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 Vol. 27 No. 2, February 2006
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(Pediatrics in Review. 2006;27:56-63.)
© 2006 American Academy of Pediatrics

Separation Anxiety Disorder and School Refusal in Children and Adolescents


Gregory L. Hanna, MD*
Daniel J. Fischer, MSW{dagger}
Thomas E. Fluent, MD{ddagger}
 * Associate Professor of Psychiatry; Director, Section of Child and Adolescent Psychiatry, University of Michigan Medical School, Ann Arbor, Mich
{dagger} Chief Social Worker, Section of Child and Adolescent Psychiatry, University of Michigan Medical School, Ann Arbor, Mich
{ddagger} Clinical Assistant Professor; Director, Child and Adolescent Psychiatry Training Program, University of Michigan Medical School, Ann Arbor, Mich
The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the relationship of separation anxiety to school phobia or school refusal.
  2. Explain the developmental appropriateness of separation anxiety in the preschool child and during the first months of school.
  3. Discuss the family dynamics of separation anxiety disorder.
  4. Distinguish between separation anxiety disorder and truancy as a cause of school absence.
  5. Describe the etiologic role of the parent (often the mother) in separation anxiety disorder.
  6. Develop a therapeutic plan for abnormal separation anxiety.


   Case Study
 
JC is a 9-year-old boy who lives with his mother and attends the third grade, where he is an A student. During the last 2 weeks, he has refused to go to school and has missed 6 school days. He is awake almost all night worrying about going to school. As the start of the school day approaches, he cries and screams that he cannot go, chews holes in his shirt, pulls his hair, digs at his face, punches the wall, throws himself on the floor, and experiences headaches, stomachaches, and vomiting. If he attends school, he is less anxious until bedtime. As his separation anxiety has increased, he has become gloomy, has stopped reading for fun, and frequently worries about his mother’s tachycardia.

JC was seen once by a psychiatrist at age 3 years for problems with separation anxiety. He did well in preschool and kindergarten. He was seen at a community mental health center during the first grade for school refusal, but did well again during the second grade. In addition to having recurrent symptoms of separation anxiety disorder, he is phobic of dogs, avoids speaking and writing in public, and has symptoms of generalized anxiety disorder and obsessive-compulsive disorder. His mother has a history of panic disorder.


   Introduction
 
Pediatricians are familiar with separation anxiety as a . . . [Full Text of this Article]






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