School Refusal in Immigrants and Ethnic Minority Groups: A Qualitative Study of Adolescents' and Young Adults' Experiences

Roll call: Why the child and adolescent mental health sector must be present for severe school refusal

School refusal can be a complex and intractable transdiagnostic syndrome that derails psychosocial development and jeopardises the successful transition to adulthood. Amid a global youth mental health crisis and in the aftermath of the COVID-19 pandemic, school refusal rates appear to have surged, prompting calls for urgent action. With a focus on severe forms of school refusal, we present an agenda for how the child and adolescent mental health sector can support the education sector in answering this call. We first identify three core challenges that must be tackled: (1) the need for clearer distinctions between mild and severe forms of school refusal to support classification, research, and intervention planning; (2) the treatment gap, which leaves many young people without timely or appropriate care; and (3) the absence of an evidence base to guide interventions for treatment non-responders. Then, for each challenge, we identify potential solutions, namely: (1) developing clinical staging frameworks to enhance conceptual clarity and support targeted research; (2) exploring outreach models of care to improve treatment access and engagement; and (3) devising robust methodologies for evaluating intensive Tier-4 interventions to strengthen the evidence base for treatment non-responders. Just as a roll call ensures that every individual is accounted for, this paper calls on the child and adolescent mental health sector to be fully present in addressing severe school refusal. By strengthening collaboration between clinical practice, education systems, and researchers, the field can move towards more effective, integrated, and scalable solutions that better meet the needs of these students and their families.

Trajectories of school refusal: sequence analysis using retrospective parent reports

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.

The effect of social withdrawal on life satisfaction among multicultural adolescents: The mediating and moderating effects of parental support

Background

The number of multicultural adolescents is continuously increasing, and they tend to experience more psychological difficulties than their non-multicultural peers.

Objective

This study investigates the mediating and moderating effects of parental support on the relationship between social withdrawal and life satisfaction among multicultural adolescents.

Methods

This secondary data analysis utilized the Multicultural Children & Adolescents Panel Survey conducted by the National Youth Policy Institute. The analysis included data from 2018 and involved 1197 multicultural adolescents. The data were analyzed using the R-Statistics 4.1.1 program.

Results

Social withdrawal and parental support had a detrimental impact on life satisfaction among multicultural adolescents. Parental support also played a partial mediating role in the connection between social support and life satisfaction. Furthermore, parental support was a moderating factor capable of mitigating the negative influence of social withdrawal on life satisfaction.

Conclusion

Measures to reduce social withdrawal and increase parental support are very effective in improving the life satisfaction of multicultural adolescents. More focused professional intervention measures for social withdrawal and parental support must be considered when seeking and preparing support measures to improve the life satisfaction of multicultural adolescents.

School refusal behavior in children and adolescents: a five-year narrative review of clinical significance and psychopathological profiles

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.