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Di Vincenzo C, Pontillo M, Bellantoni D, Di Luzio M, Lala MR, Villa M, Demaria F, Vicari S. School refusal behavior in children and adolescents: a five-year narrative review of clinical significance and psychopathological profiles. Ital J Pediatr 2024; 50:107. [PMID: 38816858 PMCID: PMC11141005 DOI: 10.1186/s13052-024-01667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/28/2024] [Indexed: 06/01/2024] Open
Abstract
The aim of the study was to explore the clinical significance of school refusal behavior, its negative impact on psychological well-being of children and adolescents and its relationship with the most common psychopathological conditions during childhood and adolescence (e.g. neurodevelopmental disorders, psychiatric disorders). School refusal behavior refers to a distressing condition experienced by children and adolescents that compromise regular school attendance and determine negative consequences on mental health and adaptive functioning. A narrative review of the literature published between January 2019 and March 2023 was conducted. Ten studies (n = 10) were included from a literature search of the electronic databases PubMed, CINAHL, PsycInfo, MedLine, and Cochrane Library. The results indicate that school refusal is highly present in neurodevelopmental disorders such as autism and attention-deficit/hyperactivity disorder due to the presence of behavioral problems and deficits in communication skills. As for psychiatric disorders, school refusal appears to be highly common in anxiety disorders, depressive disorders, and somatic symptoms. We also found that school refusal behavior may be associated with various emotional and behavioral conditions that act as risk factors. Especially, but are not limited to, it may be associated with a diminished self-concept, exposure to cyberbullying, specific affective profiles and excessive technology usage. Our results indicate that school refusal is a condition with many clinical facets. It can be attributed to both vulnerability factors, both temperamental and relational, and to various psychopathological conditions that differ significantly from each other, such as neurodevelopmental disorders and psychiatric disorders. Recognizing these aspects can improve the implementation of patient-tailored therapeutic interventions that are consequently more likely to produce effective outcomes. The therapeutic intervention should facilitate the recognition of cognitive biases regarding school as a threatening environment, while regulating negative emotions associated with school attendance. Additionally, therapeutic intervention programs linked to social skill training and problem-solving training, conducted directly within the school setting, can enhance children's abilities to cope with academic performance and social relationships, ultimately preventing school refusal.
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Affiliation(s)
- Cristina Di Vincenzo
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy.
| | - Maria Pontillo
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Domenica Bellantoni
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Michelangelo Di Luzio
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Maria Rosaria Lala
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Marianna Villa
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Francesco Demaria
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Stefano Vicari
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
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Benoit L, Chan Sock Peng E, Flouriot J, DiGiovanni M, Bonifas N, Rouquette A, Martin A, Falissard B. Trajectories of school refusal: sequence analysis using retrospective parent reports. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02419-5. [PMID: 38602549 DOI: 10.1007/s00787-024-02419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024]
Abstract
School refusal (SR) is a form of school attendance problem (SAP) that requires specific mental health care. Despite improvements in the definition of SAPs, the course of SR is not well characterized. To explore three-year patterns of SR course in children, as reported by their parents, we deployed an anonymous web-based survey. We defined SR onset as the absence of ≥ 2 school weeks during one academic year, combined with emotional distress. We defined standard SR trajectories using sequence analysis of parents' recollection of three consecutive years of school attendance. We obtained 1970 responses, 1328 (67%) completed by a parent and meeting the definition of SR. Of these, 729 (55%) responses included three years of school attendance recollection. We identified five prototypical trajectories of SR: two profiles for children: beaded absences (n = 272), and rapid recovery (n = 132); and three for adolescents: prolonged recovery (n = 93), gradual decline (n = 89), and rapid decline (n = 143). We found five distinct trajectories of retrospective recall of SR course. Through pattern recognition, this typology could help with timely identification of SR and implementation of evidence-based interventions to optimize outcomes. Prospective replication of these findings and their field application is warranted.
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Affiliation(s)
- Laelia Benoit
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, 94807, Villejuif, France.
- Yale School of Medicine, New Haven, CT, USA.
- APHP-Cochin Hospital, Maison de Solenn, Paris, France.
- QUALab, Qualitative and Mixed-Methods Lab, a Collaboration Between the Yale Child Study Center and Inserm U1018, New Haven, CT, USA.
| | | | - Julien Flouriot
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, 94807, Villejuif, France
| | | | | | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, 94807, Villejuif, France
- Service d'Epidémiologie et de Santé Publique, APHP-Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Andrés Martin
- Yale School of Medicine, New Haven, CT, USA
- QUALab, Qualitative and Mixed-Methods Lab, a Collaboration Between the Yale Child Study Center and Inserm U1018, New Haven, CT, USA
| | - Bruno Falissard
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, 94807, Villejuif, France
- QUALab, Qualitative and Mixed-Methods Lab, a Collaboration Between the Yale Child Study Center and Inserm U1018, New Haven, CT, USA
- Service d'Epidémiologie et de Santé Publique, APHP-Paris-Saclay, Le Kremlin-Bicêtre, France
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Heyne D. Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:471-494. [PMID: 35762908 DOI: 10.1024/1422-4917/a000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is important to consider developmental issues when addressing school refusal (SR) in adolescence. Referral rates appear to be higher among adolescents relative to children, and treatment appears to be less effective among adolescents. This paper provides an in-depth review of developmental issues associated with adolescent SR and treatment via cognitive-behavioral therapy (CBT). It begins by considering the reasons for the higher referral and poorer treatment outcomes, including the higher level of absenteeism in adolescence, higher rates of concurrent social anxiety disorder and depressive disorder, and the developmental challenges inherent to adolescence. Such challenges include increased academic and social demands in the secondary-school environment, and increasing autonomy which may contribute to family conflict. These developmental issues may potentiate and exacerbate an adolescent's difficulty attending school, make it difficult for families to cope, and complicate practitioners' efforts to provide effective treatment for SR. Further, the review describes CBT manuals for SR and the extent to which they are developmentally sensitive. There are five CBT manuals, which vary in their sensitivity to developmental issues. Various multimodal treatments employ interventions in addition to CBT, such as medication or inpatient treatment, to address the complexity of SR in adolescence. Nevertheless, nonresponse to treatment for adolescent SR ranges from one-third to two-thirds of youths. Attention thus needs to be given to ways of improving treatment outcomes.
