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Fernández de la Cruz L, Rautio D, Wickberg F, Gordan C, Silverberg-Mörse M, Mataix-Cols D. The Impact of Pediatric Obsessive-Compulsive Disorder on School Attendance and School Functioning: A Case for Supported Education. Child Psychiatry Hum Dev 2025:10.1007/s10578-025-01846-y. [PMID: 40343603 DOI: 10.1007/s10578-025-01846-y] [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] [Accepted: 04/24/2025] [Indexed: 05/11/2025]
Abstract
School-related functional impairment is common in children and adolescents with obsessive-compulsive disorder (OCD). However, little is known about the characteristics of youth with OCD who struggle in school, whether these struggles interfere with treatment outcomes, and whether treatment improves school-related function. Among 385 youth with OCD at a specialist clinic (mean age [sd] = 13.7 [2.5]; 63.1% girls), 21.6% had partial or no school attendance at intake. Among those who received specialist treatment (n = 322), clinical outcomes were similar in those with no or partial attendance vs. those with full attendance, although the latter group needed fewer treatment sessions and were less likely to take psychotropic medication. At post-treatment, 10.5% still had partial or no school attendance, and 22.8% of youths and 33.3% of parents reported significant school impairment, regardless of response status. Some youth with OCD may benefit from specific supported education and return to school strategies to complement regular evidence-based interventions.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Frida Wickberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Cecilia Gordan
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
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Johnsen DB, Lomholt JJ, Heyne D, Jensen MB, Jeppesen P, Silverman WK, Thastum M. The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial. Res Child Adolesc Psychopathol 2024; 52:1397-1412. [PMID: 38739306 PMCID: PMC11420258 DOI: 10.1007/s10802-024-01196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/14/2024]
Abstract
School attendance problems (SAPs) are associated with negative short- and long-term outcomes. Despite high prevalence of SAPs, there is a shortage of evidence-based interventions. Existing approaches often target either school refusal or truancy, leaving a gap in effective interventions addressing both types of SAPs. This randomized controlled trial (RCT) assessed the effectiveness of Back2School (B2S), a modular transdiagnostic cognitive behavioral therapy (CBT) for SAPs, compared to treatment as usual (TAU). Outcomes included youths' school attendance and mental health. A group (B2S, TAU) × time (Pre, Post, 3-Month Follow-Up) design involving 152 youths (B2S; n = 74, TAU; n = 78) with SAPs (i.e., ≥ 10% absence in the past three months), aged 6-16 years (M = 12.2, SD = 2.2, males = 60%) were used. B2S comprised three months of CBT with youths, parents, and school involvement, while TAU comprised public and/or private intervention services. On average, youths in B2S received 15.0, (SD = 3.9) hours of intervention, while those in TAU received 13.4, (SD = 21.6). Intervention effects were investigated using mixed linear models. Both B2S and TAU exhibited significant within-group improvements in school attendance, with no significant differences between them. However, the B2S group significantly outperformed TAU in reducing youths' emotional problems, conduct problems, problems with peers, the overall impact of problems, and increasing youths self-efficacy for attending school and parent self-efficacy for dealing with a SAP. This RCT represents the first evaluation of a modular transdiagnostic CBT for youths displaying SAPs, showing significant mental health and self-efficacy benefits. (Clinical trial registration: ClinicalTrials.gov: NCT03459677).
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Affiliation(s)
- Daniel B Johnsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Johanne J Lomholt
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- TrygFonden's Centre for Child Research, Aarhus University, Aarhus, Denmark
| | - David Heyne
- School of Psychology, Deakin University, Melbourne, Australia
| | - Morten B Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
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Pflug V, Schneider S. [School Absenteeism and Anxiety Disorders]. Psychother Psychosom Med Psychol 2024; 74:134-148. [PMID: 38552620 DOI: 10.1055/a-2245-5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Many children and adolescents in Germany do not attend school regularly despite compulsory school attendance. Some of them only miss a few lessons, while others stay away from school for whole days, months or even years. The article shows how anxiety disorders can be the cause of school absenteeism and how this can be treated therapeutically.
