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| {{Short description|Child-motivated refusal to attend school or difficulty in remaining in class the full day}} | |||
| {{multiple issues| | {{multiple issues| | ||
| {{POV|date=October 2012}} | |||
| {{tone|date=October 2012}} | {{tone|date=October 2012}} | ||
| {{More citations needed|date=October 2009}} | |||
| {{essay-like|date=October 2014}} | {{essay-like|date=October 2014}} | ||
| }} | }} | ||
| '''School refusal''' is a child-motivated refusal to attend school or difficulty remaining in class for the full day.<ref>{{Cite journal|last=Kearney|first=Christopher A.|date=1996|title=The Evolution and Reconciliation of Taxonomic Strategies for School Refusal Behavior|journal=Clinical Psychology: Science and Practice|volume=3|issue=4|pages=339–354|doi=10.1111/j.1468-2850.1996.tb00087.x|issn=0969-5893}}</ref> Child-motivated ] occurs autonomously, by the volition of the child. This behavior is differentiated from non-child-motivated absences in which parents withdraw children from school or keep them home for circumstances such as homelessness.<ref name=":02" /><ref name=":0">{{Cite journal|last1=Dube|first1=S. R.|last2=Orpinas|first2=P.|date=2009-04-01|title=Understanding Excessive School Absenteeism as School Refusal Behavior|journal=Children & Schools|volume=31|issue=2|pages=87–95|doi=10.1093/cs/31.2.87|issn=1532-8759}}</ref> School refusal is characterized by avoidance and/or emotional distress at the time of attending school.<ref name=":42" /> | |||
| '''School refusal''' is the refusal to attend school due to emotional ]. School refusal differs from ] in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. Children's Hospital Boston provides a chart<ref>{{cite web|url=http://www.childrenshospital.org/az/Site1562/mainpageS1562P0.html |title=School Refusal approach at CHB |publisher=Childrenshospital.org |accessdate=2012-10-26}}</ref> showing the difference between school refusal and truancy.<ref>{{cite web|publisher=Children’s Hospital Boston|title=School Refusal|url=http://www.childrenshospital.org/az/Site1562/mainpageS1562P0.html|accessdate=2012-10-26}}</ref> | |||
| Rates of ] due to school refusal behavior manifest in a variety of ways and are defined, tracked, and reported differently among schools and school districts.<ref name=":6" /><ref name=":42" /> Academic literature estimates that school refusal occurs in 1–2% of the general population and in 5–15% of youth who are referred to clinics.<ref name=":83" /><ref name=":6" /><ref name=":7" /> | |||
| School refusal behavior has no single cause. Rather it has a broad range of contributing factors that include the individual, family, school, and community.<ref name=":52" /> These factors can be organized into four main categories: (1) avoidance of school‐based stimuli that cause negative affect, (2) avoidance of stressful social and/or evaluative situations, (3) pursuit of attention from significant others, and/or (4) pursue tangible reinforcers outside of school.<ref name=":32" /><ref name=":42"/> | |||
| ⚫ | ==Classification== | ||
| The term ''school refusal'' was coined to reflect that children have problems attending school for a variety of different reasons, and these reasons might not be the expression of a true phobia{{Definition needed|date=January 2018}}, such as separation or social anxiety.<ref name=Wimmer>{{cite web|author=Wimmer, M.|title=School refusal: Information for educators|publisher=National Association of School Psychologists|url=http://www.nasponline.org/families/schoolrefusal.pdf|accessdate=2012-10-26|deadurl=yes|archiveurl=https://web.archive.org/web/20140211071449/http://www.nasponline.org/families/schoolrefusal.pdf|archivedate=2014-02-11}}</ref> | |||
| ⚫ | School refusal behavior is characterized by an emotional and behavioral component. The emotional component consists of severe emotional distress at the time attending school. The behavioral component manifests as school attendance difficulties.<ref name=":42" /> School refusal is not classified as a disorder by the ''Diagnostic and Statistical Manual of Mental Disorders'' ]]. | ||
| == |
=== Emotional === | ||
| ⚫ | ] typically does not occur until the morning before the child is to attend school, and is often accompanied by physical symptoms, the degree of distress exhibited varying among children. There is also an instant return to a stable mood after the child decides not to attend school or is removed from school.<ref name=":42" /> | ||
