幼稚園與小學時期懼學症的相關因素

THE RELEVANT FACTORS OF SCHOOL PHOBIC IN KINDERGARTEN OR PRIMARY SCHOOL

本研究之目的是調查幼稚園及小學的懼學症之相關因素。本研究的懼學症兒童來自社區，主要由學校輔導室提供，或見新聞媒體之消息而來的。診斷係根據Berg等人（1969）的四準則－(1)嚴重的上學困難，(2)嚴重的情緒不安或抱怨身體不舒服（但無生理原因），(3)在父母知情的情況下，留在家裏，(4)没有明顯的反社會行為。由於導師提供的名單中頗多為不曾缺席，但每天上學前都鬧脾氣、身體不舒服，或在校啼哭，對父母與老師造成困擾，而達兩週以上，這類個案也歸類於懼學症組，診斷結果，有20名懼學症兒童，其餘（12名）為非懼學症兒童，另外取對照組20名，而對照組在性別、年級、學區等項上與懼學症組配對。本研究的主要結果為：(1)懼學症多發生於女生。(2)懼學症多發生於一年級，三年級次之，五年級再次之，而三、五年級常重新編班與換老師，故換新環境（包括新老師）可能是一重要的促發懼學因素。另外，在幼稚園階段，懼學症個案多在小、中班，故進入新環境亦是促發幼稚園時期懼學之因素。(3)懼學症組有一半以上的個案屬折衷家庭或大家庭（即與祖父母同住），顯著多於對照組與非懼學症組。(4)懼學症組有85%的個案曾鬧過不上學。(5)懼學症組有60%的個案害怕老師，有50%的個案害怕離開家，均顯著多於對照組與非懼學症組。害怕離開家是分離焦慮的一種表現，而害怕老師的個案中大都是分離焦慮高的小孩。本研究結果顯示新進入學校（發生在小學一、三、五年級），是懼學症的促發因素之一。因此，分離焦慮強的兒童，換新的學校環境，又碰上嚴厲的老師，就容易產生懼學或拒學行為，並易伴隨間斷性尿床、睡眠困擾等問題。

The purpose of the study is to investigate the relevant factors of students with school refusal in the kindergartners or primary schools. The probable cases were referred from community. Most of cases are referred by the counseling centers of schools, or came with mothers who read the newspaper about the school phobia research. . Those probable cases were diagnosed by the psychiatrist based on the following criteria (1) severe difficulty in attending school, (2) severe emotional upset (or somatic complain), (3) staying at home with the knowledge of the parents, (4) absence of significant antisocial behavior (Berg et. al., 1969). Since some of the probable case referred by teachers or parents were not absentees, but they had tantrums or somatic complaints every morning, or crying at school every day, these cases also were diagnosed as school phobia. There were 20 children diagnosed as school phobia and 12 children diagnosed as non-school phobia. Otherwise, there were 20 normal children matched the school phobia by grade and sex. The following observations were made in the school phobia as compared with the other two groups: (1) more cases were the females. (2) predominant in the first grade, then the third grade and the fifth grade when the crucial period for the cases were to cope with the new teacher or unfamiliar situation, home, the changing situation of the crucial period might be a trigger factor. (3) more than one half of the cases were either in the electric family (live with parents and grandparents) or in the large family (live with parents, grandparents, uncles or aunts). (4) In addition to the present symptoms or signs of school phobia, 85% of the cases had the past history of school avoidance. (5) 60% of the cases were scared with their teachers and 50% worried about leaving home. In conclusion, the study suggests that the unfamiliar situation for the students in the first, third and fifth grade might be an important and relevant factor for the school phobia, especially for separation anxiety children.