Management of school refusal

School refusal: mapping the literature by bibliometric analysis

School refusal is considered a risk factor for academic, social, and personal situations, such as school dropouts. Studies have been carried out on school refusal for almost 50 years. However, general research trends have not been mapped yet. This study summarizes the bibliometric analysis of scientific collaborations and prevalence across locations by country and institution, leading researchers, journals, and trends (keywords) in school refusal research. The United States, Japan, Spain, and England are the countries that stand out in terms of school refusal. It can be said that the Journal of American Academy of Child and Adolescent Psychiatry, Cognitive and Behavioral Practice, and Frontiers in Psychology are important journals that publish on school refusal. Researchers named Christopher A. Kearney, Carolina Gonzálvez, Jose Manuel Garcia-Fernandez, David A. Heyne, and Brigit M. Van Widenfelt have been found to have more intensive studies and collaborations on school refusal. The authors keywords common use for school refusal; are truancy, school absenteeism, adolescence, school attendance, school phobia, autism spectrum disorder, and bullying. The findings show that school refusal is a current research area, and scientific collaborations continue to be established. The findings reveal all the details of the school refusal research.

A Systematic Review of Somatic Symptoms in School Refusal

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.

Rapid Return for School Refusal: A School-Based Approach Applied With Japanese Adolescents

Cognitive behavioral therapy (CBT) is often effective in the treatment of school refusal (SR). Its usefulness is limited, however, if youth displaying SR also refuse to attend treatment sessions. In these cases parents and school staff may consider using school-based interventions that do not rely on face-to-face assessment and treatment with the young person. The current study examined the effectiveness of a school-based intervention applied in Japan to achieve rapid return to school among adolescents displaying SR. Between 2009 and 2015, the parents of 62 adolescents displaying SR were invited to implement a school-based rapid return approach. Thirty-nine parents agreed to implement the approach and 23 decided to wait until their child spontaneously attended school. Of the 39 cases in which the approach was implemented, 28 adolescents (72%) resumed attendance at their original school, 2 (5%) transferred to another school, and 9 (23%) did not resume attendance. In contrast, all 23 non-intervention cases continued to refuse to attend school for 3 months or longer, and none of these adolescents returned to regular school attendance within 9 months. This study tentatively suggests that the rapid return approach may be an effective form of intervention for adolescents displaying SR and simultaneously refusing to attend individual therapy. Because this approach is ethically complex, involving forced school attendance in adolescence, it should only be employed under specific circumstances. These circumstances are discussed.

Migrant Parents of Adolescents With School Refusal: A Qualitative Study of Parental Distress and Cultural Barriers in Access to Care

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.

Absence from school and mental health

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.

Positive practice routines in overcoming resistance to the treatment of school phobia: a case study with follow-up

The treatment is described of a 6-year-old first grade girl who refused to attend her classroom without adult accompaniment. For eight weeks an attempt was made, using different adult escorts, to prompt/shape classroom attendence through classroom exposure. However, the outcome was the development of an unwavering preference to remain in the principal's office after the child would not tolerate separation from these adults. Rather then continue to take her to the classroom, an intervention was initiated designed to structure her daily experiences and provide instruction. In this she was expected to practice several educational activities at designated times in the principal's office. This intervention resulted in a complete elimination of the child's classroom avoidance within five weeks and concomitant improvements in both social and academic functioning. Although the child's mother suddenly died during intervention, follow-up at one and 12 months in a different school indicated the maintenance of all therapeutic gains. Unique aspects of the procedures pertaining to refractory problems and some tentative behavioral guidelines to overcoming resistance to treatment are discussed.