School refusal - Misplaced Pages

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School refusal is the refusal to attend school due to emotional distress. School refusal differs from truancy 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 showing the difference between school refusal and truancy.

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.

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, such as separation or social anxiety.

Signs and symptoms

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.

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.

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. However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic 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.

Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it can be associated with several psychiatric disorders, including separation anxiety disorder, social phobia, and conduct disorder. Therefore it is critical that youths who are school refusing receive a comprehensive evaluation by a mental health professional.

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 psychodynamic or cognitive behaviour therapy. Some families have sought alternative education 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.

A medical condition often mistaken for school refusal is delayed sleep phase syndrome (DSPS). DSPS is a circadian rhythm sleep disorder which is characterized by a chronic delayed sleep cycle.

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.

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. 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.

Risk Factors for School Refusal Behavior
Individual Factors	Family Factors	School Factors	Community Factors
behavioral inhibition fear of failure low self-efficacy physical illness learning difficulties	separation and divorce parent mental health issues overprotective parenting style dysfunctional interactions loss or bereavement high levels of family stress	bullying physical education transitioning into secondary school school day structure testing peer or staff relationship difficulties	pressure to achieve academically inconsistent professional advice poor support services

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.

Classification and Diagnosis

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.

Certain children who are particularly attached to their mother or other family figure due to separation anxiety or attachment theory often suffer the onset early, in pre-school, crèche 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

Approximately 1% to 5% of school-aged children have school refusal, though it is most common in five- and six-year olds and in 10- and 11-year olds, 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. 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.

The rate is similar within both genders, and although it is significantly more prevalent in some urban areas, there are no known socioeconomic differences.

Notes

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

References

"School Refusal approach at CHB". Childrenshospital.org. Retrieved 2012-10-26.
"School Refusal". Children’s Hospital Boston. Retrieved 2012-10-26.
^ 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.
^ 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.
^ 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)
^ 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)
^ 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.
Stroobant, Emma; Jones, Alison (June 2006). "School Refuser Child Identities". Discourse: Studies in the Cultural Politics of Education. 27 (2): 209–223. doi:10.1080/01596300600676169. ISSN 0159-6306.
^ 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)
"School Refusal". Anxiety Disorders of America. Retrieved 2012-10-26.
Trueman, David. "What are the characteristics of school phobic children?." Psychological Reports 54.1 (1984): 191-202.
"Educational Psychology Service | West Sussex Services for Schools". schools.westsussex.gov.uk. Retrieved 2019-02-16.
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
Fremont, W. P. (2003). "School refusal in children and adolescents". American Family Physician. 68 (8): 1555–1560. Retrieved 2012-10-26.

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