| Symptoms of school refusal include the child saying they feel sick often or waking up with a headache, stomachache, or sore throat. If the child stays home from school, these symptoms might go away but come back the next morning before school. Additionally, children with school refusal may have crying spells or throw temper tantrums.<ref name="AAFP">{{cite journal|last1=Fremont|first1=Wanda P.|year=2003|title=Information from your family doctor: What to do when your child refuses to go to school|url=http://www.aafp.org/afp/2003/1015/p1563.html|journal=American Family Physician|volume=68|issue=8|pages=1563–4|pmid=14596444|accessdate=2012-10-26}}</ref> | |||
| === Behavioral === | |||
| Warning signs of school refusal include frequent complaints about attending school, frequent tardiness or unexcused absences, absences on significant days (tests, speeches, physical education class), frequent requests to call or go home, excessive worrying about a parent when in school, frequent requests to go to the nurse’s office because of physical complaints, and crying about wanting to go home.<ref name=Wimmer /> | |||
| ⚫ | School attendance difficulties include a broad range of different behaviors. The spectrum of refusal spans from occasional reluctance to complete refusal.<ref name=":42" /> Students may miss the entire day, a partial day, skip class, or arrive late.<ref name=":02">{{Citation|last1=Kearney|first1=Christopher A.|title=School Refusal Behavior|date=2010|encyclopedia=The Corsini Encyclopedia of Psychology|pages=1–2|publisher=American Cancer Society|doi=10.1002/9780470479216.corpsy0827|isbn=9780470479216|last2=Turner|first2=Dio|last3=Gauger|first3=Marisa}}</ref> | ||
| === Assessment === | |||
| If a parent wishes to keep their child in school, they must correct the problem quickly; the longer a child stays out of school, the harder it will be to return.<ref name=AAFP /> However, it may be hard to accomplish as when forced they are prone to ], crying spells, ] or ] symptoms and threats of self-harm. Sometimes, these problems fade if the child is allowed to stay home, or given more freedom in the amount of time they spend in school.<ref name=":0">{{Cite journal|last=Stroobant|first=Emma|last2=Jones|first2=Alison|date=June 2006|title=School Refuser Child Identities|journal=Discourse: Studies in the Cultural Politics of Education|volume=27|issue=2|pages=209–223|doi=10.1080/01596300600676169|issn=0159-6306}}</ref> | |||
| Because school refusal behavior is a multifaceted issue, there is not a single valid measure or assessment method for diagnosis.<ref name=":7">{{Cite journal|last1=Egger|first1=Helen Link|last2=Costello|first2=Jane E.|last3=Angold|first3=Adrian|date=July 2003|title=School Refusal and Psychiatric Disorders: A Community Study|journal=Journal of the American Academy of Child & Adolescent Psychiatry|volume=42|issue=7|pages=797–807|doi=10.1097/01.chi.0000046865.56865.79|pmid=12819439|s2cid=25115126 |issn=0890-8567}}</ref> Assessment first involves measuring and evaluating the number of days the child is absent, late, or leaving school early. Parent reports and self-reports from the child regarding emotional distress and resistance towards attendance are taken into account.<ref name=":6" /> The assessment aims to (1) confirm that the behavior represents school refusal as opposed to ] or legitimate absence, (2) evaluate the extent and severity of absenteeism, (3) the type(s) and severity of emotional distress, (4) obtain information regarding the child, family, school, and community factors that may be contributing to the behavior, and (5) use the information obtained to develop a working hypothesis that is used for planning appropriate interventions.<ref name=":42" /> Tools used to obtain information about school refusal behavior include clinical behavioral interviews, diagnostic interviews, self-report measures of internalizing symptoms, self-monitoring, parent- and teacher-completed measures of internalizing and externalizing problems, review of attendance record, and systematic functional analysis.<ref name=":6" /><ref name=":7" /> | |||
| ==Signs and symptoms== | |||
| Although school refusal is not a clinical disorder according to the ], Fourth Edition, it can be associated with several psychiatric disorders, including ], ], and ].<ref name=Setzer /> Therefore it is critical that youths who are school refusing receive a comprehensive evaluation by a mental health professional.<ref>{{cite web|publisher=Anxiety Disorders of America|title=School Refusal|url=http://www.adaa.org/living-with-anxiety/children/school-refusal|accessdate=2012-10-26}}</ref> | |||
