School Refusal

Question 1

What is School Refusal?

Answer 1

• child’s deliberate and illicit refusal to go to school

Question 2

What is School Truancy?

Answer 2

• delinquent behaviour
• absence is not accompanied by emotional symptoms
• parents either unaware of absence or unable to change behaviour
• undercontrolled-externalising type e.g. acting out, aggressive, anti-social acts

Question 3

What is School Phobia?

Answer 3

• wants to go to school but unable to leave house
• anxious when it is time for school e.g. severe fear, temper tantrums
• can exhibit expressive symptoms
• parents aware of absence and sometimes consenting
• overcontrolled-internalizing type e.g. fear, anxiety

Question 4

Prevalence of School Refusal

Answer 4

• 5-28% of children display some aspect of school refusal behaviour (difficult to measure)
• peak age 11-13 years, primary to secondary transition is critical
• equal in girls and boys but girls express more anxiety and phobia and boys express more conduct disorders

Question 5

Factors Contributing to School Refusal

Answer 5

• family factors e.g. recent loss
• school factors e.g. bullying
• environmental factors e.g. poverty, teenage pregnancy
• child factors e.g. anxiety, over-dependence on parents

Question 6

Mental Health and School Refusal (Egger et al, 2003)

Answer 6

• 165 youths with anxiety based refusal: 24.5% of these had a psychiatric disorder
• 517 youths with truancy based refusal: 25.4% of these had a psychiatric disorder

Question 7

Mental Health and School Dropout (Esch et al, 2014)

Answer 7

• found that mental health is a predictor of drop out e.g. substance abuse, social phobia etc
• mental health also found to be an outcome of dropout, especially externalising disorders

Question 8

Likelihood Negative Consequences of Refusal

Answer 8

Depends on:

• severity of school refusal
• age of onset
• how quickly an intervention is put in place - less effective if the school refusal is prolonged (2 years or more)

Question 9

3 Steps of Assessing School Refusal Problems

Answer 9

1. interview/observe child and family
   - interviews, self-report, school refusal assessment scale, direct observation of child (beware of social desirability when speaking to child)
2. teachers report
3. integration of information

Question 10

Explaining School Refusal

Answer 10

• negative reinforcement: avoid negative stimulus (school) that provokes anxiety
• positive reinforcement: staying outside school is reinforced by a positive experience e.g. lie ins, video games

Question 11

Psychological Interventions for School Refusal

Answer 11

• child-based techniques: aim to manage anxiety in school setting e.g. CBT, exposure based therapy
• parent and family-based techniques: manage contingencies for attendance and non-attendance e.g. establish routines
• school-based techniques: work with the school to arrange extra support

Question 12

CBT as an Intervention for School Refusal

Answer 12

• a common intervention
• Mansdorf and Lukens (1987): 2 children received an intervention with cognitive and behavioural aspects.
  FINDINGS? In a 3 month follow up both children were in school

Question 13

Interventions for Children who AVOID Stimuli that Provokes Negative Affectivity

Answer 13

• pharmacotherapy e.g. SSRIs
• CBT
• psychoeducation

Question 14

Interventions for Children who ESCAPE Aversive Social or Evaluative Situations

Answer 14

• pharmacotherapy e.g. SSRIs
• CBT
• cognitive restructuring

Question 15

Interventions for Children who Refuse School for Attention

Answer 15

• work with parents to restructure commands
• ignore simple inappropriate behaviours: avoiding the trap of attending to the child
• positive reinforcement for school attendance e.g. praise, attention, money etc