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Affiliation(s)
- David Heyne
- Institute of Psychology, Leiden University, The Netherlands
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John A, Friedmann Y, DelPozo-Banos M, Frizzati A, Ford T, Thapar A. Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK. Lancet Psychiatry 2022; 9:23-34. [PMID: 34826393 PMCID: PMC8674147 DOI: 10.1016/s2215-0366(21)00367-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Poor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion. METHODS In this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7-16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13-2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation. FINDINGS School attendance, school exclusion, and health-care data were available for 414 637 pupils (201 789 [48·7%] girls and 212 848 [51·3%] boys; mean age 10·5 years [SD 3·8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2·1 (95% CI 2·0-2·2) for those with neurodevelopmental disorders to 6·6 (4·9-8·3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2·0 (1·9-2·1) for those with neurodevelopmental disorders to 5·5 (4·2-7·2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1·7 (1·3-2·2) for those with eating disorders to 22·7 (20·8-24·7) for those with a record of drugs misuse. aORs for exclusion ranged from 1·8 (1·5-2·0) for those with learning difficulties to 11·0 (10·0-12·1) for those with a record of drugs misuse. INTERPRETATION Children and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required. FUNDING The Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council. TRANSLATION For the Welsh translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ann John
- Swansea University Medical School, Swansea University, Swansea, UK.
| | - Yasmin Friedmann
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Aura Frizzati
- Cedar Healthcare Technology Research Centre, Cardiff Medicentre, University Hospital of Wales, Cardiff, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Li A, Guessoum SB, Ibrahim N, Lefèvre H, Moro MR, Benoit L. A Systematic Review of Somatic Symptoms in School Refusal. Psychosom Med 2021; 83:715-723. [PMID: 33951013 DOI: 10.1097/psy.0000000000000956] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE School refusers often display somatic symptoms that are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. METHODS PubMed and PsycINFO databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1025 identified studies, 148 were included. RESULTS Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue, and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training, and ignoring the somatic symptoms. CONCLUSIONS Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third-wave behavioral therapies, and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians, and psychologists/psychiatrists is needed to improve well-being in children who experience somatic symptoms as related to school avoidance.
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Affiliation(s)
- Anne Li
- From the AP-HP, Cochin Hospital, Maison des Adolescents-Maison de Solenn, Integrated Youth Health Care Service (Li, Guessoum, Ibrahim, Lefèvre, Moro, Benoit), Paris; Faculty of Medicine, Paris-Saclay University (Li), Orsay; University of Paris, PCPP (Guessoum, Ibrahim, Moro), Boulogne-Billancourt; Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy (Guessoum, Ibrahim, Lefèvre, Moro, Benoit), Villejuif, France; Yale School of Medicine, Yale University (Benoit), New Haven, Connecticut; and French Clinical Research Group in Adolescent Medicine and Health (Li, Ibrahim, Lefèvre), Paris, France
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Gonzálvez C, Díaz-Herrero Á, Sanmartín R, Vicent M, Fernández-Sogorb A, García-Fernández JM. Testing the Functional Profiles of School Refusal Behavior and Clarifying Their Relationship With School Anxiety. Front Public Health 2020; 8:598915. [PMID: 33344402 PMCID: PMC7744459 DOI: 10.3389/fpubh.2020.598915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
Students with school attendance problems are a diverse and heterogeneous group whose patterns of symptomatology can change over time. This study aims to identify different school refusal behavior profiles and to determine whether these profiles differ from each other based on four situational factors and three response systems of school anxiety across gender. The participants were 1,685 Spanish students (49% female) aged 15–18 years (M = 16.28; SD =0.97). The School Refusal Assessment Scale-Revised (SRAS-R) and the School Anxiety Inventory (SAI) were administered. Latent profile analysis revealed five school refusal behavior profiles: Non-School Refusal Behavior, Mixed School Refusal Behavior, School Refusal Behavior by Positive Reinforcement, Low School Refusal Behavior, and High School Refusal Behavior. The results indicated that High School Refusal Behavior and Mixed School Refusal Behavior groups were the most maladaptive profiles since it obtained the highest mean scores on school anxiety. In contrast, Non-School Refusal and School Refusal Behavior by Positive Reinforcement groups revealed the lowest scores in school anxiety. Non-significant gender-based differences were found, only girls were more represented in the mixed school refusal behavior profile in comparison with boys but with a small effect size. Findings are discussed in relation to the importance of promoting good mental health to prevent school attendance problems in adolescents and younger ages.
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Affiliation(s)
- Carolina Gonzálvez
- Department of Development Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - Ángela Díaz-Herrero
- Department of Development Psychology and Education University of Murcia, Murcia, Spain
| | - Ricardo Sanmartín
- Department of Development Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - María Vicent
- Department of Development Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - Aitana Fernández-Sogorb
- Department of Development Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - José M García-Fernández
- Department of Development Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
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7
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Lomholt JJ, Johnsen DB, Silverman WK, Heyne D, Jeppesen P, Thastum M. Feasibility Study of Back2School, a Modular Cognitive Behavioral Intervention for Youth With School Attendance Problems. Front Psychol 2020; 11:586. [PMID: 32328012 PMCID: PMC7153503 DOI: 10.3389/fpsyg.2020.00586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/12/2020] [Indexed: 11/25/2022] Open
Abstract
There is large heterogeneity among youth with school attendance problems (SAPs). For this reason, protocols for the treatment of SAPs need to be flexible. Back2School (B2S) is a new manual-based, modular transdiagnostic cognitive behavioral intervention to increase school attendance among youth with SAPs. It also aims to increase the self-efficacy of these youth and their parents. B2S includes evidence-based modules addressing youth anxiety, depression, and behavior problems, together with modules focused on parent guidance and school consultation. The current study examined the feasibility of evaluating B2S in an randomized controlled trial and acceptability of the B2S program in a non-randomized trial, including both qualitative and quantitative data, in preparation for a randomized controlled trial of its effectiveness. Youth, parents, and teachers completed questionnaires at baseline, post-intervention, and follow-up. School attendance data were collected from school registers. Twenty-four youth with a SAP (defined as more than 10% absenteeism during the last 3 months) were recruited from primary and lower secondary schools in Aarhus Municipality, Denmark. Their parents also participated in B2S. Two of the 24 families withdrew during the intervention, after sessions two and six respectively. Of the remaining 22 families, 19 (86%) completed all 10 sessions. Parents and youth rated their satisfaction with B2S as high, and high levels of satisfaction were maintained 1 year after the intervention. Teacher satisfaction was lower than that of youth and parents, but the majority found the school’s participation in the intervention helpful. Preliminary evaluation of intervention outcomes showed significant increase in school attendance and decrease in psychological symptoms, as well as a significant increase in self-efficacy for both youth and parents. Based on this feasibility data, adaptations were made to the B2S manual and study procedures prior to commencement of a randomized controlled effectiveness trial. The main adaptation to the manual was to increase school consultation. The main procedural adaptation was to broaden recruitment. Furthermore, it was necessary to increase level of staffing by psychologists because treatment delivery was more time consuming than expected.
