by
Dany Ghassan Charbel, Msc
Robert W.D. Gorter, MD, PhD.
August 30th, 2024
Back to School Separation Anxiety
Some children find it difficult to be apart from their parents or another caretaker. With separation anxiety, this is often because of a fear that they will not see each other again. Sometimes the fear is that the child may be harmed in some way if their parent is not around, and other times it may be the opposite – the child may fear that their parent or caretaker may be harmed. This makes it difficult for these children to take part in activities and they may become withdrawn and ruminate.
School Refusal
School refusal is not a Diagnostic and Statistical Manual of Mental Disorders (DSM–5) diagnosis. It is described as a symptom that can be associated with several other diagnoses, for example, social anxiety disorder, generalized anxiety disorder, specific phobia, major depression, oppositional defiant disorder, post-traumatic stress disorder, adjustment disorder, among others. School refusal describes the disorder of a child who refuses to go to school on a regular basis or has problems staying in school. Children may avoid school to cope with stress or fear for a vast number of reasons.
School refusal is a challenge for children, families, and school personnel. Failing to attend school has significant short and long-term effects on children’s social, emotional, and educational development.
Main Reasons of School Refusal
If the child has been home for a while, for example during summer vacation, another holiday break, or a brief illness, it may trigger the problem. A stressful event like the death of a pet or relative or moving to a new house may also precipitate the condition. When a child does not want to go to school often says they are sick. When they wake up in the morning, they complain of having a headache, stomachache, or a sore throat.
Stressful life events like moving or starting a new school, among others may trigger School Refusal. Other reasons include the child’s fear a parent being harmed once they are in school or fear that they may not do well in school, or they may be afraid of another student
Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are sometimes called internalizing disorders.
1. What is bullying?
The incidence of bullying and its detrimental effects are often underestimated. Therefore, we want to pay attention to the phenomenon itself and the cause of psychological and physical complaints and illness.
Bullying (mobbing)…
• is verbal, physical and/or psychological aggression.
• is open and/or concealed violence against people.
• lasts for a long time.
• has the aim of deliberately excluding or destroying someone.
• occurs more frequently in control-free spaces and in hierarchically structured systems.
• symbolizes the power imbalance between perpetrator and victim.
• is a systemic problem.
Bullying does not mean when two children or young people of almost equal strength argue, fight or have a conflict.
2. When does one speak of bullying?
Bullying often begins gradually. A student is bullied when an individual classmate or a group repeatedly
• says mean or unpleasant things to him/her over a longer period of time.
• repeatedly teases him/her in a mean way.
• makes him/her look ridiculous in front of others.
• acts as if he/she is not there.
• threatens or puts pressure on him or her.
• locks him or her in a room.
• takes things away from him or her.
Over time, the bullying behavior increases in frequency and intensity. There is a shift in norms within the class that redefines the boundaries of social interaction to the detriment of the person being bullied. It has become normal to pick on XY.
3. How widespread is bullying?
Selected studies on bullying show that on average three children in every class are affected by bullying.
• 17.7% of children are bullied at school and one in ten is made fun of.
• One in every nineteen students experiences physical violence in everyday school life.
• Bullying occurs more frequently in the first two years after changing schools. (Pisa study 2017)
But it is also true that three out of four young people (75 percent) feel an above-average sense of belonging to their school and their classmates and 85 percent rule out being an outsider or being “ignored” in everyday school life.
4. How is bullying done?
Bullying is diverse and can take on mixed forms.
• Physical bullying: The perpetrator constantly gives the victim head butts or blows to the neck.
Relational bullying: A student repeatedly spreads rumors about a classmate.
• Destroying objects: A student constantly kicks the victim’s school bag during recess.
• Verbal bullying: A student constantly insults the victim in front of the whole class.
• Cyberbullying: A student insults a classmate on social networks and asks others to spread the word.
• Girls bully more often by excluding, teasing and spreading lies.
• There are no significant differences in the number of violent acts committed between children and young people with and without a migrant background.
5. Can certain factors increase the risk of bullying?
The following conditions can encourage the emergence and maintenance of bullying:
• high pressure to perform
• school stress or boredom
• perceived insufficient social support
• uncooperative school climate
• disturbed social relationships
• teachers are not contact persons
• lack of rules and agreements, or failure to comply with them
• lack of prevention and intervention
• loveless and unattractive outdoor facilities and school rooms
The risk of bullying is increased more by external factors than by personality factors of the victim. This can be the route to school or “dark” spots on the school premises. We recommend that school teachers create a map of their school and document incidents in the schoolyard on the map over a certain period of time.
6. How do I know that someone may be affected by bullying?
Long-term bullying can have serious consequences for the victim. Recognizing bullying early on helps to prevent it from becoming entrenched.
The following areas can be affected:
• physical damage = e.g. injuries
• psychological damage = e.g. destruction of self-confidence
• psychosomatic reactions = e.g. loss of appetite, stomach aches, nightmares, sleep disorders
• other reactions = e.g. lack of concentration, days off due to “sick days” or skipping school, withdrawal from social relationships, anxiety, depression
Mobbing victims behave anxiously or insecurely, are avoided in study and work groups, and are often alone when eating or during breaks. Some children and young people are at risk of suicide.
Fear of School
Fear of school is defined as “Resisting school-age child not to go to school, not accepting friends and carrying out behaviors like crying” and according to research, 4 out of 5 children have problems on the first days of school.
Starting school for a child is the first step of entering the social environment outside of his family. According to his/her parents, the main reason for the child’s fear of school is leaving him there and not picking him up again. Therefore, some children may develop school phobia. In fact, what is feared is not only the school, but the fear of losing the child’s trust, control, nutrition, approval, protection.
In these children, which we frequently encounter in schools, movements such as loss of interest and energy, irritability, introversion, crying without reason, complaints of headache and abdominal pain can be observed.
Anxieties in regards to getting infected with childhood diseases and pandemics
Usually induced by the teachers and the parents at home, the more the parents and the teachers express their fears and support of forced vaccinations, children fear to go to school and fear to be injected more and more often.
Treatment plan
A range of empirically supported exposure-based treatment options is available in the management of common disorders among children back to school. Treatments include cognitive behavior therapy, educational-support therapy, pharmacotherapy, and sometimes parent-teacher interventions. Providers may provide psychoeducational support for the child and parents, monitor medications, and help with a referral to more intensive psychotherapy
References:
Kearney CA. School absenteeism and school refusal behavior in youth: a contemporary review. Clin Psychol Rev. 2008 Mar;28(3):451-71.
Lingenfelter N, Hartung S. School Refusal Behavior. NASN Sch Nurse. 2015 Sep;30(5):269-73.
Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects. Behav Modif. 2004 Jan;28(1):147-61.
Studienreferate
Begünstigen entwicklungsneurologische oder psychiatrische Defizite Mobbing?
Pädiatrie up2date 2024; 19(02): 95-96 DOI: 10.1055/a-2284-9098
PK Smith, P Brain – Aggressive Behavior: Official Journal of the …, 2000 – Wiley Online Library: Bullying in schools: Lessons from two decades of research
N Moyano, M del Mar Sanchez-Fuentes – Aggression and violent behavior, 2020 – Elsevier: Homophobic bullying at schools: A systematic review of research, prevalence, school-related predictors and consequences
I Orue, E Calvete – School psychology review, 2018 – meridian.allenpress.com
… between homophobic attitudes and homophobic bullying in school. In … homophobic bullying at school and to homophobic language at home predicts homophobic attitudes and bullying