Les refus scolaires sont des motifs de consultation de plus en plus fréquents en pédopsychiatrie. L’école sollicite les remaniements cognitifs, affectifs et identitaires des adolescents, pouvant révéler des difficultés individuelles. Le refus scolaire recouvre des situations variées et autant d’hypothèses diagnostiques pour le clinicien. Nous présentons l’observation clinique de Salha, 16ans, une adolescente migrante d’origine algérienne, lycéenne en seconde générale en France. Elle n’a aucun antécédent médical. Elle est née à Oran et sa famille a déménagé en France lors de son entrée en CP. Salha est une bonne élève. Quelques jours après la rentrée en seconde, elle présente une attaque de panique inaugurale dans le métro et développe des symptômes anxio-dépressifs conduisant à un refus scolaire anxieux. Ce cas clinique illustre la question du diagnostic de phobie scolaire (ou refus scolaire anxieux), des diagnostics associés et des diagnostics différentiels. Le traitement de la phobie scolaire est souvent long et le pronostic médiocre. Un travail de réseau est nécessaire pour favoriser une reprise scolaire rapide afin de limiter, tant que possible, la chronicisation du symptôme. Un partenariat étroit entre les différents professionnels sanitaires et pédagogiques est indispensable. Cette observation soulève la question spécifique de la construction identitaire chez l’adolescent dans une approche transculturelle. En situation de migration, la réussite scolaire peut être une forme d’intégration dans le pays d’accueil. L’adolescent, en quête de son identité, peut être pris entre un désir d’intégration porté par ses parents, son propre désir et le risque de rupture avec son identité familiale.

School refusal is an increasingly common motive for consultation in child psychiatry. School tends to stretch the cognitive, emotional and identity changes occurring in adolescents, and may reveal individual fragilities. Situations leading to school refusal are extremely diverse, and many diagnosis hypotheses are available to the clinician. We present here the clinical case of Salha, a sixteen-year-old migrant adolescent of Algerian origin, studying in high school in France. She had no medical history. She was born in Oran, and her family moved to France when she was six. She was a gifted student, but a few days after the start of her first year of high school, she had a panic attack in the subway while going back home. She started to show depressive and anxious symptoms, leading to school refusal. She was initially treated for depression. Despite her recovery, the anxious school refusal persisted. An attempt was made for her return to school with individualized educational program and reduced timetable. As she still refused to go to school, hospitalisation was recommended, but denied by her parents. Nevertheless, she carried on with weekly psychological interviews and group therapy. It helped her to work out the identity conflict between her family background and her desire for integration in France. She resumed fulltime school the following year. This clinical case illustrates the challenge of differential diagnosis of anxious school refusal and its psychiatric comorbidities. Its treatment is usually long and rarely fully successful. Teamwork is necessary to manage a quick return to school and prevent the absenteeism to become chronic. Close partnership between medical and pedagogical professionals is indispensable. This observation raises the specific question of transcultural aspects in identity development during adolescence. For migrant adolescents, school achievement is a way of integration in their host country. Searching for their identity, they might be caught in the conflict between their parents’ integration desire, their own aspirations, and the fear of loosing their family identity.