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Affiliation(s)
- Johanne Jeppesen Lomholt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.,TrygFonden's Centre for Child Research, Aarhus University, Aarhus, Denmark
| | - Daniel Bach Johnsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | | | - David Heyne
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Gentofte, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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8
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Gonzálvez C, Díaz-Herrero Á, Vicent M, Sanmartín R, Pérez-Sánchez AM, García-Fernández JM. School refusal behavior: Latent class analysis approach and its relationship with psychopathological symptoms. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00711-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Gallé-Tessonneau M, Heyne D. Behind the SCREEN: identifying school refusal themes and sub-themes. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2020. [DOI: 10.1080/13632752.2020.1733309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - David Heyne
- Leiden University Institute of Psychology , Leiden, The Netherlands
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10
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Martin R, Benoit JP, Moro MR, Benoit L. School Refusal or Truancy? A Qualitative Study of Misconceptions Among School Personnel About Absenteeism of Children From Immigrant Families. Front Psychiatry 2020; 11:202. [PMID: 32265757 PMCID: PMC7099978 DOI: 10.3389/fpsyt.2020.00202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School refusal is a form of school attendance problem (SAP) distinct from truancy, school withdrawal, and school exclusion; it requires specific mental health care. Schools' identification and referral to care of school refusers depends on school personnel's interpretation of the reasons for absences. Because cultural factors can induce misunderstanding of the young people's behavior and of their parents' attitudes toward school attendance, school personnel can have difficulty understanding these reasons for children with transcultural backgrounds (migrants or children of migrants). The aim of this study was to explore the experiences and opinions of school personnel, mainly teachers, related to school refusal among these students. METHODS Grounded theory methodology was used to conduct 52 qualitative interviews of school personnel in two regions of France. Their daily practices with students presenting with school refusal were addressed in general (i.e., in response to absence of all youth) and in transcultural contexts (i.e., absence of migrant children or children of migrants). This study analyzed the interviews of the 30 participants who reported working with students from transcultural backgrounds. RESULTS Many school personnel reported experiencing difficulties, ambivalence, and destabilizing feelings in situations involving immigrant families whose school culture differed from their own. Talking about culture appeared to be taboo for most participants. These situations challenged the participants' usual strategies and forced them to devise new ones to deal with these young people and their families. Although some personnel were at risk of developing exclusionary attitudes, others dealt with school refusal with both commitment and creativity. CONCLUSION The tensions experienced by these participants reveal contradictions between the French universalist ideology and the reality of daily life in schools becoming increasingly multicultural. School personnel's attitudes toward children with transcultural backgrounds presenting with school refusal can affect children's access to care and shape social inequalities. Further research should develop, implement, and assess interventions including transcultural training of school personnel, improved use of interpreters at school for migrant families, and the addition of a transcultural dimension to SAP assessment scales, especially for school refusal.
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Affiliation(s)
- Robin Martin
- Maison des Adolescents de Saint-Denis, Saint-Denis Hospital, Saint Denis, France
| | - Jean Pierre Benoit
- Maison des Adolescents de Saint-Denis, Saint-Denis Hospital, Saint Denis, France
| | - Marie Rose Moro
- Maison des Adolescents-Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,University of Paris, Medical School, Faculty of Psychology, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Team DevPsy, Villejuif, France
| | - Laelia Benoit
- Maison des Adolescents-Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,University of Paris, Medical School, Faculty of Psychology, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Team DevPsy, Villejuif, France
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11
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Gonzálvez C, Díaz-Herrero Á, Vicent M, Sanmartín R, Pérez-Sánchez AM, García-Fernández JM. Subtyping of Adolescents with School Refusal Behavior: Exploring Differences Across Profiles in Self-Concept. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4780. [PMID: 31795273 PMCID: PMC6926772 DOI: 10.3390/ijerph16234780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023]
Abstract
Not all adolescents with school attendance problems attribute their behavior to the same causes. Knowing the subtypes of students who reject school and their relationship with new variables, such as self-concept, is an unresolved task. This study aimed to identify different school refusal behavior profiles and to determine whether these profiles differed from each other based on the scores of the eleven dimensions of self-concept (Physical appearance, Physical abilities, Parent relations, Same-sex relations, Opposite-sex relations, Honesty, Emotional stability, Self-esteem, Verbal, Math, and General school). The participants were 1315 Spanish students (57.6% male) aged 12-18 years (M = 15.21; SD = 1.74). The School Refusal Assessment Scale-Revised and the Self-Description Questionnaire II-Short Form were administered. A latent class analysis revealed four school refusal behavior profiles: Moderately High School Refusal Behavior, Moderately Low School Refusal Behavior, Mixed School Refusal Behavior and Non-School Refusal Behavior. The results indicated that the Mixed School Refusal Behavior group was the most maladaptive profile and revealed the lowest mean scores on self-concept. In contrast, Non-School Refusal and Moderately Low School Refusal Behavior groups revealed the highest scores in all dimensions of self-concept. Implications for working toward the prevention of school refusal in students with low self-concept are discussed.
