What Is Scolionophobia

  • Reem Alamin Hassan Bachelor's degree, Biomedical Sciences, Queen Mary University of London, UK

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Introduction

Definition of scolionophobia

Scolionophobia, also known as ‘school phobia’ can be defined intentionally as a partial or total lack of ability to go to school that results from an irrational dread or fear of some aspect of school. It is followed by physiologic symptoms of anxiety or even panic when school attendance is approaching.1 

Studies have shown that there are at least four classifications of scolionophobia; these include:2 

  • Serious difficulty in going to school often results in a lengthy absence.
  • Serious emotional upset is shown by symptoms such as extreme panic, undue tempers, distress, or complaints of feeling ill without an obvious cause when faced with the possibility of going to school.
  • Staying at home when they should be at school with the awareness of the parents at some stage during the disorder.
  • Absence of serious antisocial disorder, such as lying, stealing, wandering, aggressiveness, or sexual misbehaviour.

Significance of understanding scolionophobia

Understanding scolionophobia, which is an intense/irrational fear of going to school or attending classes, is significant for several reasons:3 

  • Early intervention: Recognising scolionophobia in children or adolescents allows for early intervention and support. Identifying and addressing these fears promptly can prevent them from becoming more entrenched and affecting the individual's academic and emotional well-being.
  • Mental health: Understanding scolionophobia is crucial for recognising the impact of mental health on a person's life. It underscores the importance of mental health awareness and the need for accessible mental health services, especially for children who may struggle silently with anxiety related to school.
  • Educational success: Overcoming scolionophobia can significantly improve a student's chances of success in school. When students can attend school comfortably, they can engage in learning, develop social skills, and build a foundation for their future.
  • Quality of life: Scolionophobia can have long-term consequences if left unaddressed. Understanding it allows for interventions that can improve a person's overall quality of life, including their emotional well-being, social interactions, and prospects.
  • Family dynamics: Scolionophobia can impact family dynamics as parents or caregivers may need to provide support and make adjustments to accommodate the child's needs. Understanding the condition helps families navigate these challenges more effectively.

In summary, understanding scolionophobia is significant because it promotes early intervention, mental health awareness, educational success, improved quality of life, and better family support for those experiencing this fear of attending school.

Understanding scolionophobia

Origins and etymology

The term ‘scolionophobia’ has been used interchangeably with other terms such as ‘school phobia’, ‘didaskaleinophobia’, ‘fear of school’, and ‘school refusal’ to explain the same phenomenon.4  Early studies of scolionophobia were discussed only in terms of truancy but Broadwin’s study (1932) was the first study to describe a form of truancy that was later referred to as scolionophobia or school phobia.5 

Prevalence and demographics

The prevalence of scolionophobia, also known as school phobia, isn't easy to pinpoint because it has been underreported in history. This means that there hasn't been a clear understanding of how common it is. In the past, when children had this fear, they were frequently not transferred to child psychiatrists but rather to truancy officers or authorities.

Nevertheless, in recent times, further cases of scolionophobia have been recognised and referred to psychiatric clinics. For instance, in one clinic, the number of cases went up from four cases per 1000 admissions in 1948 to 17 cases per 1000 in 1956, and presently, it's about 30 cases per 1000. This increase may not necessarily mean that other children are experiencing it; it might be because schools and health professionals are getting better at identifying it.

One study showed that when a special program was set up in a school system to help children with scolionophobia, they found a lot of other cases than they anticipated, about 10 times more. This suggests that there are likely numerous other cases out there that are unknown because they have not been reported to psychiatric clinics.

So, in simple terms, the prevalence of scolionophobia, or school phobia, has been underreported in history, but as knowledge grows and schools and healthcare professionals get better at identifying it, they're starting to realise that it might be more common than was originally thought.6  

Common triggers and causes

Different studies state the common triggers and causes of scolionophobia or school phobia. Some of these triggers and causes include:4 

  • Genetic factors: Children with parents who have anxiety disorders are more likely to show symptoms of school phobia
  • Traumatic separation: Children who experience a traumatic and prolonged separation from their primary caregiver, like losing their biological mother, might develop school phobia
  • Fear of specific school-related aspects: Some children are afraid of specific parts of the school experience, such as riding the bus, eating in the cafeteria, or fears of violence at school
  • Family dysfunction and stressful events: Children in stressful or dysfunctional family situations might feel the need to stay home. For example, a child might fear going to school if they're worried about their mother's safety at home
  • Fear of bullying

Symptoms and diagnostic assessment

Symptoms

Recognising the symptoms of scolionophobia is important for teachers and counsellors to provide timely help to children facing school phobia. 