| School refusal behavior is a ] behavior characterized by a variety of internalizing and externalizing symptoms. Internalizing symptoms include ] (general, social, and separation anxiety), social withdrawal, ], ], and/or ].<ref name=":02" /> Children may also have complaints of somatic symptoms such as headaches, stomachaches, or a sore throat. Children may also exhibit externalizing symptoms such as nausea, vomiting, sweating, diarrhea, or difficulties breathing as a result of their anxiety.<ref name=":42" /> Other externalizing symptoms include defiance, aggression, tantrums, clinging to a parent, refusing to move, and/or running away.<ref name=":02" /> If the child stays home from school, these symptoms might go away but come back the next morning before school.<ref name="AAFP">{{cite journal|last1=Fremont|first1=Wanda P.|year=2003|title=Information from your family doctor: What to do when your child refuses to go to school|url=http://www.aafp.org/afp/2003/1015/p1563.html|journal=American Family Physician|volume=68|issue=8|pages=1563–4|pmid=14596444|accessdate=2012-10-26}}</ref> | |||
| Whereas some cases of school refusal can be resolved by gradual re-introduction to the school environment, some others may need to be treated with some form of ] or ]. Some families have sought ] for school refusers which has also proved to be effective. In extreme cases, some form of medication is sometimes prescribed but none of these have stood out prominently as solutions to the problem.{{Citation needed|date=January 2018}} | |||
| Researchers are motivated to assess and treat this behavior because of its prevalence and potential negative consequences.<ref>{{Citation|last1=Kearney|first1=Christopher A.|title=School Refusal Behavior|date=2013-10-10|work=The Wiley Handbook of Cognitive Behavioral Therapy|pages=875–892|editor-last=Hofmann|editor-first=Stefan G|publisher=John Wiley & Sons, Ltd|language=en|doi=10.1002/9781118528563.wbcbt37|isbn=9781118528563|last2=Diliberto|first2=Rachele}}</ref> Short-term negative consequences of school refusal for the child include distress, social alienation, and declining grades. Familial conflict and legal trouble may also result.<ref name=":02" /> Excessive ] is commonly associated with various negative health and social problems.<ref name=":0" /> | |||
| A medical condition often mistaken for school refusal is ] (DSPS). DSPS is a ] which is characterized by a chronic delayed sleep cycle. | |||
| Problematic school absenteeism is also associated with illicit drug use (including tobacco), suicide attempts, poor nutrition, risky sexual behavior, teenage pregnancy, violence, injury, driving under the influence of alcohol, and binge drinking.<ref name=":02" /><ref name=":6" /> | |||
| The attempt to control by means of threats or pressure, the behavior of the student, is also still in danger as external (extrinsic) motivation to undermine intrinsic motivation and a sense of self-control, self-worth and self-responsibility. Some social scientists and evaluators view the condition as a pseudophobia.<ref>Trueman, David. "What are the characteristics of school phobic children?." Psychological Reports 54.1 (1984): 191-202.</ref> | |||
| ==Causes== | ==Causes== | ||
| School refusal behavior |
School refusal behavior includes ] due to a broad range of potential causes. School refusal can be classified by the primary factor that motivates the child's absence. School refusal behavior has no single cause. Rather it has a broad range of contributing factors that include the individual, family, school, and community. The ] identifies four functional causes: (1) avoiding school‐based stimuli that provoke negative effects, (2) escaping aversive social and/or evaluative situations, (3) pursuing attention from significant others, and/or (4) pursuing tangible rewards outside of school. Categories one and two refer to school refusal motivated by ]. Categories three and four represent refusal for ].<ref name=":32">{{Cite journal|last1=Kearney|first1=Christopher A.|last2=Albano|first2=Anne Marie|date=January 2004|title=The Functional Profiles of School Refusal Behavior|journal=Behavior Modification|volume=28|issue=1|pages=147–161|doi=10.1177/0145445503259263|pmid=14710711|s2cid=34542111 |issn=0145-4455}}</ref><ref name=":42">{{Cite book|title=Understanding school refusal : a handbook for professionals in education, health and social care|last=S.|first=Thambirajah, M.|date=2008|publisher=Jessica Kingsley Publishers|others=Grandison, Karen J., De-Hayes, Louise.|isbn=9781846427473|location=London|oclc=646763769}}</ref> | ||
| The onset of school refusal can be sudden or gradual. In cases of sudden onset, refusal often begins after a period of legitimate absence. The problem may start following vacations, ], ], or brief illness |
The onset of school refusal can be sudden or gradual. In cases of sudden onset, refusal often begins after a period of legitimate absence. The problem may start following vacations, ], or brief illness. It can also occur after a stressful event, such as moving to a new house, or the death of a pet or relative.<ref name="AAFP" /> Gradual onset emerges over time as a few sporadically missed days become a pattern of non-attendance.<ref name=":42"/> | ||
