children who have a history of excessive school absences or separation difficulties as a younger child tend to do the same things even when they grow up. Separation from home and parents brings out anxiety in them.
• Such children have a record of recurrent physical complaints that do not have an underlying pathology. Parents of a school avoider often feel helpless to compel their adolescent to attend school, may lack the sophistication to distinguish malingering from illness, or may have an underlying need to keep the teenager at home.
• In such cases complete history and physical examination and all pathological tests should be performed and patient's medical, educational and psychiatric history should also be taken properly.
• If the reports are normal and child persists that he isn’t well, signs of emotional problems should be carefully evaluated. Parents, school authorities and teachers can help make a diagnosis.
• The adolescent may be having problems with particular teachers or subjects or experiencing adversity at school (eg, schoolyard bullying or an intimidating instructor).
• Sometimes students get so far behind academically that they see no way of catching up and feel overwhelmed. Separation anxiety of long duration may be manifested in subconscious worries that something may happen to the mother while the teenager is at school.
• The school nurse may give useful information, including the number of visits to the nurse during the last school year.

An important part of the history is how the parents respond to the absences and somatic complaints. The parent(s) may be making a subconscious attempt to keep the adolescent at home, which may be coupled with secondary gains for the patient, such as increased parental attention.

Treatment

The importance of returning to school quickly after a period of avoidance needs to be emphasized. The healthcare provider should facilitate this process by offering to speak with school officials to excuse missed examinations, homework, and papers. The doctor should speak directly with teachers who are punitive with the objective of making the transition back to school as easy as possible. The longer adolescents stay out of school, the more anxious they may become about returning and the more difficult the return becomes. If an illness or symptom becomes so severe that an adolescent cannot go to school, the patient and the parents must be informed that a visit to a medical office is necessary. The physician focuses visits on the parents as much as on the adolescent to alleviate parental guilt about sending the child to school. If the adolescent cannot stay in school, hospitalization should be recommended for in-depth medical and psychiatric evaluation. Parents should be cautioned about the possibility of relapse after school holidays, summer vacation, or an acute illness.

References

1. Hanna GL et al: Separation anxiety disorder and school refusal in children and adolescents. Paediatric Rev 2006;27:56. [PMID: 16452275]
2. Suveg C et al: Separation anxiety disorder, panic disorder, and school refusal. Child Adolescence Psychiatry Clinics of North America 2005;14:773. [PMID: 16171702]
3. Nelson textbook of paediatrics, 19th edition, Kliegman, Stanton, St. Geme, Schor, Behrman. Elsevier publication. ISBN: 978-1-4377-0755-7. Chapter-12
4. Current Pediatric Therapy, 18th edition, Frederic et al, ISBN-13: 978-0-7216-0549-4. Chapter-6