Some symptoms of scolionophobia may include:4

  • Regular complaints about not wanting to attend school
  • Often arriving late or missing school, especially on important days like tests
  • Asking to call or go home frequently during school hours
  • Constantly concerned about a parent's well-being while at school
  • Visiting the nurse often due to issues like stomachaches, nausea, or headaches
  • Crying often and wanting to go home
  • Finding it hard to be away from parents or caregivers, sometimes showing clinginess, or having tantrums
  • Facing problems falling asleep or having bad dreams
  • Being overly scared of things like darkness, certain animals, or being alone in a room.
  • Real physical symptoms like dizziness, fast heartbeat, or stomach pains that get better when they stay home, and behavioural issues like getting angry easily or even hurting themselves

Diagnostic assessment

Because school avoidance may be heightened or exacerbated by different factors, a complete and detailed assessment should be carried out, including a full medical exam to eliminate organic disorders. A detailed diagnostic assessment should also be carried out by a child psychiatrist or psychologist.7 

The diagnostic assessment performed should involve the following:7

  • evaluate the child’s cognitive, affective and behavioural functioning
  • consist of self-monitoring and self-reporting (some self-reporting tools used with children who have scolionophobia include, Fear Survey Schedule for Children-Revised, the Social Anxiety Scale for Children-Revised, the Children’s Manifest Anxiety Scale and others)8 
  • consist of child and parent interviews
  • consist of behavioural observation at school and home
  • parents blame the school, a change in school may not resolve the phobia. 
  • Family therapy requires the involvement of the child’s family in the development of a treatment plan and even though this therapy has proven effective in some cases, studies show that family therapy is not a key treatment of scolionophobia.8 

Treatment and Management

Therapeutic approaches

Cognitive-Behavioral Therapy (CBT)

This form of treatment involves a combination of cognitive therapy and behavioural techniques. The CBT approach is based on the theory that faulty cognitive processing exhibited by the child may be a causal factor of anxiety.8  Regarding scolionophobia, it is reasoned that the child usually sees an aspect of going to school as dangerous (it could be that it’s harmful to the child in school or harmful to the caregiver at home) and feels that he/she is not capable of controlling the situation.

In CBT, the clinician helps the child to identify and monitor all their statements that usually result in anxiety about school attendance. The clinician then replaces these statements that result in anxiety with opposite and positive statements that show the child how the anxiety decreases once the positive statements are used instead. After this is established, the clinician then draws up an action plan with detailed steps to be taken to achieve an effective and long-lasting return to school.

Family therapy

Family influence is a huge and important factor that must be considered when developing a treatment plan for scolionophobia.8 It is only when a child sees that his/her family/parents are completely dedicated to ensuring a return to school will real progress is made.9 

Self-help strategies

Children/people with scolionophobia should be encouraged to be gradually exposed to school until they are fully comfortable to completely resume school attendance. Where this is not possible straight away, they should be encouraged to practice modelling (simulation of going to school), and role-playing and some cognitive approaches should be adopted.8 

Pharmacotherapy

Studies have shown that pharmacotherapy in scolionophobia is under-researched, controversial, and has little place in the treatments available.8  Scolionophobia has been said to be related to major depressive disorder and/or separation anxiety, so, some studies state that the use of Imipramine, an antidepressant which reduces panic attacks in addition to behavioural techniques could improve the treatment in a child. However, these drugs have side effects such as weight loss, and nausea and are toxic when an overdose is taken and this could be detrimental to the child.

There have also been other studies where antidepressants and anxiolytics were used in the treatment of scolionophobia but due to the lack of evidence of their efficacy in the treatment and the unwanted side effects, it has been advised that these medications be avoided.