| There are a broad range of risk factors, which may interact and change over time. |
There are a broad range of risk factors, which may interact and change over time. Within the literature the risk factors are typically condensed into four categories: individual, family, school, and community.<ref name=":52">{{Cite journal|last1=Maynard|first1=Brandy R.|last2=Heyne|first2=David|last3=Brendel|first3=Kristen Esposito|last4=Bulanda|first4=Jeffery J.|last5=Thompson|first5=Aaron M.|last6=Pigott|first6=Terri D.|date=2015-08-10|title=Treatment for School Refusal Among Children and Adolescents|journal=Research on Social Work Practice|volume=28|issue=1|pages=56–67|doi=10.1177/1049731515598619|s2cid=35321528 |issn=1049-7315}}</ref> | ||
| {| class="wikitable" | {| class="wikitable" | ||
| ! colspan="4" |Risk Factors for School Refusal Behavior<ref>{{Cite web|url=http://schools.westsussex.gov.uk/Services/3282|title=Educational Psychology Service {{!}} West Sussex Services for Schools|website=schools.westsussex.gov.uk|access-date=2019-02-16}}</ref><ref name=":52" /> | ! colspan="4" |Risk Factors for School Refusal Behavior<ref name=":1">{{Cite web|url=http://schools.westsussex.gov.uk/Services/3282|title=Educational Psychology Service {{!}} West Sussex Services for Schools|website=schools.westsussex.gov.uk|access-date=2019-02-16}}</ref><ref name=":52" /> | ||
| |- | |- | ||
| !Individual Factors | !Individual Factors | ||
| Line 58: | Line 59: | ||
| * transitioning into secondary school | * transitioning into secondary school | ||
| * school day structure | * school day structure | ||
| * tests or exams | |||
| * testing | |||
| * peer or staff relationship difficulties | * peer or staff relationship difficulties | ||
| * emergency drills | |||
| | | | | ||
| * pressure to achieve academically | * pressure to achieve academically | ||
| Line 65: | Line 67: | ||
| * poor support services | * poor support services | ||
| |} | |} | ||
| There are a variety of primary and comorbid disorders associated with school avoidance behavior. Common diagnoses include ] (22.4%), ] (10.5%), ] (8.4%), ] (4.9%), ] (4.2%), ] (3.5%), and ] (2.8%).<ref name=":32"/> Negative reinforcement school refusal behavior is associated with anxiety-related disorders, such as ]. Attention-seeking school refusal behavior is associated with separation-anxiety disorder. School refusal classified by the pursuit of tangible reinforcement is associated with ] and ].<ref name=":32"/> | There are a variety of primary and comorbid disorders associated with school avoidance behavior. Common diagnoses include ] (22.4%), ] (10.5%), ] (8.4%), ] (4.9%), ] (4.2%), ] (3.5%), and ] (2.8%).<ref name=":32"/> It is also associated with ].<ref>{{Cite journal |last1=Munkhaugen |first1=Ellen Kathrine |last2=Gjevik |first2=Elen |last3=Pripp |first3=Are Hugo |last4=Sponheim |first4=Eili |last5=Diseth |first5=Trond H. |date=2017-09-01 |title=School refusal behaviour: Are children and adolescents with autism spectrum disorder at a higher risk? |url=https://www.sciencedirect.com/science/article/pii/S1750946717300739 |journal=Research in Autism Spectrum Disorders |language=en |volume=41-42 |pages=31–38 |doi=10.1016/j.rasd.2017.07.001 |hdl=10852/68503 |issn=1750-9467|hdl-access=free }}</ref> Negative reinforcement school refusal behavior is associated with anxiety-related disorders, such as ]. Attention-seeking school refusal behavior is associated with separation-anxiety disorder. School refusal classified by the pursuit of tangible reinforcement is associated with ] and ].<ref name=":32"/> | ||
| ⚫ | === Bullying === | ||
| ⚫ | ==Classification |
||
| {{NOCITE|section|date=August 2024}} | |||
| ⚫ | School refusal behavior characterized by an emotional and behavioral component. The emotional component consists severe emotional distress at the time attending school. The behavioral component manifests as school attendance difficulties.<ref name=":42"/> School refusal is not classified as a disorder by the ''Diagnostic and Statistical Manual of Mental Disorders'' ]]. | ||
| At times a child may refuse to go to school because they are being bullied. The possibility of ], including ], should always be evaluated as part of assessing school refusers. Some children will willingly report being bullied; however, others may be ashamed of their inability to stand up to bullying and wish to conceal the fact that they are bullied within their schools -- by other students, or in some cases by teachers -- or harassed via texting, e-mail, or social media used to intimidate the child. | |||
