It happens most often with preschool children; but when I say “most often”, I don’t mean that it happens often. When it does happen (rarely), it’s with preschool children, usually. So what is it that we’re talking about? It’s a phenomenon called School Refusal. A child psychologist would be familiar with this; a general pediatrician probably wouldn’t. It usually happens like this - a parent of a small child repeatedly shows up at the emergency room trying to get her child treated for some kind of ordinary ailment - a sore throat, a cough, a headache that won’t go away - something or the other. The parent asks for a doctor’s note so that the child can skip a day’s school. If an attending physician isn’t really attentive, he’s going to miss how it’s so many complaints by one child. Pretty soon, the doctor gets a call from the school, wondering what’s going on. How can one child get sick this often - often enough to miss months of school, with sheafs of doctor’s notes?
As it turns out, in these cases the child is faking it, because he suffers from a phobia of school. Often, it’s something that comes from a kind of anxiety disorder and depression. School refusal though isn’t really a disease. It’s a symptom of several kinds of problems. A child can have a learning disorder; there could be a psychological problem where the child just doesn’t engage with the whole learning endeavor (the way some adults just don’t engage with the world of the working); there could be a bully; they could have problems being social. It’s just that one of the primary ways in which preschool children (or even children who are slightly older than that) carry out their plan is faking illnesses. As a child grows older, all-out truancy may be the method of choice.
Since school refusal is only a symptom, diagnosing the cause that stands behind it can be quite a problem. It requires a child psychologist, a pediatrician and a teacher to come together to try to thrash out a solution. The cause could be school related, as in a bully, it could be psychological, as an a learning disability or a fear of certain school related social situations, or it could be health related.
The basic idea here then is that if one finds preschool children (since school refusal usually starts at an early age) missing school far too much for what appears to be completely legitimate reasons, one needs to suspect school refusal. Almost all children manage to go to school regularly in spite of anything that life throws up. If a particular child happens to have everything in his life working up to one more reason why he should skip school, it’s time to ask psychologist about school refusal.