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Affiliation(s)
- Carolina Gonzálvez
- Department of Development Psychology and Teaching, University of Alicante, 03690 San Vicente del Raspeig, Spain; (C.G.); (M.V.); (R.S.); (A.M.P.-S.); (J.M.G.-F.)
| | - Ángela Díaz-Herrero
- Department of Development Psychology and Education University of Murcia, 30003 Murcia, Spain
| | - María Vicent
- Department of Development Psychology and Teaching, University of Alicante, 03690 San Vicente del Raspeig, Spain; (C.G.); (M.V.); (R.S.); (A.M.P.-S.); (J.M.G.-F.)
| | - Ricardo Sanmartín
- Department of Development Psychology and Teaching, University of Alicante, 03690 San Vicente del Raspeig, Spain; (C.G.); (M.V.); (R.S.); (A.M.P.-S.); (J.M.G.-F.)
| | - Antonio M. Pérez-Sánchez
- Department of Development Psychology and Teaching, University of Alicante, 03690 San Vicente del Raspeig, Spain; (C.G.); (M.V.); (R.S.); (A.M.P.-S.); (J.M.G.-F.)
| | - José M. García-Fernández
- Department of Development Psychology and Teaching, University of Alicante, 03690 San Vicente del Raspeig, Spain; (C.G.); (M.V.); (R.S.); (A.M.P.-S.); (J.M.G.-F.)
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Kearney CA, Gonzálvez C, Graczyk PA, Fornander MJ. Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1). Front Psychol 2019; 10:2222. [PMID: 31681069 PMCID: PMC6805702 DOI: 10.3389/fpsyg.2019.02222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
School attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Many efforts have been made to conceptualize and address this population across various categories and dimensions of functioning and across multiple disciplines, resulting in both a rich literature base and a splintered view regarding this population. This article (Part 1 of 2) reviews and critiques key categorical and dimensional approaches to conceptualizing school attendance and school absenteeism, with an eye toward reconciling these approaches (Part 2 of 2) to develop a roadmap for preventative and intervention strategies, early warning systems and nimble response, global policy review, dissemination and implementation, and adaptations to future changes in education and technology. This article sets the stage for a discussion of a multidimensional, multi-tiered system of supports pyramid model as a heuristic framework for conceptualizing the manifold aspects of school attendance and school absenteeism.
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Affiliation(s)
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - Patricia A. Graczyk
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Gonzálvez C, Díaz-Herrero Á, Sanmartín R, Vicent M, Pérez-Sánchez AM, García-Fernández JM. Identifying Risk Profiles of School Refusal Behavior: Differences in Social Anxiety and Family Functioning Among Spanish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3731. [PMID: 31623358 PMCID: PMC6801475 DOI: 10.3390/ijerph16193731] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
School attendance problems negatively affect students' development. This study attempted to identify different school refusal behavior profiles and to examine their relationship with three dimensions of social anxiety (fear of negative evaluation, social avoidance and distress in new situations, and social avoidance and distress that is experienced more generally in the company of peers) and the perception of family functioning. Participants included 1842 Spanish adolescents (53% girls) aged 15-18 years (M = 16.43; SD = 1.05). The School Refusal Assessment Scale-Revised (SRAS-R), the Social Anxiety Scale for Adolescents (SAS-A), and the Family APGAR Scale (APGAR: Adaptation, Partnership, Growth, Affection, and Resolve) were administered. Latent class analysis revealed four school refusal behavior profiles: non-school refusal behavior, high school refusal behavior, moderately low school refusal behavior, and moderately high school refusal behavior. Analyses of variance (ANOVA) indicated that adolescents' with the profile of high school refusal behavior showed higher scores in all the subscales of social anxiety. In contrast, the non-school refusal behavior group revealed higher scores in the perception of good family functioning, whereas the high school refusal behavior profile obtained the lowest scores in this scale. These findings suggest that students who reject school are at a higher risk of developing social anxiety problems and manifesting family conflicts. These students should be prioritized in order to attend to their needs, promoting self-help to overcome social anxiety and family problems with the purpose of preventing school refusal behaviors.
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Affiliation(s)
- Carolina Gonzálvez
- Department of Development Psychology and Teaching, Faculty of Education, University of Alicante, 03690 Alicante, Spain.
| | - Ángela Díaz-Herrero
- Department of Development Psychology and Education, Faculty of Psychology, University of Murcia, 30003 Murcia, Spain.
| | - Ricardo Sanmartín
- Department of Development Psychology and Teaching, Faculty of Education, University of Alicante, 03690 Alicante, Spain.
| | - María Vicent
- Department of Development Psychology and Teaching, Faculty of Education, University of Alicante, 03690 Alicante, Spain.
| | - Antonio M Pérez-Sánchez
- Department of Development Psychology and Teaching, Faculty of Education, University of Alicante, 03690 Alicante, Spain.
| | - José M García-Fernández
- Department of Development Psychology and Teaching, Faculty of Education, University of Alicante, 03690 Alicante, Spain.
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Brouwer-Borghuis ML, Heyne D, Sauter FM, Scholte RH. The Link: An Alternative Educational Program in the Netherlands to Reengage School-Refusing Adolescents With Schooling. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ingul JM, Havik T, Heyne D. Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Heyne D, Gren-Landell M, Melvin G, Gentle-Genitty C. Differentiation Between School Attendance Problems: Why and How? COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.03.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chu BC, Guarino D, Mele C, O’Connell J, Coto P. Developing an Online Early Detection System for School Attendance Problems: Results From a Research-Community Partnership. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rosenthal L, Moro MR, Benoit L. Migrant Parents of Adolescents With School Refusal: A Qualitative Study of Parental Distress and Cultural Barriers in Access to Care. Front Psychiatry 2019; 10:942. [PMID: 31998159 PMCID: PMC6962236 DOI: 10.3389/fpsyt.2019.00942] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/28/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: School refusal is an important problem in adolescent psychiatry. However, little is known about the experience of school refusal among minority youth (migrants and minority ethnic groups). This study assesses how parents of various cultural backgrounds experience their adolescents' school refusal. Method: This qualitative study is based on interviews of 11 parents of teenagers diagnosed with school refusal at three adolescent outpatient mental health units in Paris and its suburbs. Interpretative phenomenological analysis was used for the thematic investigation. Results: The analysis found four themes: (i) confronting school and school refusal distresses parental representations; (ii) school refusal as a failure of the family's obligation to succeed after migration; (iii) representations of school that fluctuate with time since arrival: idealization, followed by mistrust and disappointment in the inequalities, even the racism; (iv) solutions envisioned for school refusal, confronting the healthcare system, stigma, and, again, inequality. Conclusion: All parents question their parenting choices when their children become school refusers. However, when families belong to minority groups, school refusal calls into question parents' relations with the French school system and their immigration choices. At the same time, the construction of a multicultural identity for children and adolescents in transcultural situations requires them to strike a balance between two worlds, and school refusal endangers this delicate negotiation. Subsequent misunderstandings can lead clinicians to misdiagnose school refusal as truancy. Clinicians must take the parents' culture and migration history into account to minimize the risk of complete failure of treatment for school refusal and the ensuing inequality of care and opportunity that can result.
