The Application of DSM‐III Diagnostic Criteria to School Refusal

Abstract

The DSM‐III diagnostic criteria were applied to school refusal cases, and the possibility of a subclassification of school refusal through the DSM‐III was studied. The subjects were 50 cases diagnosed as school refusal following the criteria defined by Sumi and Tatara. As for the Axis I diagnoses, the subjects fell under the separation anxiety disorder (7 cases), avoidance disorder (13 cases), overanxious disorder (8 cases), identity disorder (5 cases), adjustment disorder (11 cases) and others. On Axis II, no case was diagnosed as having the personality disorder, but 14 cases showed pathological personality traits. On Axis III, nine cases showed some physical disorders or conditions. Among the five major diagnostic groups, there were some definite differences concerning the onset age, clinical course, psychosocial stress, response to therapy and prognosis of disorders. These results suggest the availability of a subclassification of school refusal by means of the DSM‐III criteria.

Outcome of children with school refusal

“…This is similar to other clinic-based studies on school refusal where more severe forms have been reported. 7,8 Temperamental difficulties were found in a high proportion of the subjects (69.7%) as reported in earlier studies. 4 Depressive disorders were the commonest diagnoses in the present study (63.6%), which is similar to recent literature on school refusal.…”

“…Appropriate treatment of depression using antidepressants and psychosocial interventions may help speedy return to school. High rates of anxiety disorders 7,6 have been reported in younger children. Nineteen (57.6%) subjects had anxiety disorders in our study, which included separation anxiety disorder, specific phobias, obsessive compulsive disorder and generalized anxiety disorder.…”

“…High rates of anxiety disorders with multiple diagnoses and associated family stressors have been reported. 6,7 School phobic children had more severe school refusal with later age of onset compared to separation anxious children. 6 Recent studies on adolescents with school refusal show a high prevalence of mood disorders.…”

School Refusal

“…[15] Reports of the prevalence of depressive symptoms and depressive disorders in children exhibiting school refusal vary considerably. [4,26,27] More pervasive and persistent oppositional behaviour, as encompassed in oppositional defiant disorder, has been reported in between 9 and 21% of anxious children exhibiting school refusal. [11,14] As many as 50% of children may display subclinical depression (i.e.…”

School refusal and depression with school inattendance in children and adolescents: Comparative assessment between the Children’s Depression Inventory and somatic complaints

“…In another study, Buitelaar et al investigated the DSM‐III diagnoses at first visit of 25 school refusers, and report diagnoses of anxiety disorder in eight (32%), depressive disorder in seven (28%), somatoform disorder in six (24%), and conduct/personality disorder in four (16%) cases 16 . In addition, Hoshino et al conducted a similar study on DSM‐III diagnoses in 50 cases of school refusal in Japan, and reported the principal diagnosis as being separation anxiety disorder in seven (14%), avoidance disorder in 13 (26%), over‐anxious disorder in eight (16%), identity disorder in five (10%), and adjustment disorder in 11 (22%) cases, among others, while also commenting on difficulties in applying DSM‐III diagnosis to school refusal 17 …”