School Phobia, Panic Attacks and Anxiety in Children - part 1 potx

School Phobia, Panic Attacks and Anxiety in Children... Chapter 2 Anxiety Disorders 39 Chapter 4 Separation Anxiety 86 Chapter 6 Positively Dealing with the Child’s Chapter 7 When the Ch

School Phobia, Panic Attacks and Anxiety in Children

Helping Children to Build Self-Esteem

A Photocopiable Activities Book

Stop the Bullying

A Handbook for Schools

Ken Rigby

ISBN 1 85302 070 3

School Phobia, Panic Attacks and Anxiety in Children

Márianna Csóti

Jessica Kingsley Publishers

London and New York

All rights reserved No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988

or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1P 9HE Applications for the copyright owner’s written permission to reproduce any part of this publication

should be addressed to the publisher.

Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution The right of Márianna Csóti to be identified as author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988.

First published in the United Kingdom in 2003

by Jessica Kingsley Publishers Ltd

116 Pentonville Road London N1 9JB, England

and

29 West 35th Street, 10th fl.

New York, NY 10001-2299, USA

www.jkp.com Copyright © 2003 Márianna Csóti

Library of Congress Cataloging in Publication Data

A CIP catalog record for this book is available from the Library of Congress

British Library Cataloguing in Publication Data

A CIP catalogue record for this book is available from the British Library

ISBN 1 84310 091 6 Printed and Bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear

Chapter 2 Anxiety Disorders 39

Chapter 4 Separation Anxiety 86

Chapter 6 Positively Dealing with the Child’s

Chapter 7 When the Child is Severely Affected by

Anxiety and Related Problems 186 Chapter 8 First Steps in Recovery: Letting Go 221 Chapter 9 What to do if the Child Regresses 227

This book is dedicated to my daughter

and all other children who have had, or currently suffer

from, problems outlined in this book.

I should like to thank Chris and Fiona Woods for all their help in our time of need, it remains much appreciated.

I should also like to thank Dr Gill Salmon, Consultant Child and Adolescent Psychiatrist and Senior Lecturer in Child and Adolescent Mental Health, for her considerable and invaluable help in the final stages of writing this book.

No official statistics are available for children suffering from school

phobia in the UK However, according to Anxiety Care (see Useful

Contacts) the number of children who dislike school, and avoid it

whenever possible, is probably more than five per cent of the school agepopulation; but less than one per cent could be genuinely called schoolphobic The Royal College of Psychiatrists suggests that between fiveand ten per cent of children and young people have anxiety problemsbad enough to affect their ability to live a normal life

This book gives information and advice to parents and carers of, andprofessionals working with, children aged 5 to 16 who suffer fromanxiety disorders, especially separation anxiety and social phobia thatare part of school phobia (see Chapter Two) Chapter One includesphotocopiable pages for professionals, and parents and carers, to give toteachers to help them understand the anxieties some children haveabout school

Occasionally, a child who has suffered from school phobia inprimary school has it recur in secondary school, often in a differentform This book helps parents, carers and professionals support children

of any age to recover from school phobia, guard against recurrence, andguard against it starting with a younger sibling It also has many practi-cal tips

My interest in writing this book is largely personal My owndaughter suffered severely from school phobia, starting just before hersixth birthday and coming through about nine months later Shesuffered most of the symptoms mentioned in this book and became a

7

sickly child from constant stress and lack of food Her ability to functionoutside the confines of her home became extremely limited and herfears affected her whole life, which affected ours During the extremes

of her suffering, she attended school only part time on health grounds

I found out that most of the people I turned to for help did not knowhow to give it Some were unwilling to even try As one who likes toproblem-solve, I worked hard at finding my own solutions and hadthese confirmed by my daughter and the child and adolescent psychia-trist to whom she was referred after persistent requests The practicaladvice given in this book has come from my own experiences with mydaughter

It was only when I heard of other children suffering from schoolphobia that I realised it was a more common problem than I’d thoughtand I wanted to share what I had learnt with others to limit the damage

to all involved, but most particularly to the children vulnerable in theirdistress

The reasons for school phobia to play a part in any child’s life arevaried but the theme that is common to all is stress that the child isunable to handle The quickest way through is to remove the stress,allowing the child to relearn that the things he or she now perceives asdangerous are completely safe If this is not possible, the child must behelped to deal with the stress and understand why he or she has suchfears and learn to keep them under control

The stresses in my own daughter’s life that led to school phobiawere the following:

