LNSLNS Gorzny rightly points out the importance of possible visual impairments for the development of learning difficulties/school performance, which may be crucially involved in the development of school avoiding behavior (cf. the figure showing individual factors relevant for the pathogenesis). Unfortunately we are not aware of any studies on this topic, and as far as we know, possible associations between auditory impairments (in the sense of an auditory processing disorder) or other functional disorders and successive school avoidance have not been investigated either. We wish to remind readers of the extremely heterogeneous causes of school avoiding behaviors, which necessitate an interdisciplinary approach to the problem—including consultation with an ophthalmologist if the indication exists. In our own clinical practice in an outpatient clinic for school avoiders, this is our default approach. If visual impairments are suspected, an ophthalmologist is consulted, and if auditory disorders are suspected, then we initiate a pediatric audiology examination. The current state of research, however, allows only for a rough sketching out of individual risk factors and their importance.
DOI: 10.3238/arztebl.2010.0360b


Dr. phil. Martin Knollmann
Klinik für Psychiatrie und Psychotherapie
des Kindes- und Jugendalters
Rheinische Kliniken Essen
Virchowstr. 174
45147 Essen, Germany
martin.knollmann@lvr.de


Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Knollmann M, Knoll S, Reissner V, Metzelaars J, Hebebrand J: School avoidance from the point of view of child and adolescent psychiatry: Symptomatology, development, course, and treatment [Schulvermeidendes Verhalten aus kinder- und jugendpsychiatrischer Sicht: Erscheinungsbild, Entstehungsbedingungen, Verlauf und Therapie]. Dtsch Arztebl Int 2010; 107: 43–9. VOLLTEXT
1. Knollmann M, Knoll S, Reissner V, Metzelaars J, Hebebrand J: School avoidance from the point of view of child and adolescent psychiatry: Symptomatology, development, course, and treatment [Schulvermeidendes Verhalten aus kinder- und jugendpsychiatrischer Sicht: Erscheinungsbild, Entstehungsbedingungen, Verlauf und Therapie]. Dtsch Arztebl Int 2010; 107: 43–9. VOLLTEXT