SCHOOL PHOBIA IN OLDER CHILDREN AND ADOLESCENTS: DIAGNOSTIC IMPLICATIONS AND PROGNOSIS

A series of 20 cases of school phobia in older children and adolescents was analyzed and categorized into three diagnostic groups: neurotic, organic and schizophrenic. Important differences were noted between neurotic and schizophrenic patients, particularly with respect to the malignant psychiatric symptoms, high intelligence and relapsing tendency of the schizophrenic group. The features common to all groups were pathological maternal attitudes, somatic complaints, anxiety and depression, rarity of prior history of significant anxiety about school, and favorable response to treatment. The symptoms most amenable to treatment were anxiety (both sexual and separation), depression, somatic complaints, and school phobia. With alleviation of these symptoms, there followed an improvement in physical health, school achievement, and social adjustment. Regular school attendance was achieved without coercion in 18 patients. A long-term follow-up averaging 5 years showed sustained improvement in 18 patients. School phobia in late childhood and adolescence is a different syndrome from that in early childhood, and it has graver diagnostic implications.