| ⚫ | |||
| ⚫ | Emotional distress typically does not occur until the morning before |
||
| == Treatment == | |||
| The primary goal of treatment for school refusal behavior is for the child to regularly and voluntarily attend school with less emotional distress.<ref name=":83">{{Citation|last1=Heyne|first1=David|chapter=Treatment of School Refusal|pages=243–272|publisher=John Wiley & Sons Ltd|isbn=9780470753385|last2=King|first2=Neville J.|doi=10.1002/9780470753385.ch11|title=Handbook of Interventions that Work with Children and Adolescents|year=2004}}</ref> Some scholars also emphasize the importance of helping the child manage social, emotional, and behavioral problems that are the result of prolonged school nonattendance.<ref name=":42" /> Treatment of school refusal depends on the primary cause of the behavior and the particular individual, family, and school factors affecting the child.<ref name=":83" /><ref name=":02" /> Analysis of the child's behavior often involves the perspective of the parent/family, school, and child.<ref name=":42" /><ref name=":1" /> When school refusal is motivated by anxiety, treatment relies mostly on child therapy during which children learn to control their anxiety with relaxation training, enhancement of social competence, ], and exposure.<ref name=":83" /> For children who refuse school in pursuit of attention from parents, parent training is often the focus of treatment. Parents are taught to set routines for their children and punish and reward them appropriately. For children refusing school in pursuit of rewards outside of school, treatment often takes a family-based approach, using family-based contingency contracting and communication skills training.<ref name=":102">{{Cite journal|last1=Kearney|first1=Christopher A.|last2=Bensaheb|first2=Arva|date=January 2006|title=School Absenteeism and School Refusal Behavior: A Review and Suggestions for School-Based Health Professionals|journal=Journal of School Health|volume=76|issue=1|pages=3–7|doi=10.1111/j.1746-1561.2006.00060.x|pmid=16457678|s2cid=27815950 |issn=0022-4391}}</ref><ref name=":02" /> In some instances, children may also engage in peer refusal skills training.<ref name=":102" /> | |||
| ⚫ | School attendance difficulties include a broad range of behaviors. The spectrum of refusal spans from occasional reluctance to complete refusal.<ref name=":42" /> Students may miss the entire day, a partial day, skip class, or arrive late.<ref name=":02">{{Citation| |
||
| Certain children who are particularly attached to their mother or other family figure due to separation anxiety or ] often suffer the onset early, in pre-school, ] or before school starts. | |||
| School phobia is diagnosed primarily through questionnaires and interviews with doctors. Other methods like observation have not proven to be as useful. This is partly because (school) anxiety is an internal phenomenon. An example of a modern multidimensional questionnaire is the "Differential Power Anxiety Inventory approach, with twelve scales to diagnose four different areas: anxiety-inducing conditions, manifestations, coping strategies and stabilization forms." | |||
| *Cognitive and lifestyle exploration | |||
| *'School Phobia Test' (SAT) | |||
| *'Anxiety questionnaire for students', (AFS) | |||
| ==Epidemiology== | ==Epidemiology== | ||
| There are no accurate figures regarding the prevalence of school refusal behavior because of the wide variation in how the behavior is defined, tracked, and reported across schools, school districts, and countries.<ref name=":42" /> The most widely accepted prevalence rate is 1–2% of school-aged children. In clinic-referred youth samples the prevalence rate is 5–15%.<ref name=":42" /><ref name=":6">{{Cite journal|last=KEARNEY|first=C|date=March 2008|title=School absenteeism and school refusal behavior in youth: A contemporary review|journal=Clinical Psychology Review|volume=28|issue=3|pages=451–471|doi=10.1016/j.cpr.2007.07.012|pmid=17720288|s2cid=34755569|issn=0272-7358}}</ref><ref name=":83" /> There are no known relationships between school refusal behavior and gender, income level, or race.<ref name=":02" /> Whilst refusal behavior can occur at any time, it occurs more frequently during major changes in a child’s life, such as entering kindergarten (ages 5–6), changing from elementary to middle school (ages 10–11), or changing from middle to high school (age 14).<ref name="Wimmer">{{cite web|url=http://www.nasponline.org/families/schoolrefusal.pdf|title=School refusal: Information for educators|author=Wimmer, M.|publisher=National Association of School Psychologists|archiveurl=https://web.archive.org/web/20140211071449/http://www.nasponline.org/families/schoolrefusal.pdf|archivedate=2014-02-11|url-status=dead|accessdate=2012-10-26}}</ref><ref name=":42" /><ref name=":1" /><ref name="Setzer">{{cite web|author=Setzer, N., & Salzhauer, A|year=2001|title=Understanding school refusal|publisher=New York University Child Study Center|url=http://www.aboutourkids.org/articles/understanding_school_refusal|accessdate=2012-10-26}}</ref> | |||
