What Contributes to the Development and Maintenance of School Refusal in Chinese Adolescents: A Qualitative Study

Raising Generation Z Children in China: Parenting Styles and Psychosocial Adjustment

Objective: This study aims to analyze the relationship between parenting styles, i.e., authoritative, indulgent, authoritarian, and neglectful, and psychosocial adjustment, i.e., aggression, self-concept, and emotional-social competence, among Generation Z (Gen Z) individuals. Method: The participants were 1,417 Chinese individuals, 736 young adults (born between 2003-2005) and 681 adolescents (born between 2006-2008). A multivariate multifactorial design 4 × 2 × 2 × 2 was applied. Dependent variables were various components of child psychosocial adjustment (aggression, five dimensions of self-concept and emotional-social competence). Independent variables were parenting styles, children antisocial tendency during adolescence, sex, and age (adolescent vs. young adult cohorts). Results: Children from authoritarian homes reported higher levels of aggression, and the worst scores in self-concept and emotional-social competence. By contrast, the optimal results were consistently associated with warm parenting (i.e., authoritative and indulgent). Conclusions: Parental warmth was beneficial for Gen Z, including both adolescent and young adult cohorts. The present findings seriously questioned that the Chinese authoritarian parenting, which has often been related to positive outcomes-particularly for educational success-is beneficial for child psychosocial adjustment.

Functional analysis of school refusal: An exploratory study in the Indian context

Background

School refusal behaviour is an umbrella term that often subsumes constructs such as truancy, school refusal, and school phobia. It is influenced by various psychological and psychosocial factors and can lead to significant distress to the child and the family.

Aim

To assess the clinical and functional profile of school refusal behavior in children and adolescents presenting to a tertiary care child and adolescent psychiatry center in the Indian context.

Materials and Methods

Thirty-six subjects (6-17 years) presenting to a tertiary Child and Adolescent Psychiatry service with school refusal behavior (SRB) were evaluated using the MINI-KID 6.0 and School Refusal Assessment Scale-Revised (SRAS-R). The sociodemographic and clinical characteristics of the sample were studied using frequency analysis and central tendencies. The association between school refusal and these variables was examined using Cramer's V coefficient.

Results

Anxiety in social/evaluative situations associated with tangible rewards at home was the predominant primary reason for school refusal in this sample. There was a significant statistical association between functions of school refusal and scholastic performance, psychiatric diagnosis, and family stressors. The Children's Global Assessment Scale (CGAS) scores varied widely from 30 to 80 indicating an inability to function in almost all areas to no more than a slight impairment in functioning.

Conclusions

School refusal is a complex multifactorial phenomenon with both individual and psychosocial contributing factors. Understanding the phenomenon from a functional perspective helps in devising an individualized treatment plan that may lead to better outcomes.

Self-injury functions mediate the association between anxiety and self-injury frequency among depressed Chinese adolescents: sex differences

Objective

Non-suicidal self-injury (NSSI) has become a common clinical problem that severely threatens the mental and physical health of Chinese adolescents. This study explores the mediation effects of NSSI functions on the relationship between anxiety and NSSI frequency among depressed Chinese adolescents as well as the sex differences in the mediating effects.

Methods

In this study, a cross-sectional survey method was used to obtain data of 1773 adolescent patients with major depressive disorders from over 20 specialized psychiatric hospitals across multiple provinces in China. A self-designed questionnaire for demographic information, the Chinese version of Functional Assessment of Self- Mutilation (C-FASM), and the 7-item Generalized Anxiety Disorder Scale (GAD-7) were employed to investigate demographic data, NSSI frequency, NSSI functions, and anxiety and to analyze the mediating effects of NSSI functions on the association between anxiety and NSSI frequency among adolescents of different sexes.

