FAMILY RELATIONS IN THE DEVELOPMENT OF SCHOOL PHOBIA DR. WALDFOGEL: While school phobia has been recognized as a distinct disturbance of childhood for several decades, relatively little discussion of this problem has appeared in the literature. In most published reports the number of cases described has been small, and there seems to be some disagreement among the various authors regarding both its course and treatment. Although school phobia in its acute form does not occur very commonly in children, it can, once entrenched, become one of the most crippling disorders of childhood, with the principal symptom persisting indefinitely.Our desire to increase our clinical effectiveness in dealing with this acute problem was one of the principal reasons for undertaking the present investigation. While our central purpose has been to explore possibilities for more effective treatment and management through closer cooperation of the school and clinic, we have not confined ourselves to therapeutic considerations alone. We have also been interested in learning more about both the etiology and epidemiology of this disturbance, particularly as they shed light on such basic theoretical issues as the specificity of symptom choice, the relation between the structure of personality and symptom formation, and the dynamics of parent-child relatipships in the development of neurosis.The term school phobia refers td'reluctance to go to school as a result of a morbid dread of some aspect of the school situation. The fear may be attached to the teacher, the other children, the janitor, eating in the lunchroom, or almost any detail of school life. It is invariably accompanied by somatic symptoms, usually involving the gastrointestinal tract, but sometimes including such diverse symptoms as sore throat, headache, or leg pains. The somatic complaints are used as a device to remain a t home, and often disappear once the child is assured that he does not have to attend school. The most typical picture is that of a child nauseated and vomiting at breakfast or complaining of abdominal pain, resisting all attempts at reassurance, reasoning, or coercion to get him to school. Often other phobic symptoms may accompany the fear of school-fear of animals, fear of noises, night terrors, etc.During the period of this study, 53 cases of school phobia of varying de-*

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Forty‐nine school‐phobic children were re‐evaluated five to ten years after the original contact. Assessments were made of school attendance and adjustment, subsequent development, adolescent attitudes toward family, heterosexuality and independence. Only two have not returned to school. The children are divided into three groupings: those with no limitations, those moderately limited and those severely limited, in their subsequent development.

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F 52 asthmatic children studied in the Massachusetts General Hospital, 0 3 were chosen for this presentation because their mothers were likewise asthmatic. They demonstrated in strong relief certain dynamic features pertaining to the basic conflicts of the mother-child relationship of the other asthmatic children in the series. Fragments of 3 cases are presented.Case 1. Martha, 61, the elder of two girls, was hospitalized for the second time with severe status asthmaticus. The asthma disappeared rapidly. It was believed separation from mother was a decisive factor and psychiatric referral was recommended.Mother was an intelligent woman of 34 who dressed carefully and in taste. She had a pleasant controlled faGade, but the underlying anxiety was evident, and behind her smile there was a worried look which made her appear older than her age. She still saw her mother almost daily and was dependent upon her opinions. There was a guilty strain of resentment toward her which expressed an underlying feeling that her mother had never done enough for her. Mother, like Martha, was the elder of two girls. Her younger sister, like her younger daughter May (at the time of referral), was asthma-free and healthy. Mother always felt her sister had been preferred; although she herself had received much attention, she felt it was because she was sick. She resented her mother's having "made" her an invalid and handicapped her more than necessary, but now found that she herself fostered the same invalidism and exaggerated protection that her mother had demonstrated toward her.Mother's asthma started when she was six. I t kept her from participating in many activities with other children and she had consequently lived a rather quiet, restricted life. Her parents tried to make up for this lack of social contact in other ways. She considered her asthma in some ways "a blessing in disguise'' and thought that if she had not had it, her life "would probably not have been so happy." She probably would not have met her husband, might have gone out a great deal and gotten into "all sorts of difficulties as some of the other girls did." The asthma was particularly severe during adolescence and early marriage. At this time she was nursed by her husband.