Prevention

Early intervention

Early intervention involves dealing with the problem (scolionophobia) while it has just begun to develop in a person. The child could be making excuses to stay home or he/she could get upset on Sunday nights thinking about Monday morning. By stepping in early, parents, teachers, and counsellors can chat with the child about their fears. This helps in understanding the real reasons behind their worry and addressing them before they become bigger issues. It's like seeing a small spark and putting it out before it becomes a fire.

Education and awareness

Education and awareness are about tutoring everyone such as children, parents, schoolteachers, and including the community,  about scolionophobia. It's like when everyone knows about a problem, they can work together to stop it. By understanding that scolionophobia is a real concern and not just" children being children", there is a better chance to support and help those who are struggling. This can be done through workshops, school meetings, or just regular discussions at home. When everyone knows what to look for and how to help, it becomes easier to ensure children feel safe and happy about going to school.

FAQs about scoliophobia

What is scolionophobia? 

Scolionophobia is the intense fear or anxiety related to attending school. It's more commonly referred to as school phobia.

What causes scolionophobia? 

The causes can vary but often include past traumatic events, fear of separation from parents, social anxieties, or fear of specific aspects of school, such as tests or bullying.

How can you tell if someone has scolionophobia? 

Common signs include frequent absences from school, regular complaints about attending, extreme anxiety or panic when thinking about school, and physical symptoms like stomachaches or headaches on school days.

Can scolionophobia be treated? 

Yes, early intervention is key. A combined effort from teachers, counsellors, parents, and school nurses can help devise a treatment plan. Therapies, counselling, and support from loved ones can help a student overcome their fears.

How can schools help students with scolionophobia? 

Schools can provide a supportive environment, involve trained counsellors, and adapt flexible learning plans. Teachers and staff should be understanding and patient, working together with the student and their families to help them feel more comfortable and safe at school. Involve assessment of family dynamics and include reports from parents, teachers, and the school nurse.

Diagnostic assessment is important because physical illness, learning disorders, conduct disorders, and depression all need to be eliminated or confirmed before an individual healthcare plan for the child is established. The child’s self-monitoring is a very important element of the diagnostic assessment because it requires the child to report concurrently his/her feelings and behaviour, and factors that trigger, alleviate or worsen their anxiety, in a daily diary. This enables the clinician to have all the valuable information required.8 

Summary

Scolionophobia, also known as school phobia, is an increasing disorder where students experience severe anxiety and fear related to going to school. If not addressed as soon as possible, it can lead to prolonged school absences, learning issues, social difficulties, and even depression. Early intervention, involving a joint effort from school nurses, teachers, counsellors, and parents, is crucial. School health professionals have a significant role in shaping the treatment plan, using a mix of adaptability, innovation, determination, and patience to help students overcome their fear of school.7

References

  • Eisenberg L. School phobia: diagnosis, genesis and clinical management. Pediatr Clin North Am. 1958 Aug;5(3):645–66.
  • Baker H, Wills U. School phobia: classification and treatment. Br J Psychiatry. 1978 May;132:492–9.
  • Gordon DA, Young RD. School phobia: a discussion of aetiology, treatment and evaluation. Psychol Rep. 1976 Dec;39(3):783–804.
  • Ahmed MS. School Phobia and Its Consequences on School Children: The Way Forward.
  • School phobia and its treatment(1987) [Internet]. Routledge; 2018 [cited 2023 Nov 1]. Available from: https://www.taylorfrancis.com/books/9780203701553
  • Eisenberg L. School phobia: diagnosis, genesis and clinical management. Pediatr Clin North Am. 1958 Aug;5(3):645–66.
  • Tyrrell M. School phobia. The Journal of School Nursing [Internet]. 2005 Jun [cited 2023 Nov 1];21(3):147–51. Available from: http://journals.sagepub.com/doi/10.1177/10598405050210030401.
  • Elliott JG. School refusal: issues of conceptualisation, assessment, and treatment. J Child Psychol Psychiatry. 1999 Oct;40(7):1001–12.
  • Berg I. Absence from school and mental health. Br J Psychiatry [Internet]. 1992 Aug [cited 2023 Nov 2];161(2):154–66. Available from: https://www.cambridge.org/core/product/identifier/S0007125000138930/type/journal_article

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