Psikiyatride Güncel Yaklaşımlar (Dec 2010)
School Refusal: Clinical Features, Diagnosis and Treatment
Abstract
Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of psychiatric disorders or that they are more likely to require psychological assistance. It is for these reasons that the treatment of school refusal is increasingly gaining impor-tance. The major aim of the treatment is to help the child return to school at the shortest time possible. The treatment should be carried out in cooperation with the child’s parents and the school personnel. A widely accepted approach to the treatment of school refusal is one that is concerned with the application of a multi-faceted treatment. Psychosocial and psychopharmacological approaches constitute the crucial parts of the therapeutic process. Today, cognitive behaviour therapy and medication are the most frequently employed approaches in the treatment of school refusal.
