School Refusal

Abstract

School refusal is differentiated from other attendance problems such as truancy and school withdrawal. It is characterised by the child's emotional upset at the prospect of going to school, parental awareness of and antipathy toward the problem, and an absence of significant antisocial behaviour in the child. The child's emotional upset is frequently associated with an anxiety disorder, but it may also be associated with a mood disorder. School refusal affects approximately 1% of school children across the primary and secondary school levels. Severe and prolonged school refusal jeopardises the young person's social, emotional and academic development, and may be associated with mental health problems in adulthood. A first step in management involves efficient identification and the assessment of contributing and maintaining factors. Clinical outcome studies support the efficacy of cognitive behavioural therapy (CBT). The psychosocial approach encompassed in CBT incorporates anxiety management training with the young person, behaviour management training with parents and consultation with school personnel. Pharmacological treatments are commonly employed although empirical support for their use is limited. Tricyclic antidepressants and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the more commonly used agents, with the latter having fewer associated adverse effects. It is suggested that the first line of treatment should be CBT, with simultaneous or subsequent pharmacological treatment contingent upon the response to CBT.

The predictors of school refusal: Depression, anxiety, cognitive distortion and attachment

“…There are inconsistent study results in the literature. In some studies (Heyne et al, 2001;King & Bernstein, 2001), it is reported that school refusal is at equal rates in both genders; however, in another study (Nishida, Sugiyama, Aoki, & Kuroda, 2004), higher rates are shown for men. Based on the results, it can be stated that the roots of school refusal behaviours have more specific features, and cannot be completely explained through gender stereotypes.…”

“…Similarly, Maric, Heyne, MacKinnon, Widenfelt, and Westenberg (2012), claimed that negative automatic thoughts related aversion, and negative overgeneralizing cognitive distortion predict school refusal behaviour. For this reason, cognitive-behavioural techniques are mostly used techniques when studying on school refusal to define and alter school related irrational thoughts, and to reintegrate them into a specific school setting (Heyne, King, Tonge, & Cooper 2001;Kearney, 2008b).…”

Predicting risk of school refusal: Examining the incremental role of trait EI beyond personality and emotion regulation

“…The literature shows that school refusal is related to both internalizing disorders, such as anxiety, fatigue, somatic complaints and depression, and to externalizing disorders, such as verbal and physical aggression, and escape from school and/or home (Heyne, King, Tonge, & Cooper, 2001; Kearney, 2008). However, the role of some individual variables, such as personality and emotional skills, has been overlooked.…”

School Refusal Behavior in Students with Intellectual Disabilities and Comorbid Disorders in Japan: A Brief Review

“…One promising treatment, cognitive behavioral therapy [CBT], the most frequently reported approach in the literature, has been demonstrated to be e ective in remediating school refusal behavior and is o en used with multiple behavioral and cognitive techniques (e.g., Heyne et al, 2014;King, Tonge, Heyne, Turner, Pritchard, Young, Rollings, Myerson, & Ollendick, 2001). CBT is a short-term, focused approach that helps students e ectively manage their external and internal symptoms, modify their thoughts regarding schoolrelated events, and eventually integrate their thoughts on a particular adverse stimulus in school (Heyne, King, Tonge, & Cooper, 2001). Mansdorf and Lukens (1987) initially examined the e ectiveness of CBT in school refusal behavior with two school-age students.…”