Back to text of article | Info Centre Home | Contents | Search | eMJA Home

www.mja.com.au
© 1998 MJA

A 9-year-old girl, "Anne", presented with a 16-month history of increasing fearfulness, refusal to go to school, stomach pains before school and social withdrawal. She would not let her mother out of her sight, which complicated the care of her 2-year-old sister. The father was increasingly angry with Anne and to avoid the situation withdrew to his workshop when home. There were no problems with the 7-year-old brother.

Anne rated herself at the maximum of 100 on the drawing of a "fear thermometer"¹⁰ which indicated how afraid she was to leave home and go to school. Anne also drew a picture of a bad dream³ in which an "angry baby monster" made the crying mother "take poison pills and die". Family assessment revealed that the mother was suffering a persistent depressive illness that had commenced in the postnatal period following the birth of her youngest daughter and that she had taken an unreported overdose of sleeping tablets about 20 months ago "to escape for a while into sleep". The father felt confused and powerless and had withdrawn into his work and hobbies. Therefore, Anne was anxious about her mother's mental health and was staying home to keep her safe.

Treating Anne's condition involved addressing the problems of the whole family. Her mother received antidepressant drug therapy (selective serotonin reuptake inhibitor) and some home help. Both parents were given guidance on consistent child management and education about postnatal depression. The father was involved in parental duties, taking responsibility for getting Anne to school. Anne was taught relaxation techniques to apply when anxious (including the use of an audio tape). Her school teacher was enlisted to help provide successful school experiences and support for school return.

In the improved home environment that followed these interventions and with new skills to manage anxiety, Anne recovered from her fears and returned happily to school.

Back to article . . .