| Approximately 1% to 5% of school-aged children have school refusal,<ref>{{cite journal|author=Fremont, W. P.|year=2003|title=School refusal in children and adolescents|journal=American Family Physician|volume=68|issue=8|pages=1555–1560|url=http://www.aafp.org/afp/2003/1015/p1555.html#afp20031015p1555-t1|accessdate=2012-10-26}}</ref> though it is most common in five- and six-year olds and in 10- and 11-year olds,<ref name=AAFP /> it occurs more frequently during major changes in a child’s life, such as entrance to kindergarten, changing from elementary to middle school, or changing from middle to high school.<ref name=Wimmer /> | |||
| == History == | |||
| The rate is similar within both genders,<ref name=AAFP /> and although it is significantly more prevalent in some urban areas, there are no known socioeconomic differences.<ref name=Setzer>{{cite web|author=Setzer, N., & Salzhauer, A|year=2001|title=Understanding school refusal|publisher=New York University Child Study Center|url=http://www.aboutourkids.org/articles/understanding_school_refusal|accessdate=2012-10-26}}</ref> | |||
| There has been little consensus on the best method for organizing and classifying children demonstrating school refusal behavior. School refusal was initially termed psychoneurotic truancy and characterized as a school ].<ref>{{Cite journal|last=Partridge|first=J. M.|date=1939|title=Truancy|journal=Journal of Mental Science|volume=85|issue=354|pages=45–81|doi=10.1192/bjp.85.354.45|issn=0368-315X}}</ref><ref name=":2">{{Cite journal|last1=Lyon|first1=Aaron R.|last2=Cotler|first2=Sheldon|date=2007|title=Toward reduced bias and increased utility in the assessment of school refusal behavior: The case for diverse samples and evaluations of context|journal=Psychology in the Schools|volume=44|issue=6|pages=551–565|doi=10.1002/pits.20247|issn=0033-3085}}</ref> The terms fear‐based school phobia, anxiety‐based school refusal, and delinquent‐based truancy were commonly described as school refusal behavior.<ref name=":02" /> In early studies, children were diagnosed with a school phobia when they exhibited (1) persistent difficulties attending school, (2) severe emotional upset at the prospect of going to school, (3) parental knowledge of the absence, and (4) no antisocial characteristics.<ref>{{Cite journal|last1=Berg|first1=Ian|last2=Nichols|first2=Keith|last3=Pritchard|first3=Colin|date=October 1969|journal=Journal of Child Psychology and Psychiatry|volume=10|issue=2|pages=123–141|doi=10.1111/j.1469-7610.1969.tb02074.x|pmid=5368365|issn=0021-9630|title=School Phobia?its Classification and Relationship to Dependency}}</ref> These criteria were later declared inadequate in capturing the full range of school refusal behavior.<ref name=":2" /> While the term school phobia is still commonly employed, this anxiety-based classification is not appropriate for all cases of school refusal.<ref name=":2" /> School refusal is now considered an ] for non-] problematic absenteeism, regardless of the root cause.<ref name=":02" /> | |||
| ==See also== | ==See also== | ||
| *] | |||
| *] | *] | ||
| *] | *] | ||
| *] – a phenomenon in Japan of social isolation that often starts out as school refusal | *] – a phenomenon in Japan of social isolation that often starts out as school refusal | ||
| ⚫ | *] | ||
| *] | *] | ||
| *] | |||
| ⚫ | *] | ||
| ==Notes== | ==Notes== | ||
| Line 113: | Line 107: | ||
| ==External links== | ==External links== | ||
| * | |||
| * | |||
| {{Authority control}} | |||
| * | |||
| {{DEFAULTSORT:School Refusal}} | {{DEFAULTSORT:School Refusal}} | ||
| ] | ] | ||
| ] | ] | ||
| ] | ] | ||
Latest revision as of 15:39, 29 October 2024
Child-motivated refusal to attend school or difficulty in remaining in class the full day | This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these messages)
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School refusal is a child-motivated refusal to attend school or difficulty remaining in class for the full day. Child-motivated absenteeism occurs autonomously, by the volition of the child. This behavior is differentiated from non-child-motivated absences in which parents withdraw children from school or keep them home for circumstances such as homelessness. School refusal is characterized by avoidance and/or emotional distress at the time of attending school.
