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Am J Psychiatry 1959;116:540-544.
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Instructor in Psychiatry, Johns Hopkins Univ. School of Medicine, Baltimore, Md.

Associate Professor of Psychiatry and Pediatrics, The Johns Hopkins University School of Medicine, and The Children's Psychiatric Service, Harriet Lane Home, The Johns Hopkins Hospital, Baltimore, Md.

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A clinical study of 41 cases of school phobia confirmed the hypothesis that this syndrome is a variant of separation anxiety; the basic issue proved to be leaving home, not going to school. The outcome of these cases after a mean period of 3 years confirmed the utility of a treatment program of brief psychotherapy centered about prompt return to school. Therapeutic success was shown to vary inversely with the age of the child and the severity of his psychopathology.School phobia constitutes a symptom complex which may be a manifestation of a readily reversible situational reaction or of a severely neurotic or even psychotic adjustment. Effective treatment should be based on a careful diagnostic formulation. But, with the sole exception of the overtly psychotic child, the central focus of the treatment program for all cases should be placed upon firm insistence on early return to school, reinforced by appropriate sanctions of authority.

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