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School Refusal and School Absentee

In clinical pedagogy, problems that are as serious as bullying are the problems of school refusal and school absentee. These problems became an issue of concern once in the 1960s, then began to decline in the 1980's, but began to increase rapidly once again in the 1990s.

The first time I became aware of these behavioral problems was in the 1970's when I examined several patients suffering from symptoms while making rounds. At that time, in the pediatric ward of the university, I saw a young adolescent girl walking the halls looking very glum. Her sad expression was so powerful that I still remember it to this day. She had been examined physically and was diagnosed with no special problems or course of clinical treatment. She was hospitalized to receive counseling for her refusal to attend school.

In American textbooks at that time, "school refusal" was categorized as a type of neurosis or a mental disorder then. Therefore, such children were referred to the neurology or psychiatry wards in our department and were treated by a team of clinical psychologists with pediatricians.

However, the recent school of thought is to think of this behavioral problem as a product of an imbalance between the school, family and social environment. The word "school maladjustment" is coming to the fore, as a more ecological viewpoint is being taken in the dilemma of children refusing to attend school -- an important space where children learn the social elements of living. The problem can be considered a new illness or new morbidity which is complicated and is an integration of various factors, frequently occurring in a wealthy society.

The Ministry of Education defines "disliking school" as a student who is absent from school for more than 50 days in a school year. The Ministry of Justice, on the other hand, identifies school absentee as a "condition in which the student cannot attend school for some psychological or environmental difficulties. Attending school is a very important right of all children, and thus, the Ministry of Justice cannot remain. According to the statistics produced by the Ministry of Education in 1996, there were approximately 15,000 elementary school students, approximately 62,000 junior high students, or in other words, of those mandated to receive compulsory education, one in every one hundred were estimated to be absent from school noting some sort of psychological or emotional challenge in Japan.

The above is an estimate of those who were absent for 50 days, but if we include those potentially carrying the emotional burden of school absentee or school refusal, the numbers would be enormous. For example, if we make the definition of school absentee to being absent for more than 30 days, the numbers increase by twenty or thirty percent. The gray zone of school absentee is huge and it is critical that we not leave it in the gray zone, but try to make light of the situation as much as possible.

Presently, "school refusal" and "school absentee" are seen as two different conditions and carry with them, each their own connotations. This is probably due to the fact that both situations are very complex and there are various cases in each condition, as well as the fact that many researchers and academics have come to attach different meanings to each. Specifically, "school refusal" implies some intention on the part of the student. There is some implication that the student, for some reason such as an interpersonal relationship problem with a fellow student, or teacher, refuses the attendance of school. Furthermore, there are even some parents refusing the contemporary society's rule that children should naturally attend school, questioning the basis for such a claim for society. When we speak of school absentee, we often refer to the condition where the child cannot find any motivation to attend school. In addition, there is just unquestioned regret and acknowledgement of the student's prolonged absence from school. It was reported at an international conference I attended in Norway that these types of children often ended up living on the streets and were thus, considered street children in Ireland.

If we expand the meaning of the word, the gray zone of "school refusal", could include those students who physically come to school, but spend their days in the infirmary or the health room instead of attending classes. It has been established that these types of students have doubled within the past ten years and the "symptoms" of these children do not differ much from those with school refusal. These students seem to come to the nurse's room seeking some sort of psychological help and comfort. Although the nurse's room is where students are supposed to come to seek medical treatment, it seems they are probably seeking some oasis of kindness or gentle interpersonal contact with someone.

In elementary school, it seems that students mention a physical ailment as their first reason for coming to the nurse's room, but soon enough, they hint at psychosomatic symptoms as their second and third symptoms. Up to 15% of the symptoms are those that cannot be quickly diagnosed such as, nausea, pain, distress, and vomiting. In the case of junior high school students and high school students, this number of general physical complaints rises to about 20-30%. There are also those students who accompany the student with the physical symptoms, but ends up talking to the nurse about his or her own situation. Often, these children are already being seen by a pediatrician for symptoms of neurosis or psychological maladjustment.

What can we do for this increasing population of school refusal and school absentee children? This is a good time for us to think about this critical problem together.
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