• We had moved to a 12th-century castle to be houseparents tostudents that lived in that part of the college The buildingwas noisy with wind, doors banging, voices echoing incorridors, flag pole wire banging against the pole, the collegerescue services’ call-out siren (which was an old World War

II siren sited above my daughter’s bedroom), fire alarms(there was a beeper in my daughter’s bedroom) and doorbells

on both floors of our accommodation (one of which wasfixed to my daughter’s bedroom door)

• Drizzle, fog, flies, wind blowing in particles and detectorfaults continually set off the over-sensitive fire alarms

8 SCHOOL PHOBIA, PANIC ATTACKS AND ANXIETY IN CHILDREN

Consequently, my daughter became very afraid of fire, ofalarms, of being burnt, of going to sleep and of being leftalone.

• My daughter heard students’ footsteps coming up the stonestairs and was afraid someone would come into her room.(Strangers had wandered into our flat more than once to lookaround, having ignored all the private signs at the gates.)Consequently, my daughter became very afraid of strangerscoming in, being burgled and, again, of going to sleep and ofbeing left alone

• Her bedroom had large shadows from the various arches anddoorways and this made her afraid of things lurking in thedark

• She had a bad bout of croup and vomited before and duringher journey to hospital in the ambulance She developed afear of being sick, of being ill and of dying

• There were three deaths she knew of before her troublestarted and another, a friend of her father’s, later in the year.This increased her fear of illness and dying

• For some time she had an undetected urine infection thatmade her need to frequently visit the toilet She worriedabout needing to go when there wasn’t a toilet For a yearafter her infection had cleared up she continued to go to thetoilet with great frequency, especially when she was anxious.(This was the last symptom of her anxiety to go.)

• She stepped in dog mess one morning before getting ontothe school bus and it made her feel sick She connectedvomiting in the ambulance with being sick on the school busand was afraid to travel on the bus again

• She was sent home from school three times as soon as shearrived because teachers thought she was ill, but she was justanxious This increased her concern for her health, refusing

to believe me when I told her she was fine

The combined effect of these events made my daughter anxious aboutleaving home and not being in the same room as either my husband or

me when at home, needing to follow us everywhere

Nine months later she was a different child, having 90 per centrecovered It helped that the student house in the castle closed and wewere moved to be houseparents to students who lived adjacent to ournew family house, but she had started to recover six months before Themove had just speeded up her recovery She did briefly regress threeyears later but all was resolved within three weeks and this prompted me

to write Chapter Nine

Just because a child is shy or anxious about some things or tions, it is important not to label his or her whole character as such.There can be many facets to a child For example, my daughter remains ashy child with new adults but is outgoing with friends and people sheknows well She developed an early taste for scary theme park rides onwhich many of her friends could not contemplate going There are otherglimpses of a determined and fun-loving personality that we try to build

situa-on, trying not to be over-protective and encouraging her to be ally challenged so that she is moving forward, but without pressurisingher We show our expectation that she will be fine If she expresses adesire to do something, and it is within our power to agree (withoutthere being concrete reasons to disagree), she is encouraged to go for it

continu-Author’s note

Although professionals use the term school refusal, and sometimesschool avoidance, throughout this book this condition has beenreferred to as school phobia This is to avoid confusing truancy with ananxiety problem, and because many parents and carers think of a child

as having school phobia, discuss the problem with others using thisterm and, in using it, the underlying fear the child has is immediatelyunderstood

A chapter has been included on general information about anxiety,

as school phobia is a result of extreme anxiety in children and is acomplex disorder Many anxiety disorders coexist or are linked in someway

Because anxiety is such a big problem for children with Aspergersyndrome, and many children with it experience a high degree of school

10 SCHOOL PHOBIA, PANIC ATTACKS AND ANXIETY IN CHILDREN

phobia, information that is specific to understanding and helping thesechildren through their particular fears has also been included Childrenwith Asperger syndrome need to be handled differently to childrenwithout; for example, desensitisation (graduated exposure) may causefurther distress in an Asperger child yet can help a child without thesyndrome.

