School phobia or school refusal: controversial concepts

For some time the concept of "school phobia" has been associated with anxiety disorders in children and adolescents, and especially with separation anxiety. The scope of this concept is now being broadened to include other underlying disorders such as antisocial disorders and behaviors such as school truancy, which were previously among the differential diagnoses. The term "school refusal" is now preferred in the literature, being more in line with reports of increasingly complex patient and family situations. This article reviews the main clinical, psychopathological and therapeutic dimensions of school refusal. The aims are to increase child-health professionals' awareness of this disorder and to describe a treatment plan centered on school attendance. Indeed, early detection and appropriate treatment can considerably improve these children's outcome.