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Affiliation(s)
- Lucie Rosenthal
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,Department of Child and Adolescent Psychiatry, Centre Hospitalier Spécialisé Pierre-Jamet, Fondation Bon-Sauveur d'Alby, Albi, France
| | - Marie Rose Moro
- Maison des Adolescents - Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,Dept of Child and Adolescent Psychiatry, University of Paris, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Villejuif, France
| | - Laelia Benoit
- Maison des Adolescents - Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,Dept of Child and Adolescent Psychiatry, University of Paris, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Villejuif, France
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Functional profiles of school refusal behavior and their relationship with depression, anxiety, and stress. Psychiatry Res 2018; 269:140-144. [PMID: 30149271 DOI: 10.1016/j.psychres.2018.08.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
Negative emotional states are common among youth with problematic school absenteeism, but little is known about their presence across different school refusal behavior profiles. The aim of this study was twofold: to identify different cluster solutions across functional profiles of school refusal behavior (I. Avoidance of Negative Affectivity, II. Escape from Social and/or Evaluative Situations, III. Pursuit of Attention, and IV. Pursuit of Tangible Reinforcement) and to determine whether these profiles differ from each other based on dimensions of depression, anxiety, and stress. The sample consisted of 1582 Ecuadorian adolescents aged 12-18 years (M = 14.83; SD = 1.86) who completed the School Refusal Assessment Scale-Revised (SRAS-R) and the Depression, Anxiety and Stress Scale-21 (DASS-21). Latent class analysis revealed three school refusal profiles: non-school refusal behavior, school refusal behavior by tangible reinforcements, and school refusal behavior by multiple reinforcements. The last group displayed the most maladaptive profile and revealed highest mean scores on the three dimensions of the DASS-21 compared to other groups. To promote mental health in this group it is a necessary goal due to their link with these negative emotional states. Prevention measures to strengthen emotional self-regulation should be considered in these cases.
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Londono Tobon A, Reed MO, Taylor JH, Bloch MH. A Systematic Review of Pharmacologic Treatments for School Refusal Behavior. J Child Adolesc Psychopharmacol 2018; 28:368-378. [PMID: 29741917 PMCID: PMC6909768 DOI: 10.1089/cap.2017.0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE School refusal is an important pediatric problem with significant negative short- and long-term outcomes. Specific psychosocial treatments appear effective in reducing school refusal, but many children do not respond to these treatments. Although systematic reviews have examined the efficacy of psychological interventions for school refusal, no systematic reviews on pharmacological interventions exist. METHODS We conducted a comprehensive literature search of MEDLINE, PsycINFO, Scopus, and Embase for randomized controlled trials (RCTs) or quasi-experimental pharmacologic trials in children and adolescents with school refusal reported in English or Spanish until July 1, 2017. Two authors screened study titles and abstracts for eligibility. Data regarding the population, intervention, comparison, and outcomes for each trial were extracted and reported. Effect sizes for school attendance are presented. RESULTS The search identified 6 articles, including 7 trials (6 RCTs and 1 open label) and 306 youths. Pharmacologic treatments investigated for school refusal included antidepressants (imipramine, clomipramine, and fluoxetine) and benzodiazepines (alprazolam). All pharmacotherapies studied had pretreatment to posttreatment improvements on school refusal, depression, and anxiety symptoms. However, included trials were severely underpowered and did not demonstrate significant improvement compared to placebo. CONCLUSIONS Data regarding pharmacological treatments for school refusal are sparse. Most trials in this area were conducted before development of newer antidepressants, were underpowered, and have significant methodological limitations that are characteristic of the time in which they were conducted. This systematic review highlights the need for more trials with newer pharmacologic agents, larger sample sizes, and improved systematic assessments of school refusal and comorbidities. School refusal represents an important functional outcome for many children, especially those with anxiety and depression. Future pharmacologic studies of anxiety and depression in children may benefit from incorporating specific school refusal measures as secondary outcomes.
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Affiliation(s)
- Amalia Londono Tobon
- Yale Child Study Center, New Haven, Connecticut
- Yale Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Margot O. Reed
- Yale Child Study Center, New Haven, Connecticut
- College of the Holy Cross, Worcester, Massachusetts
| | - Jerome H. Taylor
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael H. Bloch
- Yale Child Study Center, New Haven, Connecticut
- Yale Department of Psychiatry, Yale University, New Haven, Connecticut
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Smerillo NE, Reynolds AJ, Temple JA, Ou SR. Chronic absence, eighth-grade achievement, and high school attainment in the Chicago Longitudinal Study. J Sch Psychol 2017; 67:163-178. [PMID: 29571532 DOI: 10.1016/j.jsp.2017.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 08/21/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
Abstract
Although not as commonly reported as average daily attendance, chronic absence data may be of significant importance for understanding student success. Using data from 1148 participants in the Chicago Longitudinal Study, we assessed the associations of chronic absence in the early middle grades, grades fourth through sixth, with eighth-grade achievement and three measures of high school attainment including four-year graduation by diploma, graduation by diploma by age 21, and any high school completion by age 21. The rate of chronic absenteeism, defined here as students missing approximately 14days of school or more in a year, was 15%. Using Ordinary Least Squares, probit regression, and inverse-probability-weighting regression-adjustment methods (IPWRA), results indicated that chronic absence in the early middle grades was negatively associated (d=-0.17) with eighth-grade math achievement and reduced the probability of four-year graduation by diploma by 18 percentage points, graduation by diploma by age 21 by 17 percentage points, and any high school completion by age 21 by 11 percentage points. IPWRA yielded similar estimates. Coefficients varied by subgroup with males and children of mothers who completed high school experiencing more detrimental effects. Associations of chronic absence with outcomes are important to understand because school interventions and practices which begin early can be effective in reducing the prevalence of absenteeism.
