Am Fam Physician. 2004 Sep 15;70(6):1032.
to the editor: I enjoyed the article “School Refusal in Children and Adolescents,”1 by Dr. Fremont in the October 15, 2003 issue of American Family Physician. School refusal is an important issue, and I would like to add a few observations and recommendations.
In my practice, I have noticed more and more cases of school refusal. In my experience as a family physician and as a parent of a child with this condition, I think that the anxiety and depression described by Dr. Fremont1 often is more related to school than the problems at home or endogenous psychologic issues.
Statistics from the U.S. Department of Education suggest that up to 40 percent of children in the United States do not read at their current grade level.2–4 Most of these children are of normal intelligence. These difficulties often are not identified for several years, by which time issues such as behavior problems, severe academic problems, or school phobia have become more problematic. When kids cannot read at their grade level, their academic and/or behavior performances deteriorate. Often, the cause of these problems is not properly identified as reading and learning problems and these kids are labeled as having behavioral or psychologic issues.
Budgets at the federal, state, and local levels are being stretched. In my experience, early evaluation and intervention of reading and learning problems are seriously delayed and often are not identified until major behavioral or emotional issues become the dominant focus for the child. Schools do not have the money, resources, or staff to properly evaluate many of these children.
Although Dr. Fremont1 suggests psychoeducational and other educational evaluations, it was my impression that the major focus of the article suggested that the origin of school phobia is a primary psychologic problem. I disagree. In dealing with many children who have school phobia, I can think of few who did not have a primary learning or reading deficit that had not been properly evaluated or addressed as the primary cause of their school phobia.
Certainly, concomitant psychologic and home issues are significant contributing factors, but I would urge the author and other clinicians who see children with school phobia to consider reading or learning issues first. The psychologic issues that physicians identify and diagnose may be secondary. Unless reading and learning issues are addressed, any other therapy is doomed to failure.
1. Fremont WP. School refusal in children and adolescents. Am Fam Physician. 2003;68:1555–60.
2. Children of the code. Accessed online June 11, 2004, at: http://www.childrenofthecode.org/cotcintro.htm.
3. National Center for Education Statistics. State results for the NAEP 2003 reading assessment. Accessed online June 11, 2004, at: http://nces.ed.gov/nationsreportcard/reading/results2003/stateresults.asp.
4. Paige R. Educating a new generation. Speech before the Los Angeles World Affairs Council on February 13, 2002. Accessed online June 11, 2004, at: http://www.lawac.org/speech/paige.htm.
editor’s note: This letter was sent to the authors of “School Refusal in Children and Adolescents,” who declined to reply.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions