There is no consensus on figures because there is no agreed definition of the condition, but several studies estimate that it affects around 1 per cent of the school population. However, some educational psychologists and people running special units for phobics believe they are picking up growing numbers of cases. Whether this is because schools are becoming more alert to the nature of non-attendance or more children are becoming distressed about going to school is unclear. What is certain is that tackling school phobia is a time-consuming, complex - and important - business.
What is school phobia?
Many schools and local authorities still make no real distinction between school refusers and phobics, although the phenomenon was first alluded to in the 1930s. At that time, a form of truancy was described in which a child was absent for periods varying from several months to a year; in which the absence was consistent; in which parents knew the child's whereabouts; where the reason for the truancy was incomprehensible to parents and the school, but the child said he or she was afraid to go to school. The main difference between refusal and phobia appears to be the level of the child's anxiety. A phobic child will have panic attacks and display excessive fear, misery or complaints of feeling ill without obvious cause when faced with the prospect of school; he or she will probably be at home with parental consent and, as opposed to truants, will tend to display no behavioural problems or anti-social disorders such as stealing, lying or destructiveness.
How many children does it affect?
There is no consensus on numbers. But the often quoted figure of 1 per cent of the school population means an average-sized secondary school may have up to 10 phobic children. This is a significant figure given the current high-profile fight to tackle school absence, and the Government's pledge to support schools and parents struggling with a child's non-attendance through mentoring, in-school counselling and case work with outside agencies. Some people working in the field, such as Sue Percival, co-ordinator of a unit for anxious or pregnant youngsters in Stockton-on-Tees, Durham, believe school phobia levels are increasing, especially among 11 to 14-year-olds. The number of phobic or "anxious" pupils taken into the Stockton unit has increased by about 25 per cent over the past few years. Adrienne Clarke, the senior educational psychologist for Herefordshire, also believes she is seeing more cases, particularly at key stage 4, although school phobia remains a small part of her work.
"There is huge pressure at GCSE level; work requirements go up and up, and anxious children tend to go somewhere that is safe and isn't school."
Brian Harrison-Jennings, general secretary of the Association of Educational Psychologists, believes the term is being applied too widely, and says true school phobics - those with irrational fears of school - are few and far between. "Children who are frightened to go to school because of bullies, or because they believe their sick mother might die while they are away, are not phobic; their fear has a rational explanation," he says.
What causes school phobia?
In the early infant stages, it tends to be triggered by separation anxiety; the young child's extreme fear of being parted from his or her parents.
This kind of school phobia tends to affect more than 1 per cent of children but, as it is associated with a development stage, it can often be dealt with quickly and effectively.
Separation anxiety can also affect vulnerable or sensitive children in the transition from primary to secondary. Difficulties can arise during the second term in secondary school after children have gone through the initial excitement, and the prolonged break over the Christmas holidays. In older pupils, school phobia can be more deep-seated and may be linked to sleeping or eating disorders, and part of a more deep-seated neurosis.
As well as separation anxiety, there are other common triggers. A recent study by the National Foundation for Educational Research, School Phobia and School Refusal: research into causes and remedies, has identified that, apart from separation difficulties, general social anxiety and home problems often underpin school phobia. Local education authorities and schools cite family conflict, a traumatic event at home, pupil illness, violence, abuse or death in the family as common causes.
However, the transition from primary to secondary, a change of school, a specific incident at school - such as bullying - or a specific lesson (PE or games are commonly mentioned where phobia is connected to body image), fear of failure in class work or tests, fear of specific places (crowded corridors or hallways, assembly, cafeteria), anxiety about the journey to school or travel sickness, particularly on school buses, change of pupil groupings, fear of an individual adult at school or specific lesson are all also listed as educational contributory factors.
Felicity Fletcher-Campbell, co-author of the NFER report, says: "Phobics may want to go to school; they may have nothing against educational learning, but something has triggered their fear. Indeed, there may be lots of little triggers. It's a process that builds up and if there is no one they can talk to, it may develop into a phobia."
How long does it last?
Months or years, depending on its causes and how well it is dealt with.
Treatment tends to be swifter and more successful in younger children. Some never manage to return to mainstream schooling. "One girl was referred to us in Year 5," says Sue Percival. "We got her back into mainstream by Year 6 but she was out again in Years 7 and 8. We finally got her back full-time into school in Year 9 and she is now taking her GCSEs and doing well."
Ann Duff is deputy head in charge of pastoral, personnel and inclusion at John Masefield School, a secondary in Ledbury, Herefordshire, which has a special unit for phobic children (see case study). She says dealing with school phobia is never simple or straightforward, and is always time-consuming. "Quite often these children cannot articulate exactly what is keeping them from school," she says. Adrienne Clarke, who handles referrals from John Masefield, says affected children "develop a habit of discomfort about school, which becomes stuck".