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Lijffijt M, Lane SD, Mathew SJ, Stanford MS, Swann AC. Heightened early-attentional stimulus orienting and impulsive action in men with antisocial personality disorder. Eur Arch Psychiatry Clin Neurosci 2017; 267:697-707. [PMID: 27662886 DOI: 10.1007/s00406-016-0734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/09/2016] [Indexed: 12/29/2022]
Abstract
We tested whether enhanced stimulus orienting operationalized as N1 and P2 auditory evoked potentials to increasing loudness (50-90 dB clicks) could be associated with trait impulsivity (Barratt Impulsiveness Scale, BIS-11), impulsive action (commission error on the Immediate Memory Task), or impulsive choice (immediate responses on temporal discounting tasks). We measured N1 and P2 loudness sensitivity in a passive listening task as linear intensity-sensitivity slopes in 36 men with antisocial personality disorder with a history of conviction for criminal conduct and 16 healthy control men. Across all subjects, regression analyses revealed that a steeper P2 slope predicted higher IMT commission error/correct detection ratio, and lower stimulus discriminability (A-prime). These associations were also found within both groups. These relationships suggest an association between enhanced early stimulus orienting (P2), impulsive action (response inhibition), and impaired signal-noise discriminability (A-prime).
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Affiliation(s)
- Marijn Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
| | - Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77030, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.,Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Alan C Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.,Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration. Clin Child Fam Psychol Rev 2015; 17:191-215. [PMID: 24338067 DOI: 10.1007/s10567-013-0160-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.
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Knollmann M, Reissner V, Kiessling S, Hebebrand J. [The differential classification of school avoidance- a cluster-analytic investigation]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013. [PMID: 23988835 DOI: 10.1024/1422-4917//a000248] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We investigated subtypes of school-avoiding children and adolescents in a German sample using cluster analysis. METHOD 169 outpatients of a specialized outpatient unit for children and adolescents with school-avoiding behavior were subjected to cluster analysis using factor scores (principal factoring, varimax-rotation: measures of internalizing and externalizing symptoms, e.g., CBCL, YSR, and variables indicating the quality of school avoiding behavior, such as initial parental knowledge of school absence, activities during school absence). The resulting clusters were compared to other variables such as parental mental health problems, parental divorce, bullying in school, class repetition, and IQ. RESULTS Three groups were identified: "school refusers" with low externalizing symptoms who mainly stayed at home with their parents and were informed about their school absence from the beginning. Second, the "truants" with strong externalizing symptoms who spent school time alone or together with peers outside their home and were absent in school without initial parental knowledge. In a third cluster, children showed more externalizing problems than the school refusers and less externalizing problems than the truants. Most of their parents were informed about the school absence from the beginning, although the dominant activity was staying at home alone. Internalizing symptoms had no impact on cluster formation. Comparisons of the three groups, however, showed higher internalizing problems for school refusers and the third cluster, which was then labeled "school avoidance with mixed symptoms." RESULTS AND CONCLUSIONS In most cases, significant differences regarding potential stressors at home (e.g., parental mental health problems) or in school (e.g., bullying, class repetition) were not obtained.
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Affiliation(s)
- Martin Knollmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen
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Schulabsentismus in Deutschland - Die Prävalenz von entschuldigten und unentschuldigten Fehlzeiten und ihre Korrelation mit emotionalen und Verhaltensauffälligkeiten. Prax Kinderpsychol Kinderpsychiatr 2013. [DOI: 10.13109/prkk.2013.62.8.570] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nik Jaafar NR, Tuti Iryani MD, Wan Salwina WI, Fairuz Nazri AR, Kamal NA, Prakash RJ, Shah SA. Externalizing and internalizing syndromes in relation to school truancy among adolescents in high-risk urban schools. Asia Pac Psychiatry 2013; 5 Suppl 1:27-34. [PMID: 23857834 DOI: 10.1111/appy.12072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To examine the relationship between externalizing/internalizing syndromes and school truancy among Form Four (10th grade) students attending "high-risk" schools in Kuala Lumpur. METHODS This is a cross-sectional study conducted upon 16-year-old adolescents attending three high-risk schools in Kuala Lumpur. A total of 373 students completed self-administered questionnaires on the sociodemographic variables and externalizing/internalizing syndromes. The number of truant-days per student during the study period was obtained from the school records. RESULTS The mean internalizing score, externalizing score and total problem score of those who were truant were found to be significantly higher (P < 0.05) than those who were non-truant. Multiple logistic regressions showed externalizing syndrome (odds ratio [OR] = 1.044; confidence interval [CI] = 1.012-1.078, P = 0.018) significantly predicts truancy but not the internalizing syndrome. Two other psychosocial factors, namely, having divorced parents (OR = 2.495, CI = 1.058-5.886, P = 0.037) and did not understand or were uncertain of the purpose of schooling (OR = 2.621, CI = 1.265-5.433, P = 0.010) were also showed to be stronger predictors of truancy compared to externalizing/internalizing syndromes. DISCUSSION Truancy has significant association to externalizing syndrome, in addition to other significant psychosocial variables like parental and schooling factors. This finding indicated the need for comprehensive assessment of students presenting with truant behavior, including the identification of associated psychological and behavioral problems which highlights the roles of mental health professionals in tackling truancy.
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Affiliation(s)
- Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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Walter D, Hautmann C, Minkus J, Petermann M, Lehmkuhl G, Goertz-Dorten A, Doepfner M. Predicting Outcome of Inpatient CBT for Adolescents with Anxious-Depressed School Absenteeism. Clin Psychol Psychother 2011; 20:206-15. [DOI: 10.1002/cpp.797] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel Walter
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Christopher Hautmann
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Johannes Minkus
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Maike Petermann
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Gerd Lehmkuhl
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Anja Goertz-Dorten
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
| | - Manfred Doepfner
- Department for Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Germany
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The Role of Cognition in School Refusal: An Investigation of Automatic Thoughts and Cognitive Errors. Behav Cogn Psychother 2011; 40:255-69. [DOI: 10.1017/s1352465811000427] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aims: The purpose of this study was to investigate the cognitions of anxious school refusers. The cognitive constructs under investigation included negative cognition commonly linked to youth anxiety (i.e. negative automatic thoughts and cognitive errors) and positive automatic thoughts. Method: The cognition of school refusers (n = 50) and youth from a community sample (n = 181) was assessed with the Children's Automatic Thoughts Scale-Negative/Positive and the Children's Negative Cognitive Error Questionnaire-Revised. Results: When controlling for anxiety, school refusers were found to report more negative automatic thoughts concerning personal failure, fewer negative automatic thoughts concerning hostility, and fewer positive automatic thoughts. Negative automatic thoughts concerning personal failure and hostility, and the negative cognitive error of overgeneralizing were found to independently predict school refusal. Conclusions: The findings underscore the importance of further researching the role of cognition in the development, maintenance, and treatment of anxiety-based school refusal.
