孩子们"厌学症"的极端表现

What child hasn't dreaded September, the end of summer and the return to school. But for some kids, the prospect of school produces a level of fear so intense that it is immobilizing, resulting in what's known as school-refusal behavior.

These are the kids who may be absent for weeks or months. Some may cry or scream for hours every morning in an effort to resist leaving home. Others may hide out in the nurse's office. Some kids who miss school are simply truant -- they'd just rather be doing something else. But in about two-thirds of cases, a psychiatric problem, most commonly an anxiety disorder, is the cause, according to research led by Christopher A. Kearney, professor and director of clinical training at the University of Nevada, Las Vegas.

Anywhere from 5% to 28% of children will exhibit some degree of school-refusal behavior at some point, including truancy, according to Dr. Kearney, a leading authority on the behavior, and other experts. For kids with anxiety-fueled school refusal, the fear is real and can take time to overcome. Families may struggle for months to help a child get back into the classroom. Ignoring the problem, or failing to deal with it completely, can lead to more-serious problems later on.

School-refusal behavior isn't just a U.S. phenomenon: Researchers from France to Finland have studied it, and it has garnered particular attention in Japan, a country known for academically rigorous schooling.

The problem affects the whole family. 'If your kid doesn't go to school, it is hard for you to keep your job,' says Helen Egger, assistant professor in the department of psychiatry and behavioral sciences at Duke University Medical Center, Durham, N.C. Kids are at heightened risk when starting a new school, and especially when entering middle school. 'It is the perfect storm with the onset of puberty, a huge transition and a much wilder academic environment,' says Dr. Kearney.

Well-meaning parents can make things worse, psychologists say, by allowing an anxious child to miss school, attending school with them as, for example, a classroom volunteer -- or home-schooling. Such accommodations send the message that school is too scary for the child to handle alone and the fear is justified. 'Overprotective parents rush in way too quickly to shield them from any experience that creates distress,' says Karen Cassiday, a clinical psychologist and the owner of the Anxiety and Agoraphobia Treatment Center in Chicago, Ill.

Untreated, a child with school-refusal behavior is likely to fall behind academically, which can then lead to more anxiety. And there may be longer-term consequences. A 1997 study, published in Comprehensive Psychiatry, followed 35 7- to 12-year-olds treated for school refusal. Twenty to 29 years later, they were found to have had more psychiatric treatment and to have lived with their parents more often than a comparison group.

Some kids with unresolved anxiety may go on to self-medicate with alcohol and drugs. A 2004 study in the Journal of Consulting and Clinical Psychology followed 9- to 13-year-olds who were treated for an anxiety disorder. Seven years after treatment, those who still had the disorder drank alcohol more days per month and were more likely to use marijuana than those whose disorder had resolved.

School refusal 'takes the child off their developmental course,' says Anne Marie Albano, associate professor of clinical psychology and psychiatry at Columbia University, New York. 'They are not going to grow in an age-appropriate way.'

Kids with school-refusal behavior may have separation anxiety, a fear of being away from their parents, or a social phobia, an inordinate fear of being judged, being called-on in class or being teased. A specific phobia -- fear of riding the bus, walking past a dog or being out in a storm -- may be present. Other children are depressed, in some cases unable to get out of bed.

Because many kids complain of headaches, stomachaches or other physical symptoms, it can be difficult to tell whether anxiety, or a physical illness, is to blame. One indicator: Anxiety-fueled ailments tend to disappear magically on weekends.