Wilmington, Del (written by Kim Hoey/The News Journal) -- Sarah Parrish can remember what she was wearing, where she was standing and how she felt when her brother threw up just before school more than 10 years ago. It caused a panic in her so terrifying it sent her into a closet to hide.
From there she started to become so obsessed that she or someone near her would throw up and there would be germs everywhere that she didn't want to go to school.
"Whenever I'd think of someone throwing up, I'd go into complete panic," said Parrish, now 16.
While every child will have days they don't want to go to class, school avoidance or school anxiety affects between 2 percent and 5 percent of the school population every year.
School avoidance isn't a disorder on its own, it is often a symptom of some anxiety being felt by the child. Common forms of anxiety include separation anxiety, social anxiety and panic disorders. Any trauma can lead to an anxiety, from bullying to not liking a teacher or, as in Parrish's case, a fear of germs.
It's important to figure out what is causing the child not to want to go to school, said Dr. Kathleen Rupertus, of the Anxiety and OCD Treatment Center in Wilmington. Once the underlying cause is identified, then treatment can begin. It's not easy for the child or the parent, but generally there are good results.
Rupertus treated Parrish, who is also her daughter. Making the child face his or her fears is a big part of treatment. Rupertus and Parrish would talk about vomit, make songs up about it, discuss what the worst-case situation could be. Then the hardest part, Rupertus would force her daughter to go to school. Rupertus said she would cry as she pulled away from the curb because she knew how difficult it was on her daughter, but she knew it was the best thing for Parrish.
Anxiety is a bully that steals a child's freedom, said Rupertus, who provides in-service seminars with teachers to help them understand and identify symptoms in their students. Of adults with anxiety disorders, 50 percent of them say it started in childhood, she said.
A basic guide for parents is that the child should go to school if there is no fever, vomiting, diarrhea, earache, toothache or a hacking cough, said Dr. Amy Anzilotti, a pediatrician in Wilmington, and author of the blog, DrAmyKids.com. There is a bit of a gray area in determining actual sickness, said Anzilotti, who tends to err on the side of sending children to school.
If the child does stay home, keep it boring, said Anzilotti. The child doesn't have to be kept in a room, but keep the fun to a minimum.
If a child is home sick, it should be for rest. Take the child to a pediatrician if he or she is out more than a day, Anzilotti recommended.
If daily complaints of illness persist for two weeks, it might be time to seek some counseling. Getting to the problem quickly can be key in treatment. The longer the child is allowed to avoid school, the harder it becomes to go back.
Sometimes the problems can be a buildup of more than one stressor. Ashley Knotts, 16, is a high school junior in Wilmington. When she was younger, she often cried before she headed to school. Sometimes now, she breaks down in uncontrollable tears again.
"It's hard to deal with," she said about school.
Just thinking about an upcoming test can make her sick and cause her to break down. Recently she came home from work in the middle of a shift at her job. She was in tears and couldn't stop. Going to school seemed out of the question.
It's all about talking for Knotts. Being able to talk to family and friends about her fears and anxieties helps her move past them, she said.
Keeping the lines of communication open between parent and teacher is very important in helping a child overcome an anxiety or fear. They have to be a team, said Rupertus. Sometimes there's not a whole lot a teacher can do, but it's still often helpful for the child to know there are people trying to help.
Parrish still doesn't like the idea of someone throwing up, but it doesn't get in the way of anything she wants to do nowadays. She thanks her mother for being so tough with her treatment.
"It was definitely a long process, but now it doesn't control me," said Parrish.