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Kearney CA. An Interdisciplinary Model of School Absenteeism in Youth to Inform Professional Practice and Public Policy. EDUCATIONAL PSYCHOLOGY REVIEW 2008. [DOI: 10.1007/s10648-008-9078-3] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kearney CA. Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity. J Child Psychol Psychiatry 2007; 48:53-61. [PMID: 17244270 DOI: 10.1111/j.1469-7610.2006.01634.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND School refusal behavior is a particularly nettlesome problem for mental health and education professionals because of its symptom severity and heterogeneity as well as lack of consensus regarding inclusive classification strategies. Alternatively, a functional model of school refusal behavior may provide a particularly useful way of organizing, assessing, and treating this population. METHOD The present study included 222 youths aged 5-17 years (134 males, 88 females) with school refusal behavior and their parents. Participants were assessed at a specialized university-based clinic for youths with school refusal behavior. Child self-report and parent-based measures of forms of behavior related to school refusal as well as functions of school refusal behavior were employed. RESULTS Hierarchical regression analysis and structural equation modeling revealed that function was a better determinant of degree of school absenteeism than behavior form. CONCLUSIONS Assessing the function of school refusal behavior is likely a key factor in the evaluation of this population and may be linked to informed decisions about choice of treatment.
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31
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Lyon AR, Cotler S. Toward reduced bias and increased utility in the assessment of school refusal behavior: The case for diverse samples and evaluations of context. PSYCHOLOGY IN THE SCHOOLS 2007. [DOI: 10.1002/pits.20247] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Brown AW. The state of mental health services for children and adolescents: an examination of programs, practices and policies. JOURNAL OF HEALTH & SOCIAL POLICY 2003; 16:139-53. [PMID: 12809384 DOI: 10.1300/j045v16n01_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article presents an overview of the state of mental health services for children and adolescents. It provides a brief historical review of policies affecting mental health services for children and adolescents with emotional and behavioral disorders. It discusses the roles of various systems in the provision services for emotionally and behaviorally disordered children and adolescents, and the need for cross-systems collaboration and funding. A model psycho-educational day treatment program. City Lights, is highlighted as an approach to serving inner-city African American adolescents with a profile of services and of the types of youth best served by such a program.
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Abstract
OBJECTIVE To examine the association between anxious school refusal and truancy and psychiatric disorders in a community sample of children and adolescents using a descriptive rather than etiological definition of school refusal. METHOD Data from eight annual waves of structured psychiatric interviews with 9- to 16-year-olds and their parents from the Great Smoky Mountains Study were analyzed. RESULTS Pure anxious school refusal was associated with depression (odds ratio [OR] = 13, 95% confidence interval [CI] 3.4, 42) and separation anxiety disorder (OR = 8.7, 95% CI 4.1, 19). Pure truancy was associated with oppositional defiant disorder (OR = 2.2, 95% CI 1.2, 4.2), conduct disorder (OR = 7.4, 95% CI 3.9, 14), and depression (OR = 2.6, 95% CI 1.2, 56). Of mixed school refusers (children with both anxious school refusal and truancy), 88.2% had a psychiatric disorder. They had increased rates of both emotional and behavior disorders. Specific fears, sleep difficulties, somatic complaints, difficulties in peer relationships, and adverse psychosocial variables had different associations with the three types of school refusal. CONCLUSIONS Anxious school refusal and truancy are distinct but not mutually exclusive and are significantly associated with psychopathology, as well as adverse experiences at home and school. Implications of these findings for assessment, identification, and intervention for school refusal are discussed.
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Affiliation(s)
- Helen Link Egger
- Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Lauchlan F. Responding to Chronic Non-attendance: A review of intervention approaches. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2003. [DOI: 10.1080/02667360303236] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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.
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Affiliation(s)
- D Heyne
- Victorian Child Psychiatry Training Department, Faculty of Medicine, Dentistry, & Health Sciences, University of Melbourne, Australia.
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Abstract
OBJECTIVE To critically review the past 10 years of research on school refusal in children and adolescents. METHOD Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies. RESULTS While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal. CONCLUSIONS From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.
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Affiliation(s)
- N J King
- Faculty of Education, Monash University, Victoria, Australia. neville.king@education
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King NJ, Heyne D, Tonge B, Gullone E, Ollendick TH. School refusal: categorical diagnoses, functional analysis and treatment planning. Clin Psychol Psychother 2001. [DOI: 10.1002/cpp.313] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
OBJECTIVE To provide clinicians with current information to assist in their consultations to schools on 4 major topics that are unique to the school environment and of serious concern to educators: absenteeism, disciplinary referrals, retention (non-promotion), and dropping out. METHOD Computer literature searches and the major journals of the various school disciplines were used to identify empirically based articles with sound methodology. Information on each of the 4 issues is presented as general characteristics, characteristics of psychopathology, prevention and treatment, and implications for consultation. RESULTS Findings are largely general, with little specific information on level of intelligence, learning disorders, psychopathology, or family stressors. Students under each topic have varied presentations. However, many pupils with absenteeism, disciplinary referrals, or retention appear to be characterized by chronic and serious academic and/or behavior problems, all of which can predate dropping out. CONCLUSIONS Considerable research is still needed on all 4 school issues, especially psychopathology. Nevertheless, consultants can reasonably first help schools to identify students at risk for the 4 outcomes, followed by appropriate screening/evaluation to indicate more clearly their true intervention needs. The ongoing process can further educate school staff about psychiatric disorders in their most problematic students.