How can you spot the school phobic?
They are often sensitive, reserved children who tend to worry. Nigel Blagg is a former senior educational psychologist with Somerset County Council who wrote School Phobia and its Treatment in the late 1980s, a book still used as a reference by many in the field. Mr Blagg, who now runs a consultancy in Taunton, says a school phobic child can, for example, find being asked questions in class or to read out loud causes of immense distress. The pupil may be an only child, or the youngest in a family.
Parents may suffer some kind of separation anxiety themselves, which makes them reluctant to let the child go and, as a result, over-attentive to the child's minor ailments.
Such children are often from close-knit or over-protective families, though often those that value education. They come from across the social range and parents may be at a loss as to why their child will not go to school. A pattern of occasional absences becomes more regular and sustained as the fear becomes entrenched.
Sue Percival says school phobics often have low self-esteem and can lack social skills and the ability to communicate their feelings. Quite often they will refer to bad experiences in their past as if they find it hard to move on. Children are most vulnerable when starting nursery or infant school, again around age 11 during the transition to secondary, and once more at key stage 4.
What are the gaps in policy?
Few schools and local education authorities distinguish between school refusers and school phobics. Less than a third of education authorities identified by the NFER as addressing school phobia said they had any written guidance for school staff or parents. Although more than half had someone within the authority with a specific responsibility for school phobic pupils, there was no consistency as to who this was. In some authorities it was the educational welfare service, in others the educational psychology service or the head of a pupil referral unit. Only one-quarter of authorities routinely collected information on numbers identified as school phobic, and only a handful referred children to the Child and Adolescent Mental Health Service for assessment, largely due to its long waiting lists. Only 17 per cent of schools in the NFER survey identified school phobics as a discrete category of non-attenders. Only one school had any written guidance for teachers on the subject.
How fast should schools act?
They must be vigilant about patterns of attendance. Nigel Blagg believes the habit of a day missed here and there should not be allowed to go on for weeks or months as it becomes "a way of life", and can increase a child's anxiety about peer relationships and falling behind with work. The class teacher, he says, should not hesitate to talk to the child one-to-one to see if there are underlying problems with work or friendships, or at home.
Both parents should also be called in, he says, in case "one parent is unaware that the child is having lots of time off". If grandparents are influential in the family set-up, they too should be called in. If absences continue, a swift referral should be made to the educational welfare service and if a diagnosis is required, the educational psychologist should be promptly involved.
How can it be dealt with?
Schools that are sensitive to school phobia tend to use a range of strategies: support from a designated adult in school; support from other pupils through peer mentoring; a change of class or tutor group; creation of a less threatening environment by providing a special support unit or allowing the pupil to come into school through a quieter entrance at a less busy time in the day; creation of an alternative curriculum; a gradual re-integration through a part-time timetable; scrutiny of peer relationships for bullying.
John Masefield school has set up a learning intervention centre, an on-site unit with a full-time teacher and support assistant, which sanctions part-time attendance. "Part-time attendance is better than none at all. We try to be as flexible as we can," says Ann Duff.
Nigel Blagg, however, believes a rapid, and, if necessary, enforced return to full-time schooling linked to a desensitisation programme is most effective. "Gradual reintegration can indicate to an anxious child that being sent home is a reward and this can reinforce the school avoidance. In some cases, if the pupil can be got back into full-time schooling and helped to stay there, the anxieties diminish in days."
Parents who tend to get tangled up in the phobia need support, he says, to cope with the "extreme levels of distress" that such a return to school might trigger in their child in the short-term. Schools, however, must first be aware of the causes. For example, a phobia that grows out of a bullying incident will not go away until the bullying has been addressed.
Schools must also have contingency planning, with all staff involved, to help a pupil catch up on missed work in a sensitive environment. Careless phrases such as "Glad to see you've decided to join us again" can create enormous setbacks. It is crucial the child is not singled out in any way and that homeschool discussions continue to iron out misunderstandings.
Are PRUs effective?
Some teachers doubt that a pupil referral unit, which may also cater for disaffected children, is the right place for a school phobic. But others, such as Adrienne Clarke, believe that for some phobics the units offer the time to talk about anxieties with more one-to-one attention. Some children who are out of the school system for long periods, she says, respond positively to a fresh environment and will come out of the PRU with qualifications.
Main text: Elaine Williams
Illustration: Thea Brine
Additional research: Sarah Jenkins
Next week: Gender differences in learning