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School refusal is a child-motivated refusal to attend school and/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 who withdraw children from school or keep them home, or circumstances such as homelessness. School refusal is characterized by an emotional distress at the time of attending school and school attendance difficulties.

School refusal behavior has no single cause. Rather it has a broad range of contributing factors that include the individual, family, school, and community. 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.

Rates of absenteeism due to school refusal behavior are difficult to quantify because behavior the manifests in a variety of ways and are defined, tracked, and reported differently among schools and school districts. The literature estimates that rates of school refusal occurs in 1-2% of the general population, and in 5-15% of clinic-referred youth samples.

Classification

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. 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 they are to attend school. Emotional distress is often accompanied by physical symptoms. The degree of distress children exhibit varies widely. 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 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 and child reports of the child's emotional distress and resistance to attendance are also taken into account. Assessment aims to (1) confirm that the behavior represents school refusal as opposed to truancy or absence, (2) evaluate the extent and severity of absenteeism, the type(s) of anxiety and its severity, (3) obtain information regarding the child, family, school, and community factors that may be contributing to the behavior, and (4) integrate the information to develop a working hypothesis 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), 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 attempt, poor nutrition, suicide attempt, risky sexual behavior, teenage pregnancy, violence, injury, driving under the influence of alcohol, and binge drinking.

Causes

School refusal behavior is an umbrella term that includes all problematic absenteeism, therefor it has a broad range of potential causes. School refusal can be classified by the primary factor that motivates the child's absence. The School Refusal Assessment Scale identifies four functional causes: (1) avoid school‐based stimuli that provoke negative affectivity, (2) escape aversive social and/or evaluative situations, (3) pursue attention from significant others, and/or (4) pursue tangible reinforcers 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, summer vacation, or brief illness, after the child has been home for some time, and usually ends prior to vacations, school holidays, or summer vacation, before the child will be out of school for some time. School refusal 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. Several authors have summarized the risk factors identified in the school refusal literature to include individual, family, school, and community factors.

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%). 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.

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. 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. 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 variety 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 gender, income level, and race. While refusal behavior can occur at anytime, it occurs more frequently during major changes in a child’s life, such as entrance to kindergarten (ages 5–6), changing from elementary to middle school (ages 10–11), or changing from middle to high school (age 14). There are no known socioeconomic differences.

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 characterized as a school phobia. The terms fear‐based school phobia, anxiety‐based school refusal, and delinquent‐based truancy are commonly used to describe school refusal behavior. Early studies required school refusers to have (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. This criteria was 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 problematic absenteeism, regardless of the root cause.

See also

• Bullying
• Absenteeism
• Hikikomori – a phenomenon in Japan of social isolation that often starts out as school refusal
• Truancy
• Fushūgaku
• Tantrum

Notes

• Fremont, Wanda P.; Smucny, John (2003). "School Refusal in Children and Adolescents". American Family Physician. 68 (8): 1555–1561. PMID 14596443.