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Affiliation(s)
- R E Mattison
- Department of Psychiatry, State University of New York at Stony Brook 11794-8790, USA.
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Farrington DP. The Twelfth Jack Tizard Memorial Lecture. The development of offending and antisocial behaviour from childhood: key findings from the Cambridge Study in Delinquent Development. J Child Psychol Psychiatry 1995; 36:929-64. [PMID: 7593403 DOI: 10.1111/j.1469-7610.1995.tb01342.x] [Citation(s) in RCA: 353] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the Cambridge Study in Delinquent Development, 411 South London males have been followed up from age 8 to age 32. The most important childhood (age 8-10) predictors of delinquency were antisocial child behaviour, impulsivity, low intelligence and attainment, family criminality, poverty and poor parental child-rearing behaviour. Offending was only one element of a larger syndrome of antisocial behaviour that arose in childhood and persisted into adulthood. Marriage, employment and moving out of London fostered desistance from offending. Early prevention experiments are needed to reduce delinquency, targeting low attainment, poor parenting, impulsivity and poverty.
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Naylor MW, Staskowski M, Kenney MC, King CA. Language disorders and learning disabilities in school-refusing adolescents. J Am Acad Child Adolesc Psychiatry 1994; 33:1331-7. [PMID: 7995801 DOI: 10.1097/00004583-199411000-00016] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We undertook this study to test the hypothesis that school-refusing adolescents hospitalized on an inpatient psychiatric unit have more language and learning disabilities than diagnosis-, age-, and sex-matched psychiatric controls. METHOD The Woodcock-Johnson Tests of Achievement-Revised (WJTA-R), the WISC-R, the Adolescent Language Screening Test, the Clinical Evaluation of Language Fundamentals-Revised, and the Test of Language Competence (TLC) were given to a group of well-characterized, primarily depressed school refusers and matched psychiatric controls. RESULTS We found that school-refusing adolescents had significantly lower WISC-R verbal intelligence scores, lower Math and Written Language subscale scores on the WJTA-R, and lower scores on the TLC than nonrefusers. School refusers were found to have a significantly higher incidence of both language impairments and learning disabilities than controls. CONCLUSIONS We infer that academic and communicative frustration and the adolescent's resulting inability to meet the academic and social demands in the school environment may play a role in the etiology of school refusal.
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Affiliation(s)
- M W Naylor
- Northwestern University Medical School, Chicago, IL 60611
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Bools C, Neale B, Meadow R. Munchausen syndrome by proxy: a study of psychopathology. CHILD ABUSE & NEGLECT 1994; 18:773-788. [PMID: 8000908 DOI: 10.1016/0145-2134(94)00044-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Munchausen Syndrome by Proxy (the fabrication of illness by a mother in her child) is often a serious form of child abuse that has been recognized increasingly over recent years. Approximately one-half of the mothers in this study had either smothered or poisoned their child as part of their fabrications. Lifetime psychiatric histories are reported for 47 of the mothers. Thirty-four had a history of a Factitious or Somatoform disorder, 26 a history of self harm, and 10 of alcohol or drug misuse. Nine mothers had a forensic history independent of convictions related to child abuse. Nineteen of these mothers were interviewed from 1-15 years after the original fabrications. The most notable psychopathology was the presence of a personality disorder in 17 of the mothers, which were predominantly Histrionic and Borderline types. Most subjects, however, met the criteria for more than one category of personality disorder.
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Affiliation(s)
- C Bools
- Department of Pediatrics and Child Health, St. James's University Hospital, Leeds, UK
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Abstract
Fifty four children were studied 1-14 (mean 5.6) years after fabrications of illness had been identified. Thirty of the 54 children were living in families with their biological mothers and 24 were with other family members or in substitute families. Further fabrications were identified for 10 children who had been living with their mothers and there were 'other concerns' for a further eight children. Thirteen children residing with mother and 14 not residing with mother at follow up had a range of disorders including conduct and emotional disorders, and problems related to school, including difficulties in attention and concentration and non-attendance. Overall, 20 children (49% of those successfully followed up) had outcomes that were considered to be unacceptable.
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Affiliation(s)
- C N Bools
- Department of Paediatrics and Child Health, St James's University Hospital, Leeds
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Silove D, Manicavasagar V. Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder? Acta Psychiatr Scand 1993; 88:385-90. [PMID: 8310844 DOI: 10.1111/j.1600-0447.1993.tb03478.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.
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Affiliation(s)
- D Silove
- University of New South Wales, Academic Mental Health Unit, Liverpool Hospital, Australia
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Berg I, Butler A, Franklin J, Hayes H, Lucas C, Sims R. DSM-III-R disorders, social factors and management of school attendance problems in the normal population. J Child Psychol Psychiatry 1993; 34:1187-203. [PMID: 8245141 DOI: 10.1111/j.1469-7610.1993.tb01782.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eighty 13-15-year-old children who failed to attend one of four schools for more than 40% of a term, without good reason, were studied. A systematic schedule (C.A.P.A.) was used in interviewing parents and children. Twenty-five had DSM-III-R Disruptive Behaviour Disorders and 15 had Anxiety/Mood Disorders. Truancy was associated with the former and school refusal with the latter but both often occurred without any Disorder. Fourteen children had neither school refusal nor truancy. Compared to controls, poor attenders came from materially disadvantaged homes. School refusal with anxiety disorders rarely received psychiatric treatment. Non-disturbed absentees were not usually dealt with appropriately.
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Affiliation(s)
- I Berg
- Department of Clinical Medicine, University of Leeds, U.K
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Abstract
Severe school attendance problems, which once commanded a great deal of attention in child and adolescent psychiatry, have fallen from favour and are increasingly viewed as varieties of social impairment which may accompany disorders such as anxiety disturbances in the case of school refusal and conduct disturbances in the case of truancy. It is argued that this relegation of school attendance difficulties may have gone too far. As presenting complaints, albeit sometimes masked by apparent physical illness, they still have much to recommend them as indicators of a wide variety of present and future problems: educational, social, family, legal, medical, and, last but not least, psychiatric. Prevalence, features, causative factors, outcome, and management are discussed. Particular attention is paid to DSM and ICD classification. Gaps in present knowledge are indicated.
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