However, it is accepted that children with AD(H)D (attention deficit(hyperactivity) disorder) and other conditions such as learning disabili-ties are also more prone to anxiety and anxiety disorders Part of thismay be because of having to deal with their condition, often in an envi-ronment where the people around them do not understand their diffi-culties or because they have not had their condition diagnosed and soare not on the road to help Some children do not neatly fit into any onecategory as many have more than one condition, thus professionals may

be reluctant to make any firm diagnosis at all which means the childcannot be statemented with special educational needs Or professionalsmay be reluctant to look further after applying one label to a child,which can also mean that the child does not get appropriate help Part ofthe difficulty in diagnosis is that children with, for example, AD(H)Dhave symptoms that overlap with the symptoms of other conditionsincluding Asperger syndrome Like children with Asperger syndrome,children with AD(H)D can have problems with social skills, makingfriends and co-ordination, so some of the advice given to adults dealingwith anxiety in children with Asperger syndrome is also applicable toAD(H)D children (such as helping with improving the child’s socialskills)

Whatever the reason for a child’s anxiety, this book will help adultsinvolved with the child understand the havoc that anxiety can wreakand the distress it causes the sufferer, so that they are more tolerant andcan assist the child in coping with his or her anxieties

Chronic fatigue syndrome (CFS) – also known as myalgicencephalomyelitis (ME) – in children is often confused with anxiety orschool phobia and parents and carers of children with CFS have oftenbeen accused of enabling them to truant by professionals who do notunderstand the condition or cannot make a diagnosis of what is wrongwith the child Because of this, children with CFS have also been men-tioned

To avoid the continual use of he/she in this book, ‘she’ has beenused to encompass both sexes except in sections that refer to autisticspectrum disorders as this difficulty mainly occurs in boys And to avoidthe continual use of parent/carer, the word parent has been used tomean any adult who is in the position of being the main carer for thechild This person may be her natural birth parent, her adoptive or fosterparent, an adult that looks after children in care or another relative such

as a grandparent When the word parents is used, this may mean either acouple or one person who has responsibility for the child

All the web addresses listed in this book were checked prior to lishing As time goes on, the list will become inaccurate although theaddresses for organisations are not likely to change

pub-12 SCHOOL PHOBIA, PANIC ATTACKS AND ANXIETY IN CHILDREN

Chapter One

School Phobia

School phobia is not a true ‘phobia’ It is far more complex and caninvolve a range of disorders including separation anxiety, agoraphobiaand social phobia, although the anxiety is centred around the schoolenvironment In reality, the school phobic child is usually afraid ofleaving the secure home environment, and the safe presence of the maincarers

A young child suffering from separation anxiety may suffer the samesymptoms when being left at a friend’s home as being left at school Achild suffering from agoraphobia may suffer the same symptoms in acinema as on the school bus And another child, suffering from socialphobia, might have the same symptoms when asked to read aloud in aplace of worship, for example; so it is not only the school that causesthese distressing symptoms

However, since these symptoms of distress occur so regularlyaround the school environment, it is not always clear what is causing thechild’s turmoil and the child may be so severely affected that she cannotattend school; the general condition is conveniently termed schoolphobia Some professionals prefer to call this school refusal or schoolavoidance but, again, confusion can come about if people think that thisincludes truants who experience no anxiety about school and who feel

no guilt or anxiety for not having attended

13

Is the child truanting?

School phobia is an umbrella term for children who do not want to go toschool because of anxiety and their anxiety keeps them at home This iscontrasted with truanting children who intentionally do not go toschool and who usually do not stay at home (and truanting older adoles-cents often show anti-social behaviour, such as being involved incriminal activities).1Other children may simply prefer to be at homeplaying, finding it more interesting than being in school and so try toget their parents’ permission to be at home, but also do not experiencefear

School phobic children who do not attend school because theirsymptoms are so severe are not truants, because they have a specificanxiety about school and they remain at home with their parents’knowledge and, perhaps, presence These children are children withspecial needs and should be dealt with in a sensitive and caring way asthey are likely to be very sensitive and timid, feeling afraid of being per-ceived as failures.2

The types of school phobia

There are two types of school phobia.3The first is related to separationanxiety (see Chapter Four) and is generally found in children up to ageeight (although older children can suffer from this too: the longer sepa-ration anxiety continues, the more difficult it is to treat) The youngerchild is less likely to have learnt to feel confident and to be independentaway from her parents The onset of separation anxiety is usually sudden

in children who have had it naturally subside after the age of three1

although it can start from the age of six to eight months and continuethereafter

The second type predominantly affects children above age eight andrevolves around the social aspects of the school and can be considered to

be social phobia (see Chapter Five) The onset of this is gradual and canstart from increased self-awareness around the time of puberty.4

Sometimes, travelling to school is the problem; the child may sufferfrom agoraphobia (see Chapter Two) However, this is usually an exten-sion of other anxiety problems the child has and so it would probablyalso be present in a child who has separation anxiety The child maywant her parents to drive her to school, fearing that something embar-

14 SCHOOL PHOBIA, PANIC ATTACKS AND ANXIETY IN CHILDREN