Rates of absenteeism due to school refusal behavior manifest in a variety of ways and are defined, tracked, and reported differently among schools and school districts. Academic literature estimates that school refusal occurs in 1–2% of the general population and in 5–15% of youth who are referred to clinics.
Classification
School refusal behavior is characterized by an emotional and behavioral component. The emotional component consists of severe emotional distress at the time attending school. The behavioral component manifests as school attendance difficulties. School refusal is not classified as a disorder by the Diagnostic and Statistical Manual of Mental Disorders .
Emotional
Emotional distress typically does not occur until the morning before the child is to attend school, and is often accompanied by physical symptoms, the degree of distress exhibited varying among children. There is also an instant return to a stable mood after the child decides not to attend school or is removed from school.
Behavioral
School attendance difficulties include a broad range of different behaviors. The spectrum of refusal spans from occasional reluctance to complete refusal. Students may miss the entire day, a partial day, skip class, or arrive late.
Assessment
Because school refusal behavior is a multifaceted issue, there is not a single valid measure or assessment method for diagnosis. Assessment first involves measuring and evaluating the number of days the child is absent, late, or leaving school early. Parent reports and self-reports from the child regarding emotional distress and resistance towards attendance are taken into account. The assessment aims to (1) confirm that the behavior represents school refusal as opposed to truancy or legitimate absence, (2) evaluate the extent and severity of absenteeism, (3) the type(s) and severity of emotional distress, (4) obtain information regarding the child, family, school, and community factors that may be contributing to the behavior, and (5) use the information obtained to develop a working hypothesis that is used for planning appropriate interventions. Tools used to obtain information about school refusal behavior include clinical behavioral interviews, diagnostic interviews, self-report measures of internalizing symptoms, self-monitoring, parent- and teacher-completed measures of internalizing and externalizing problems, review of attendance record, and systematic functional analysis.
Signs and symptoms
School refusal behavior is a heterogeneous behavior characterized by a variety of internalizing and externalizing symptoms. Internalizing symptoms include anxiety (general, social, and separation anxiety), social withdrawal, fatigue, fear, and/or depression. Children may also have complaints of somatic symptoms such as headaches, stomachaches, or a sore throat. Children may also exhibit externalizing symptoms such as nausea, vomiting, sweating, diarrhea, or difficulties breathing as a result of their anxiety. Other externalizing symptoms include defiance, aggression, tantrums, clinging to a parent, refusing to move, and/or running away. If the child stays home from school, these symptoms might go away but come back the next morning before school.
Researchers are motivated to assess and treat this behavior because of its prevalence and potential negative consequences. Short-term negative consequences of school refusal for the child include distress, social alienation, and declining grades. Familial conflict and legal trouble may also result. Excessive absenteeism is commonly associated with various negative health and social problems.
Problematic school absenteeism is also associated with illicit drug use (including tobacco), suicide attempts, poor nutrition, risky sexual behavior, teenage pregnancy, violence, injury, driving under the influence of alcohol, and binge drinking.
Causes
School refusal behavior includes absenteeism due to a broad range of potential causes. School refusal can be classified by the primary factor that motivates the child's absence. School refusal behavior has no single cause. Rather it has a broad range of contributing factors that include the individual, family, school, and community. The School Refusal Assessment Scale identifies four functional causes: (1) avoiding school‐based stimuli that provoke negative effects, (2) escaping aversive social and/or evaluative situations, (3) pursuing attention from significant others, and/or (4) pursuing tangible rewards outside of school. Categories one and two refer to school refusal motivated by negative reinforcement. Categories three and four represent refusal for positive reinforcement.
