Fad or deep reality? ⋅ Inserm, Science for Health

Multifactorial and difficult to measure, school phobia still suffers from the image of a frivolous, even fictitious, disorder. That’s why a team from Inserm explored the whole of France to shed light on this phenomenon, highlighted by the health crisis.

an article to be found in the magazineInserm #55

Measuring school phobia in France remains difficult, as the National Education Agency only measures absenteeism at four and a half days of unjustified absence per month. According to the information provided by the Ministry, in the 2020-2021 academic year, 4.8% of public high school students had a lack of attendance. ” This macroscopic vision confuses many different situations and students », laments Laelia Benoit, a child psychiatrist and sociologist at the Center for Epidemiology and Population Health Research (CESP) in Villejuif. ” These figures include both truancy and truancy of disturbed children, as well as institution-initiated expulsions and withdrawals at the discretion of parents. “But school phobia fits only the second case” a student avoids school despite reasonable efforts by his parents to bring him back when he exhibits severe emotional distress in connection with school, in the absence of antisocial behavior. “This ‘anxious school refusal’ (RSA), according to the consensus term, would cover 1-2% of students from kindergarten to high school in many countries. In France, there is certainly a lack of a precise indicator and a particularly poorly characterized a phenomenon.

Therefore, in 2018, Laelia Benoit, in collaboration with CESP, launched an extensive survey on the profiles and future of children suffering from RSA. The nearly 2,000 questionnaires collected represented a wide range of students from 5 to 18 to 20 years of age from all over France. Of the 1,328 files that met the definition of RSA, the researchers retained 729 files with non-attendance figures for three years. Their results are forthcoming.

Trouble with a thousand and one faces

We identified five recurring trajectories “, reveals Laelia Benoit. Absences among elementary school-aged students are often associated with either somatic symptoms (stomach aches, headaches, etc.) or a rare or chronic medical problem that worsens during the period in question. However, return to school is usually after a two-year follow-up. Adolescents in the study mostly developed school refusal between the ages of 11 and 12 due to various disorders (depression, social phobia) or questions (gender identity) or even the school environment they complained about. but for many, the condition worsens more or less quickly until they drop out of school altogether, despite school measures and heavy medical follow-up: numerous psychotherapies, hospitalizations, accumulation of drugs…

In addition to the heterogeneity of situations, this study confirms elements identified in the international literature. Of the 1,328 students who suffered RSA, almost half were victims of harassment, bullying or threats. Starting in elementary school, recognizing differences, a number of other recurrent factors come into play: learning difficulties (dyslexia, dysgraphia), disability, early age, autistic disorders…” He emphasized that students can develop school phobia “, the sociologist explains.

And for ethnic minorities and disadvantaged populations underrepresented in research, it’s a double whammy: “ When parents who are disengaged from the system do not respond, the institution often sees these students drop out more than emotional distress in their absence. With the eruption of group dynamics and existential questions, the beginning of college also marks the peak of new cases of RSA. Differences are better accepted in high school, but students who were good until then fall apart: ” They have to choose their orientation very early and are afraid of not being able to branch out again. “, contextualizes Laelia Benoit. Christine Baveux, head of education at the Maison de Solenn at the Cochin hospital in Paris, adds: ” In 2020, the continuous control applied to the bachelor is very worrying and keeps constant pressure throughout the year. Middle school is also the age of first depressive episodes.

Devastating individual and family consequences

Faced with this multifactorial affliction, “ You should pay attention to small wounds that prevent the child from going to school in the morning, but disappear during the holidays, and any changes in behavior: drop in grades, isolation in the yard, frequent visits to the hospital… “, Odile Mandagaran, president of the school phobia help association for parents