References

1. Kearney, Christopher A. (1996). "The Evolution and Reconciliation of Taxonomic Strategies for School Refusal Behavior". Clinical Psychology: Science and Practice. 3 (4): 339–354. doi:10.1111/j.1468-2850.1996.tb00087.x. ISSN 0969-5893.
2. ^ Kearney, Christopher A.; Turner, Dio; Gauger, Marisa (2010), "School Refusal Behavior", The Corsini Encyclopedia of Psychology, American Cancer Society, pp. 1–2, doi:10.1002/9780470479216.corpsy0827, ISBN 9780470479216, retrieved 2019-01-28
3. ^ Dube, S. R.; Orpinas, P. (2009-04-01). "Understanding Excessive School Absenteeism as School Refusal Behavior". Children & Schools. 31 (2): 87–95. doi:10.1093/cs/31.2.87. ISSN 1532-8759.
4. ^ S., Thambirajah, M. (2008). Understanding school refusal : a handbook for professionals in education, health and social care. Grandison, Karen J., De-Hayes, Louise. London: Jessica Kingsley Publishers. ISBN 9781846427473. OCLC 646763769.{{cite book}}: CS1 maint: multiple names: authors list (link)
5. ^ Maynard, Brandy R.; Heyne, David; Brendel, Kristen Esposito; Bulanda, Jeffery J.; Thompson, Aaron M.; Pigott, Terri D. (2015-08-10). "Treatment for School Refusal Among Children and Adolescents". Research on Social Work Practice. 28 (1): 56–67. doi:10.1177/1049731515598619. ISSN 1049-7315.
6. ^ Kearney, Christopher A.; Albano, Anne Marie (January 2004). "The Functional Profiles of School Refusal Behavior". Behavior Modification. 28 (1): 147–161. doi:10.1177/0145445503259263. ISSN 0145-4455.
7. ^ KEARNEY, C (March 2008). "School absenteeism and school refusal behavior in youth: A contemporary review". Clinical Psychology Review. 28 (3): 451–471. doi:10.1016/j.cpr.2007.07.012. ISSN 0272-7358.
8. ^ Heyne, David; King, Neville J., "Treatment of School Refusal", Handbook of Interventions that Work with Children and Adolescents, John Wiley & Sons Ltd, pp. 243–272, ISBN 9780470753385, retrieved 2019-02-18
9. ^ Egger, Helen Link; Costello, Jane E.; Angold, Adrian (July 2003). "School Refusal and Psychiatric Disorders: A Community Study". Journal of the American Academy of Child & Adolescent Psychiatry. 42 (7): 797–807. doi:10.1097/01.chi.0000046865.56865.79. ISSN 0890-8567.
10. ^ Fremont, Wanda P. (2003). "Information from your family doctor: What to do when your child refuses to go to school". American Family Physician. 68 (8): 1563–4. PMID 14596444. Retrieved 2012-10-26.
11. Kearney, Christopher A.; Diliberto, Rachele (2013-10-10), Hofmann, Stefan G (ed.), "School Refusal Behavior", The Wiley Handbook of Cognitive Behavioral Therapy, John Wiley & Sons, Ltd, pp. 875–892, doi:10.1002/9781118528563.wbcbt37, ISBN 9781118528563, retrieved 2019-03-01
12. ^ "Educational Psychology Service | West Sussex Services for Schools". schools.westsussex.gov.uk. Retrieved 2019-02-16.
13. ^ Kearney, Christopher A.; Bensaheb, Arva (January 2006). "School Absenteeism and School Refusal Behavior: A Review and Suggestions for School-Based Health Professionals". Journal of School Health. 76 (1): 3–7. doi:10.1111/j.1746-1561.2006.00060.x. ISSN 0022-4391.
14. Wimmer, M. "School refusal: Information for educators" (PDF). National Association of School Psychologists. Archived from the original (PDF) on 2014-02-11. Retrieved 2012-10-26. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
15. Setzer, N., & Salzhauer, A (2001). "Understanding school refusal". New York University Child Study Center. Retrieved 2012-10-26.{{cite web}}: CS1 maint: multiple names: authors list (link)
16. Partridge, J. M. (1939). "Truancy". Journal of Mental Science. 85 (354): 45–81. doi:10.1192/bjp.85.354.45. ISSN 0368-315X.
17. ^ Lyon, Aaron R.; Cotler, Sheldon (2007). "Toward reduced bias and increased utility in the assessment of school refusal behavior: The case for diverse samples and evaluations of context". Psychology in the Schools. 44 (6): 551–565. doi:10.1002/pits.20247. ISSN 0033-3085.
18. Berg, Ian; Nichols, Keith; Pritchard, Colin (October 1969). "SCHOOL PHOBIA?ITS CLASSIFICATION AND RELATIONSHIP TO DEPENDENCY". Journal of Child Psychology and Psychiatry. 10 (2): 123–141. doi:10.1111/j.1469-7610.1969.tb02074.x. ISSN 0021-9630.

External links

• School Refusers – Site for parents of children who refuse to attend school
• Schoolphobiaparents.webs.com
• – site for families who children suffer from school refusal (school avoidance) Lists treatment programs, school options, legal resources and help for dealing with your school district

• Misplaced Pages neutral point of view disputes from October 2012
• Alternative education
• Childhood psychiatric disorders
• Education issues