The onset of school refusal can be sudden or gradual. In cases of sudden onset, refusal often begins after a period of legitimate absence. The problem may start following vacations, school holidays, or brief illness. It can also occur after a stressful event, such as moving to a new house, or the death of a pet or relative. Gradual onset emerges over time as a few sporadically missed days become a pattern of non-attendance.
There are a broad range of risk factors, which may interact and change over time. Within the literature the risk factors are typically condensed into four categories: individual, family, school, and community.
| Risk Factors for School Refusal Behavior | |||
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| Individual Factors | Family Factors | School Factors | Community Factors |
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There are a variety of primary and comorbid disorders associated with school avoidance behavior. Common diagnoses include separation anxiety disorder (22.4%), generalized anxiety disorder (10.5%), oppositional defiant disorder (8.4%), depression (4.9%), specific phobia (4.2%), social anxiety disorder (3.5%), and conduct disorder (2.8%). It is also associated with autism. Negative reinforcement school refusal behavior is associated with anxiety-related disorders, such as generalized anxiety disorder. Attention-seeking school refusal behavior is associated with separation-anxiety disorder. School refusal classified by the pursuit of tangible reinforcement is associated with conduct disorder and oppositional defiant disorder.
Bullying
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At times a child may refuse to go to school because they are being bullied. The possibility of bullying, including cyber bullying, should always be evaluated as part of assessing school refusers. Some children will willingly report being bullied; however, others may be ashamed of their inability to stand up to bullying and wish to conceal the fact that they are bullied within their schools -- by other students, or in some cases by teachers -- or harassed via texting, e-mail, or social media used to intimidate the child.
Treatment
The primary goal of treatment for school refusal behavior is for the child to regularly and voluntarily attend school with less emotional distress. Some scholars also emphasize the importance of helping the child manage social, emotional, and behavioral problems that are the result of prolonged school nonattendance. Treatment of school refusal depends on the primary cause of the behavior and the particular individual, family, and school factors affecting the child. Analysis of the child's behavior often involves the perspective of the parent/family, school, and child. When school refusal is motivated by anxiety, treatment relies mostly on child therapy during which children learn to control their anxiety with relaxation training, enhancement of social competence, cognitive therapy, and exposure. For children who refuse school in pursuit of attention from parents, parent training is often the focus of treatment. Parents are taught to set routines for their children and punish and reward them appropriately. For children refusing school in pursuit of rewards outside of school, treatment often takes a family-based approach, using family-based contingency contracting and communication skills training. In some instances, children may also engage in peer refusal skills training.
Epidemiology
There are no accurate figures regarding the prevalence of school refusal behavior because of the wide variation in how the behavior is defined, tracked, and reported across schools, school districts, and countries. The most widely accepted prevalence rate is 1–2% of school-aged children. In clinic-referred youth samples the prevalence rate is 5–15%. There are no known relationships between school refusal behavior and gender, income level, or race. Whilst refusal behavior can occur at any time, it occurs more frequently during major changes in a child’s life, such as entering kindergarten (ages 5–6), changing from elementary to middle school (ages 10–11), or changing from middle to high school (age 14).
History
There has been little consensus on the best method for organizing and classifying children demonstrating school refusal behavior. School refusal was initially termed psychoneurotic truancy and characterized as a school phobia. The terms fear‐based school phobia, anxiety‐based school refusal, and delinquent‐based truancy were commonly described as school refusal behavior. In early studies, children were diagnosed with a school phobia when they exhibited (1) persistent difficulties attending school, (2) severe emotional upset at the prospect of going to school, (3) parental knowledge of the absence, and (4) no antisocial characteristics. These criteria were later declared inadequate in capturing the full range of school refusal behavior. While the term school phobia is still commonly employed, this anxiety-based classification is not appropriate for all cases of school refusal. School refusal is now considered an umbrella term for non-truant problematic absenteeism, regardless of the root cause.
See also
- Separation anxiety disorder
- Bullying
- Fushūgaku
- Hikikomori – a phenomenon in Japan of social isolation that often starts out as school refusal
- Tantrum
- Truancy
Notes
- Fremont, Wanda P.; Smucny, John (2003). "School Refusal in Children and Adolescents". American Family Physician. 68 (8): 1555–1561. PMID 14596443.
References
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