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.

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

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. 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.

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.

Treatment

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.

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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"School Refusal". Children’s Hospital Boston. Retrieved 2012-10-26.
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^ 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)
^ 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
^ Egger, Helen Link; Costello, Jane E.; Angold, Adrian (2003-07). "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. {{cite journal}}: Check date values in: |date= (help)
^ KEARNEY, C (2008-03). "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. {{cite journal}}: Check date values in: |date= (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.
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"Educational Psychology Service | West Sussex Services for Schools". schools.westsussex.gov.uk. Retrieved 2019-02-16.
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
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