Multifactorial and difficult to measure, school phobia still suffers from the image of a non-serious, even feigned disorder. A team from Inserm therefore investigated throughout France to shed light on this phenomenon, accentuated by the health crisis.
An article to be found in the magazine ofInserm n° 55
School phobia remains difficult to quantify in France, because the National Education only measures absenteeism, from four half-days of unjustified absence per month. A lack of attendance which affected 4.8% of public secondary school students over the 2020-2021 school year according to the ministry. ” This macroscopic vision mixes very different situations and students », Regrets Laelia Benoit, child psychiatrist and sociologist at the Center for Research in Epidemiology and Population Health (CESP) in Villejuif. ” These figures include both skipping school and school refusal of anxious children, but also eviction at the initiative of the establishment and withdrawal decided by the parents. “However, school phobia corresponds only to the second case, “ when a student, in the absence of antisocial conduct, exhibits severe emotional distress in relation to school, which he avoids despite his parents’ reasonable efforts to bring him back “says the researcher. This “anxious school refusal” (RSA), according to the consensual term, would concern between 1 and 2% of pupils, from kindergarten to high school, in many countries. A phenomenon undoubtedly underestimated in France, for lack of precise indicator, and especially badly characterized.
This is why Laelia Benoit launched in 2018 a vast survey on the profiles and the future of children who suffer from RSA, in collaboration with the CESP. The approximately 2,000 questionnaires collected offered a wide range of students aged 5 to 18–20, from all over France. Of the 1,328 files meeting the definition of the RSA, the researchers kept 729, for which they had absenteeism figures over three years. Their results are forthcoming.
A trouble with a thousand and one faces
« We have identified five recurring trajectories “, reveals Laelia Benoit. Among pupils of primary school age, absences are often linked either to somatic symptoms (stomach aches, headaches, etc.), or to a medical problem, rare or chronic, which worsens during the period in question. But the return to school generally takes place after two years of follow-up. The adolescents in the study rather developed a school refusal around the age of 11–12, in connection with various disorders (depression, social phobia) or questions (gender identity) or even a school environment of which they complain. Some recover, slowly, thanks to at least weekly support. But for many, the situation deteriorates, more or less quickly, until a complete dropout despite school arrangements and heavy medical follow-up: multiple psychotherapies, hospitalizations, accumulation of drugs…
In addition to the heterogeneity of the situations, this study confirms the elements identified in the international literature. Of the 1,328 students suffering from RSA, almost half had been victims of harassment, insults or threats. Several other recurring factors come into play from primary school onwards, with awareness of the differences: learning difficulties (dyslexia, dysgraphia), disability, precocity, autistic disorders…” Pointed out students can, one thing leading to another, develop a school phobia “, explains the sociologist.
And for ethnic minorities and disadvantaged populations, under-represented in the study, it is a double penalty: “ When the parents, far from the system, do not react, the establishment will very often see in the absences of these pupils a dropout rather than an emotional distress. A peak in new cases of RSA is also recorded at the start of college, with the eruption of group dynamics and existential questions. In high school, differences are better accepted, but students who were doing well until then collapse: ” They have to choose their orientation very early and are afraid of not being able to branch off any more. “, contextualizes Laelia Benoit. Christine Baveux, head of education at the Maison de Solenn at the Cochin hospital in Paris, adds: ” The continuous control introduced at the baccalaureate in 2020 is very anxiety-provoking, and maintains constant pressure throughout the year. High school is also the age of the first depressive episodes.
Devastating individual and family consequences
Faced with this multifactorial scourge, “ you have to be attentive to the little sores that prevent the child from going to school in the morning but disappear during the holidays, and to any change in behavior: falling grades, isolation in the yard, frequent visits to the infirmary… “, details Odile Mandagaran, president of the association for helping parents School Phobia. Early identification of students at risk is indeed the key because the later the diagnosis, the less favorable the outcome. And the stakes are crucial: absenteeism is associated with a risk of lower academic success, mental health problems and, ultimately, economic insecurity.
The RSA also upsets the daily lives of parents, who adapt their schedule in 69% of cases and often resort to non-reimbursed care. ” Few families spend less than 200 euros per month. A considerable budget for the most modest! “, laments Laelia Benoit. And an underestimated mental load: “ Parents blame a lot. They need psychological support “, recalls Odile Mandagaran, who has seen membership in School Phobia more than double since the Covid-19 crisis. Because families are often familiar with therapeutic wandering: “We must raise awareness among the population, but also among educational staff, general practitioners and pediatricians “urges Marie Gallé-Tessonneau, a psychologist specializing in school phobia. In addition to taking charge of any underlying disorders in students who have dropped out of school, the psychotherapist advises maintaining a healthy lifestyle, not catching up on all classes, preserving the link with the establishment and, above all, preparing for the return to school, which will have to be extremely progressive and creative in its arrangements. Similarly, at the Maison de Solenn, Christine Baveux recommends a firm and precise framework, a source of “ psychic safety “: reduced timetable, chosen subjects, absence of notes… “Because the important thing is not to pass the year, but to go back to school. And Marie Gallé-Tessonneau concludes: “ A real winning trio must form around the child, between care, family and school. »
Laelia Benoit is a researcher in the Developmental Psychiatry team of the Center for Research in Epidemiology and Population Health (unit 1018 Inserm/University of Paris-Saclay/University of Versailles-Saint-Quentin-en Yvelines) and at Yale University ( UNITED STATES).