The inner voice behind “I don’t want to go to school”: the secret of school phobia

Author: Liang Jingjing, deputy chief physician, Women and Children's Medical Center, Guangzhou Medical University

Reviewer: Jing Jin, Professor of School of Public Health, Sun Yat-sen University

In the journey of children's growth, "I don't want to go to school" may be more than a simple complaint. Today, we will explore the psychological motivations behind this complex behavior of refusing to go to school.

School refusal, medically known as school phobia, is a psychological state in which children have an abnormal fear of the school environment and strongly refuse to participate in school activities. This state not only affects children's academic performance, but also hinders their social development and even affects the daily life of the entire family.

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Children may show obvious avoidance behaviors, such as making excuses for not going to school, and experiencing anxiety and panic before going to school. Sometimes, they may also have physical symptoms, such as headaches, dizziness, abdominal pain, nausea, vomiting, fever, or frequent urination. However, these symptoms usually cannot be found to have an organic cause when they go to the hospital for examination, and they often disappear on their own when they do not have to go to school.

There are many reasons for school refusal. Personality traits, such as sensitivity and perfectionism, and stress in the school environment, such as academic workload and peer relationships, can be triggers. In addition, the stability of the family environment and the temptations of modern life, such as online games and mobile phones, may also play a role.

Children of different ages may face different challenges. Preschoolers may not want to leave their parents because of separation anxiety; school-age children may be reluctant to leave their parents because of increased homework, test anxiety, academic pressure, poor peer relationships, difficulty adapting to changing schools, or pressure to enter higher education; parents’ high expectations and demands, or strict teachers, intimidation or bullying at school are also reasons. Adolescents may be reluctant to leave their parents because of puberty, increased sense of independence, tense interpersonal relationships, academic problems or emotional problems. They may have an unrealistic "self-image" because of their strong self-awareness, and think that they are not good-looking, short, have poor learning or athletic ability, acne, etc., which may cause them to be ridiculed and humiliated by their classmates, and thus be unwilling to go to school.

Prevention is crucial for school refusal, and parents and teachers should be aware of the "warning signs" of school refusal so that they can respond quickly if their children show signs of refusal. Common "warning signs" include: frequent absences or lateness without reason; missing important days such as exams, lectures or certain classes; frequently asking to go to the school clinic without obvious physical discomfort; frequently asking to call home; difficulty sleeping, concentration, depression or irritability after major life events; and difficulty getting up in the morning and procrastinating on going to school.

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For children who have already refused to go to school, the active cooperation of doctors, families, and schools is the key to successful treatment. A comprehensive treatment plan should be adopted according to the situation of different children, to find out the causes or influencing factors of school phobia, help eliminate social and psychological factors, reduce their anxiety and fear, and enhance the attractiveness of school, so as to enable them to return to school.

Doctors are mainly responsible for eliminating the impact of physical diseases and alleviating children's concerns. At the same time, they adopt psychological and behavioral intervention measures, such as relaxation training, systematic desensitization, and gradual exposure, to help children gradually return to school. If necessary, drug treatment can be considered.

Parents should avoid forcing or scolding their children, and should not send them back to school forcibly. Instead, they should give their children sympathy, understanding and support, communicate more, encourage more, and adjust their expectations appropriately.

Teachers should treat children with a kind attitude, give them care and encouragement, and avoid treating them roughly. At the same time, they can encourage their classmates to accompany the children at home to do homework and go to school together, so as to improve the relationship between classmates and enhance the sense of collective belonging. For children who have just returned to school, they should avoid requiring them to strictly follow the school rules and regulations or teaching arrangements immediately after returning to school. The rules can be appropriately relaxed and adjusted gradually to help children adapt to school life again.

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School refusal is a challenge that requires the joint efforts of families, schools, doctors and children to overcome. Through understanding, support and professional help, we can help children regain their love for school and embark on a path of healthy growth.