Results

A total of 316 male patients and 1457 female patients were investigated. Female patients had a higher NSSI frequency (Z=3.195, P=0.001) and higher anxiety scores than did male patients (Z=2.714, P=0.007). Anxiety had a stronger positive predictive effect on the NSSI frequency in females (OR = 1.090) than in males (OR = 1.064). For male patients, the emotion regulation function in NSSI motivation played a full mediating role in the association between anxiety and NSSI frequency. For female patients, the emotion regulation and social avoidance functions in NSSI functions played a partial mediating role between anxiety and NSSI frequency.

Conclusions

There are sex differences in the mediating role of NSSI functions of depressed adolescents in the association between anxiety and NSSI frequency. When experiencing anxiety, both males and females may engage in NSSI behaviors as a means to regulate their emotions. For females, anxiety can directly predict NSSI frequency, and they may attempt NSSI to achieve the purpose of rejecting others. In the face of anxiety among depressed adolescents of different sexes, developing different emotional regulation methods and behavioral regulation strategies may be critical in preventing their NSSI behaviors.

Chinese clients' experiences throughout family therapy for school-refusing adolescents: A multiperspectival interpretative phenomenological analysis

OBJECTIVE

This study aimed to explore Chinese clients' experiences with family dynamic change throughout family therapy for school refusal and the interventions adolescents and their parents identified as useful during family therapy.

METHODS

A multiperspective interpretative phenomenology analysis (IPA) was adopted. Thirty-two participants from 11 Chinese families with school-refusing adolescents were recruited after completing family therapy at the hospitals. Semistructured interviews were conducted with the families, and the transcripts were analyzed.

RESULTS

Four main superordinate themes emerged: reshaping healthy family boundaries, building a harmonious family atmosphere, learning to cooperate and fight against stress, and achieving individual growth.

CONCLUSION

Our analysis suggested that changes in school-refusing adolescents through family therapy consisted of multilevel factors. These factors influence the reversal of adolescents' school refusal. Some targeted interventions for Chinese adolescents who refuse school are discussed and suggested.

Psychological characteristics and emotional difficulties underlying school refusal in adolescents using functional near-infrared spectroscopy

BACKGROUND

This study aims to explore the psychological characteristics, related emotional problems and potential NIR brain function mechanism of adolescents who refuse to attend school.

METHODS

The study included 38 adolescents (12-18 years old) who were not attending school and 35 healthy controls (12-18 years old) who are attending school regularly. Participants completed (1) general demographics, (2) Eysenck Personality Questionnaire (EPQ), (3) Zung Self-Rating Depression Scale (SDS), (4) Zung Self-Rating Anxiety Scale (SAS), and (5) Symptom Checklist-90 (SCL-90). In addition to the clinical tests, participants completed functional near-infrared spectroscopy (fNIRS). Mental health, personality, and emotional state were evaluated in both groups to explore the differences and to understand the underlying mechanisms of school refusal during adolescence.

RESULTS

Adolescents who did not attend school had higher neuroticism scores on the Eysenck Personality Questionnaire than healthy controls (p(FDR) < 0.001), introversion and concealment scores were lower than those of healthy controls (p(FDR) < 0.001), there was no significant difference in psychoticism scores between groups. SDS, SAS, SCL-90 scores and factor scores were higher than those of healthy control group (p(FDR) < 0.001), NIR functional brain imaging was different from healthy control group in the 12 and 27 channels (p(FDR) = 0.030, p(FDR) = 0.018), and no difference was found in the remaining channels (p(FDR) > 0.05). There were statistically significant differences in age and gender between the adolescents who refused school and the control group (p(FDR) < 0.001).

CONCLUSION

School refusal adolescents are relatively introverted and sensitive and need more attention in daily life. Although the adolescents' emotional problems did not reach the diagnostic criteria of depressive disorder and anxiety disorder, their scores were still higher than those of the control group, suggesting that we should pay more attention to their emotional problems in order to better help them return to school. Using fNIRS, it was found that abnormalities in frontal lobe regions in adolescents with school refusal behaviors, which would contribute to early diagnosis and timely intervention of school refusal behaviors.