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Zhao G, Wang B, Li H, Ren H, Jiao Z. The relationship between depressive and anxious symptoms and school attendance among adolescents seeking psychological services in a public general hospital in China: a cross-sectional study. BMC Psychiatry 2023; 23:456. [PMID: 37344768 DOI: 10.1186/s12888-023-04813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND School attendance problems (SAPs), whether absenteeism or dropout, are strongly associated with poor outcomes for adolescents. We examined multiple variables that influence SAPs to identify potential leverage points for improving school attendance. METHODS Self-reported SAPs and demographic information was collected from 392 adolescents in adolescents presenting to the general hospital for psychological services. PHQ-9 and GAD-7 were applied to assess the severity of depressive and anxious symptoms. We constructed logistic regression analysis and the Chi-Square Automatic Interaction Detection (CHAID) segmentation analysis via SPSS Decision Tree to identifying risk factors for the development of SAPs in adolescents. RESULTS SAPs were self-reported by 252 (64.3%) adolescents. The SAPs group and non-SAPs group showed a significant difference in age, PHQ9 total scores, GAD7 total scores, schools, siblings, residence, parental marital quality, general health, regular exercise, and regular diet. A post hoc comparison between the two groups showed that the frequency of SAPs was significantly higher in the moderately-severe and severe depressive groups compared with other three groups (none, mild, moderate). The frequency of SAPs in severe anxious groups was significantly different from the none-anxious group. According to the binary logistic regression analysis, the depressive severity, siblings, residence, marital quality of parents, general health, and regular diet were correlated with the SAPs among adolescents. The adjusted OR of SAPs according to moderately-severe depressive symptoms was 10.84 (95%CI: 1.967-59.742) and severe depressive symptoms was 6.659 (95%CI: 1.147-38.666). In the decision tree model, PHQ-9 severity was extracted as the first splitting variable, with regular exercise and residence as the second, and siblings as the third. The ROC curves for predicting SAPs showed a fair diagnostic accuracy of the model with AUCs of CHAID model (0.705,95%CI:0.652-0.759, P = 0.000) and logistic regression model (0.777,95%CI:0.729-0.824, P = 0.000). CONCLUSION Our study provides insights into the associations between depressive symptoms and poor school attendance and identifies a number of risk factors associated with SAPs. Effective intervention by mental health practitioners, more attention by policy makers, and further research in this area are urgently needed for adolescents.
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Affiliation(s)
- Guoqing Zhao
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Bin Wang
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Hui Li
- Department of Psychology, Qilu Hospital Of Shandong University Dezhou Hospital, Dezhou, 253014, Shandong, China
| | - Honghong Ren
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Zhian Jiao
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China.
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Heyne D, Strömbeck J, Alanko K, Bergström M, Ulriksen R. A Scoping Review of Constructs Measured Following Intervention for School Refusal: Are We Measuring Up? Front Psychol 2020; 11:1744. [PMID: 32973595 PMCID: PMC7468385 DOI: 10.3389/fpsyg.2020.01744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Reviews of the effectiveness of interventions for school refusal (SR) rely upon well-conducted primary studies. Currently there are no guidelines for those conducting primary studies about the measurement of outcome following intervention for SR. Most people would agree that it is important to measure school attendance as an outcome but there has been little discussion about other constructs that warrant measurement. To facilitate this discussion and support the development of guidelines, we conducted a scoping review of constructs measured in studies evaluating intervention for SR. We screened the title and abstract of 3,213 publications found in peer-reviewed journals between 1980 and 2019. After full text review of 271 publications, 50 publications describing 51 studies were included. Results address the frequency with which constructs were measured, along with instruments used, informants, and time-points for measurement. Based on the results, we offer guidelines for choosing constructs to measure following intervention for SR and considerations for how to measure the constructs. Guidelines can increase consistency across primary studies, with benefits for future meta-analyses and international comparisons. They also provide support for practitioners contemplating routine evaluation of their interventions for SR. Ultimately, a core outcome set for SR can be developed.
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Affiliation(s)
- David Heyne
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Johan Strömbeck
- Magelungen Utveckling AB, Stockholm, Sweden
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Katarina Alanko
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
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Towards a comprehensive assessment of school absenteeism: development and initial validation of the inventory of school attendance problems. Eur Child Adolesc Psychiatry 2019; 28:399-414. [PMID: 30043236 DOI: 10.1007/s00787-018-1204-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
School attendance problems (SAPs) become manifest in many ways and are associated with multiple risk factors, calling for comprehensive assessment methods. This study documents the development of the inventory of school attendance problems (ISAP), which assesses both the quality and the function of a broad spectrum of SAPs by first asking students with SAPs to rate the intensity of symptoms prior to or at school and then to rate their impact on school attendance. An empirically generated pool of 124 items was analyzed (explorative factor analysis) using a clinical sample of N = 245 students with SAPs (53.5% male; Mage: 14.4). The Youth Self Report (YSR), a German version of the School Refusal Assessment Scale (SRAS), and the extent of school absenteeism were used to determine construct validity. The resulting 48 items loaded on 13 factors. The 13 scales assess internalizing and externalizing symptoms (Depression, Social Anxiety, Performance Anxiety, Agoraphobia/Panic, Separation Anxiety, Somatic Complaints, Aggression, School Aversion/Attractive Alternatives) as well as emotional distress due to problems in the school or family context (Problems with Teachers, Dislike of the Specific School, Problems with Peers, Problems Within the Family, Problems with Parents). All scales showed good internal consistencies. Their correlations with the YSR and the SRAS indicated convergent and discriminant validity. Positive associations between most of the scales and the extent of school absenteeism were obtained. Although preliminary, these results support the usefulness of the ISAP for a comprehensive assessment of SAPs in clinical settings.
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Remschmidt H. How Can We Prevent School Avoidance and Behavior Problems in Preschool Children? DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:645-646. [PMID: 26479483 PMCID: PMC4627208 DOI: 10.3238/arztebl.2015.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Helmut Remschmidt
- Department of Child and Adolescent Psychiatry, Philipps University, Marburg
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