A 7-year-old girl has refused school for 3 weeks. Every morning she complains of abdominal pain and headache, which disappear within an hour when she is allowed to remain at home. She repeatedly expresses worry that something terrible will happen to her mother, follows her from room to room, and insists on sleeping in her parents' bed. Development and academics were previously normal. What is the most likely diagnosis?

• A Specific phobia of school
• B Separation anxiety disorder ✓
• C Oppositional defiant disorder
• D Malingering

Explanation

School refusal driven by excessive fear or worry about separation from the attachment figure, with somatic symptoms on school mornings that remit when the child stays home, is the classic presentation of separation anxiety disorder. Symptoms must persist at least 4 weeks in children. The core discriminator against simple truancy or conduct-related refusal is that this child stays home with the mother rather than going elsewhere, and the fears center on harm befalling the parent, not the school itself.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.