Absence from School and Mental Health

Abstract

Severe school attendance problems, which once commanded a great deal of attention in child and adolescent psychiatry, have fallen from favour and are increasingly viewed as varieties of social impairment which may accompany disorders such as anxiety disturbances in the case of school refusal and conduct disturbances in the case of truancy. It is argued that this relegation of school attendance difficulties may have gone too far. As presenting complaints, albeit sometimes masked by apparent physical illness, they still have much to recommend them as indicators of a wide variety of present and future problems: educational, social, family, legal, medical, and, last but not least, psychiatric. Prevalence, features, causative factors, outcome, and management are discussed. Particular attention is paid to DSM and ICD classification. Gaps in present knowledge are indicated.

Maternal mental illness and mother-child relations

“…Children who do not attend school regularly are at increased risk of every indicator of adversity, including non-accidental deliberate selfharm, marital breakdown, depression and substance misuse (Berg, 1992). Children who stay at home (school refusers) are more likely to suffer from anxiety disorders, while truancy is related to delinquency, though there is considerable overlap.…”

What is wrong with Sandy???!!!! Is She Seriously Ill??? School Refusal; is it a Diagnosis or a Presenting Complaint???

“…It is also worthy to remember that some parents may prefer to keep their children out of school if they do believe that education is useless or when they need their help either at home if they are ill for instance or to gain some money by forcing them to work if they are poor [1,4,8,9].…”

“…On the other hand, some children have low self-esteem and are unconfident about their performance in different school activities that make academic and social demands very stressful to them and lead to an irresistible fear from going to school. Although school refusal sufferers in general have average intelligence and satisfactory academic abilities, their academic performance may deteriorate if their fears keep them away from school for a considerable length of time [4,7,8].…”

“…After the detailed problem identification, intervention must be tailored individually and it entails a combination of Cognitive Behavior Therapy, Family Therapy, Pediatric Mental Health Education liaison, and appropriate medications for any discovered associated pediatric mental disorder [1,[6][7][8][9].…”

“…On the other hand, school refusal may be a presenting complaint of an underlying pediatric mental disorder as separation anxiety (especially among young children), specific phobias (related to school activities, the trip to and from school, a fear of bullies or an aggressive teacher, etc…. ), depression (especially in teenagers), and rarely psychosis (in adolescents) [4,[7][8][9].…”