Host: We are now being discussing the school phobia with Dr. Les Linet MD. Psychiatrist. Dr. Linet.
Dr. Les Linet: Hello! School phobia essentially is avoidance of going to school. It's not school refusal. School refusal might involve the child leaving home and not going to school and going and playing hockey. But in school phobia, children are afraid of going to school. They want to be in their home base. They often don't say, they are afraid. They often will say, I have tummy ache, headache and they stay home. They are perfectly comfortable at home.
Isn't that true with kids? They are truly afraid. I saw a boy who explained in a kind of metaphor, what he was experiencing. He said that, it was likely, there was an evil wizard in the school. And I think, that's a rather lovely way of putting it, because he wasn't giving rationalizations. He wasn't saying, the teacher is mean, the school is too hard, the other kids are nasty, I have stomach ache. He was able to say that he was afraid. But he was also telling me that he knew there was nothing to be afraid of.
And see kids with school phobia do know this, that's why they I am having a stomach ache, they know they can't explain really why they are afraid. They are afraid because their nervous system is sending them signals of danger. Very often there is a family history of parent disorder, and children school phobia. Basically there is a strong genetic component and it's an abnormality in the nervous system. Going to school is a thing that is hard for children to do if they are anxious because they have to leave the safe environment.
Host: First and most important thing parents should be aware of, if kid does not go to the school, you must go to the school and speak to the guidance, the Vice-Principal who is incharge of to these kinds of situations, and make a way out whether the kid has a phobia. You are getting help, we hope with a proper counselor, trying to get them go to, get them involved because if you don't make that effort, the parents, could have a big problem, couldn't they?
Dr. Les Linet: Yes, and a mistake, sometimes made, is to provide home schooling and the idea in that is to seduce so that the child gets an education. But the more that the child is out of school, the harder it's to get back, so that is not something I would advocate. Such children should be treated and the prognosis is actually very, very good, for treating school phobia. For treating to get the child back to school.
Host: Can the parents get a lot of trouble if the kid doesn't go to school?
Dr. Les Linet: Yes, it's not illegal to be Agoraphobic, don't be afraid to leave your home if you are in an adult but it's against the law, to not go to school. We have compulsory education in United States. So parents, not only do you as a parent want to take care of your child, and take care of problems but you are going to be in legal trouble, potentially it can be a legal trouble if you don't do something about this.
Host: What as a psychiatrist, as a person, what if the child do as a school phobic, what would you, how would you approach this problem?
Dr. Les Linet: It has an excellent prognosis, either without medicine or with medicine. There are cases though that are difficult, this is always the case and sometimes one has to use medicine because the child is in such distress trying to get to school. There was an interesting study done several years ago in which children were in two groups, a grow group and a medication group. And in both groups they were also involved in talking treatment and the parents were instructed to get the child back to school and to do whatever they had to to get the child back to school and not just to bring them to the doctor. And in the non-medication group about half the children after three weeks or so were back at school. But there is an interesting aspect of this, when asked, if it felt better, none of the children said they felt better.
In the medication group, somewhat more than half, were back to school but a great majority said they felt better. So what I would want you to understand with this is that these children are laboring with a nervous system and is sending them the signals of danger and you can't just talk them out of it. Treatment without medicine can be helpful if they get back to school and they see by experience that nothing terrible happened, and they survived, that can be therapeutic. But sometimes we do need to use medicine because of the nervous system.
Host: This fear of danger, is this real or artificial, or it will going to pause sometimes?
Dr. Les Linet: Well, Mark Twain said something that would I love to quote, he said, anxious people suffer from things that never happen. So yeah, it's an anxiety disorder, in fact that's what an anxiety disorder is, it's an excessive anxiety, to be afraid of terrorism, it can be appropriate but some people have an anxiety disorder so they are afraid of terrorism excessively and you won't have to make the judgment about the appropriateness but basically school phobic kids are just afraid of leaving home.
Host: So changing the school wouldn't change the problem?
Dr. Les Linet: No, I don't like to mention that because parents don't want to have their children off and think of things like that. If it's school phobia, then you have trouble even in another school. These kids often don't want to sleep over their friend's houses.
Host: Occasionally school phobia is mixed with a kid with a real fear of school. Because there could someone in school who had threatened the kid, we are tying to differentiate between the real threat and that conceived something that doesn't exist.
Dr. Les Linet: Yes, there can be appropriate anxiety about going to school, like somebody is just going to bully you, beat you up, take your lunch, money, and humiliate you. Such activities actually will precipitate a school phobic episode, which if it's really school phobia than he may remain phobic even when the problem is solved.
Host: So threatening and punishing or potentially threaten to punish the kid, does it help the situation, does it?
Dr. Les Linet: Not at all, but I am affirmed, when I treat kids like this, I do try to help the parents to do something that's hard for parents to do. And that is get the child to school, I mean, to see your child saying that I am going to go to school but the next morning, doubled over in abdominal pain, crying, saying please I will go tomorrow, it's very, very hard for parents to do this.
So while I am discouraging punishment, I do help parents to do something that's hard. They have to get the child to school, not by punishment, but by getting him there.
Host: We are trying also trying to differentiate between the child's first exposure to school, which everybody has a fear of, which is appropriate. This is a fear that is inappropriate. Is this correct?
Dr. Les Linet: Exactly. In all psychiatric diagnoses, we -- see, if we don't use the criteria of a significant impairment and distress. We will be calling everybody names. Everybody has felt anxious, everybody has felt depressed. We don't give the diagnosis unless it's excessive.
Host: So, two most important things in the situation, that is, understanding and helping. A good parent tries to lead, do not threat. Is this correct?
Dr. Les Linet: That's correct.
Host: And this is great, great potential, salvational situation is to get the people involved.
Dr. Les Linet: Right, and I actually love the school phobia because the prognosis is terrific.
Host: Thank you doctor Linet.
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