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Psychiatry and social medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Causes of school refusal include parental marital problems and depression in the mother. Young children are rarely fearful of the school itself. Unlike adolescents, depression and schizophrenia in a 5-year-old child do not usually present as school refusal.
School refusal
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2019
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
School refusal often presents with physical symptoms, such as nausea, recurrent abdominal pain, headaches or diarrhoea. The child’s parents may take him to the general practitioner, thinking there is something physically wrong. These symptoms can be seen as an expression of the child’s distress at being forced to go to school, and often subside once the child is sure he does not have to go to school that day – or else they will subside on Friday evening! The general practitioner has a very important role in the management of school refusal: assessing the severity of these symptoms; investigating and referring as necessary (but minimally); and, when appropriate, reinforcing the efforts of other professionals and the child’s parents to get him back to school.
School refusal
Published in Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick, Peter Hill, David Hall, Jackie Carnell, Child Mental Health in Primary Care, 2018
Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick, Peter Hill, David Hall, Jackie Carnell
School refusal can be defined as a child’s avoidance of school which is known to his parents. It is almost always linked to anxiety, although this may only be apparent when attempts are made to get the child to school. For this reason, it is sometimes called school phobia, but this implies that the anxiety is all related to school, whereas it may be at least partially home based. In contrast, truancy is the wilful avoidance of school without parental knowledge, and is far less likely to present in primary care. Usually the child leaves home as if to go to school but does not go there, or attends only for registration and then wanders, with others. In broad terms, school refusal is associated with disorders of emotion, and truancy is linked with disorders of conduct.
An Open Trial of Intensive Cognitive-Behavioral Therapy for School Refusal
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2019
Scott Hannan, Elizabeth Davis, Samantha Morrison, Ralitza Gueorguieva, David F. Tolin
School refusal, defined as total or partial absence from school associated with emotional distress (Berg, 1997; Heyne, Sauter, & Maynard, 2015), occurs in approximately 1–5% of the student population (Egger, Costello, & Angold, 2003; Granell de Aldaz, Vivas, Gelfand, & Feldman, 1984). Non-attendance creates an environment that may impede healthy development, as children not in school miss out on opportunities for social engagement and learning. In addition, efforts to get children to school may lead to new or increased family conflict. Indeed, failure to return to school has been associated with social difficulties and family dysfunction (Valles & Oddy, 1984), and chronic absenteeism has been found to have a detrimental impact on academic achievement (Balfanz & Byrnes, 2012; Baxter, Royer, Hardin, Guinn, & Devlin, 2011; Gottfried, 2009; Roby, 2003; Spradlin, Cierniak, Shi, & Chen, 2012). School refusal also poses a significant burden to school systems. Staff time must be devoted to assisting in resolving behavioral/emotional struggles in order to bring the child back into the classroom, and school systems may need to pay for tutoring or alternative school placements.
Treatment of School Refusal in an Adolescent With Comorbid Anxiety and Chronic Medical Illness
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2018
Stephanie N. Rohrig, Anthony C. Puliafico
School refusal presents on a continuum ranging from avoiding morning attendance to full school days (Kearney, 2008) and occurs in up to 1%–2% of the population, most often in adolescents (Egger, Costello, & Angold, 2003). Chronic school refusal is associated with both internalizing and externalizing psychiatric disorders, including anxiety, depression, and disruptive behavior in children and adolescents (Egger et al., 2003; Kearney, 2008). When untreated, prolonged school refusal has been associated with deleterious short-term outcomes, such as social isolation, suicidal ideation, and worsening of anxiety and depression symptoms, as well as a long-term trajectory of psychiatric treatment into adulthood (Bernstein, Hektner, Borchardt, & McMillan, 2001; Flakierska-Praquin, Lindström, & Gillberg, 1997; McCune & Hynes, 2005). Whereas school refusal behavior has been shown to improve with treatment (McShane, Walter, & Rey, 2004), the complexity of school refusal requires a myriad of treatment components, including meticulous assessment of the patient’s presentation, individualized treatment planning, and collaboration with parents and school (Kearney & Albano, 2007; Kearney & Bates, 2005).
Parents’ experiences of professionals’ involvement for children with extreme demand avoidance
Published in International Journal of Developmental Disabilities, 2018
Emma Gore Langton, Norah Frederickson
Educational welfare officers, who become involved when there are concerns about children’s school attendance, were the least likely to have been involved, but had high ratings of helpfulness. As this professional group can initiate court proceedings against parents on behalf of the local authority if they believe that parents are failing to facilitate school attendance, it is encouraging to see that parents instead tended to experience their involvement as helpful; one qualitative comment explained that the educational welfare officer had understood the child’s school refusal as symptomatic of the child’s anxiety rather than as being caused by the parents. In contrast, only one in five parents who had experienced involvement from a behavior support team reported this involvement as helpful. It is possible that this reflects a focus by behavior support teams on managing observable behavior rather than addressing its causes and reflects their usual recommendation of behavioral approaches such as rewards and consequences, which are reported to be problematic in themselves for children with PDA (Christie et al. 2012). Educational psychologists and clinical psychologists were equally likely to be experienced as helpful. Qualitative data showed that parents experienced these professional groups as having both unique and overlapping skills. Educational psychologists were valued for their ability to identify PDA and mobilize educational support systems, while clinical psychologists were valued for their power to diagnose PDA and for their holistic support to families.