Skip to main content
Log in

Outcome of children with school refusal

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal.

Methods

Thirty-three subjects (8–16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an outcome measure at 3 months) were: The Missouri Assessment of Genetics Interview for Children (MAGIC) to ascertain psychiatric diagnoses, a modified version of Parent Interview Schedule (PIS), and the Children’s Global Assessment Scale (CGAS).

Results

Twenty-nine subjects (87.9%) had a psychiatric diagnosis at baseline. Depressive disorder (63.6%) was commonest followed by specific phobias (30.3%). Psycho-social factors influenced school refusal in a majority (87.9%). Twenty of the thirty subjects (66.6%) who could be followed-up had returned to school. Psychiatric diagnosis persisted in 16 subjects. Younger age, being last-born, no or one diagnosis, and good baseline functioning predicted a favorable outcome.

Conclusions

Psychiatric morbidity is high in a clinic population of youngsters with school refusal. It is associated with temperamental, family, and other environmental adversities. Short-term outcome in these children is largely favourable in terms of return to school and global functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Elliott JG. Practitioner Review: School Refusal: Issues of conceptualization, assessment, and treatment. J Child Psychol Psychiatry 1999; 40: 1001–1012.

    Article  PubMed  CAS  Google Scholar 

  2. Broadwin IT. A contribution to the study of truancy. Am J Orthopsychiatry 1932; 2: 253–259.

    Article  Google Scholar 

  3. Johnson AM, Falstein EI, Szurek SA, Svendsen M. School phobia. Am J Orthopsychiatry 1941; 11: 702–711.

    Article  Google Scholar 

  4. King NJ, Bernstein GA. School refusal in children and adolescents: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2001; 40: 197–205.

    Article  PubMed  CAS  Google Scholar 

  5. Berg I, Nichols K, Pritchard C. School phobia: its classification and relationship to dependency. J Child Psychol Psychiatry 1969; 10: 123–141.

    Article  PubMed  CAS  Google Scholar 

  6. Last CG, Strauss CC. School refusal in anxiety-disordered children and adolescents. J Am Acad Child Adolesc Psychiatry 1990; 29: 31–35.

    Article  PubMed  CAS  Google Scholar 

  7. Hoshino Y, Nikkuni S, Kaneko M, Endo M, Yashima Y, Kumashiro H. The application of DSM-III diagnostic criteria to school refusal. Jap J Psychiatry Neurol 1987; 41: 1–7.

    CAS  Google Scholar 

  8. Mcshane G, Walter G, Rey JM. Characteristics of adolescents with school refusal. Aust N Z J Psychiatry 2001; 35: 822–826.

    Article  PubMed  CAS  Google Scholar 

  9. Bernstein GA, Hektner JM, Borchardt CM, McMillan MH. Treatment of school refusal: One-year follow-up. J Am Acad Child Adolesc Psychiatry 2001; 40: 206–213.

    Article  PubMed  CAS  Google Scholar 

  10. King NJ, Tonge BJ, Heyne D et al. Cognitive behavioral treatment of school-refusing children: A controlled evaluation. J Am Acad Child Adolesc Psychiatry 1998; 37: 395–403.

    Article  PubMed  CAS  Google Scholar 

  11. Heyne D, King NJ, Tonge BJ et al. Evaluation of child therapy and caregiver training in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry 2002; 41: 687–95.

    Article  PubMed  Google Scholar 

  12. Kearney CA, Silverman WK. The evolution and reconciliation of taxonomic strategies for school refusal behavior. Clin Psychol: Science and Practice 1996; 3: 36–54.

    Google Scholar 

  13. Last CG, Hansen C, Franco N. Cognitive behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry 1998; 37: 404–411.

    Article  PubMed  CAS  Google Scholar 

  14. Reich W, Todd R. Missouri Assessment of Genetics Interview for Children (MAGIC), St Louis, MO; Washington University School of Medicine, 1999.

    Google Scholar 

  15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV), 4th ed. Washington, DC: American Psychiatric Association, 1994.

    Google Scholar 

  16. Todd RD, Joyner CA, Heath AC, Neuman RJ, Reich W. Reliability and stability of a semistructured DSM-IV interview designed for family studies. J Am Acad Child Adolesc Psychiatry 2003; 42: 1460–1468.

    Article  PubMed  Google Scholar 

  17. Jaideep T, Reddy YC, Srinath S. Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder. Bipolar Disord 2006; 8: 182–187.

    Article  PubMed  CAS  Google Scholar 

  18. World Health Organization. Psychosocial axis of the multiaxial classification of child and adolescent psychiatric disorders. Parent Interview Schedule. Draft for comments and field testing. Geneva; World Health Organization, 1990: NIMH/MND/90.13.

    Google Scholar 

  19. Srinath S, Girimaji SC, Gururaj G et al. Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas of Bangalore, India. Ind J Med Res 2005; 122: 67–79.

    Google Scholar 

  20. Shaffer D, Gould SM, Brasic J. A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 1983; 40: 1228–1231.

    PubMed  CAS  Google Scholar 

  21. Flakierska-Praquin N, Lindstrom M., Gillberg C. School phobia with separation anxiety disorder: a comparative 20-to 29-year follow-up study of 35 school refusers. Compr Psychiatry 1997; 38: 17–22.

    Article  PubMed  CAS  Google Scholar 

  22. Srinath S, Bharat S, Girimaji S, Seshadri S. Characteristics of a Child inpatient population with hysteria in India. J Am Acad Child Adolesc Psychiatry 1993; 32: 822–825.

    Article  PubMed  CAS  Google Scholar 

  23. Kearney CA, Silverman WK. Family environment of youngsters with school refusal behavior; A synopsis with implications for assessment and treatment. Am J Fam Ther 1995; 23: 59–72.

    Google Scholar 

  24. Naylor MW, Staskowski M, Kenney MC, King CA. Language disorders and learning disabilities in school-refusing adolescents. J Am Acad Child Adolesc Psychiatry 1994; 33: 1331–1337.

    Article  PubMed  CAS  Google Scholar 

  25. Blagg NR, Yule W. The Behavioral Treatment of School Refusal-A comparative Study. Beh Res Therapy 1984; 22: 119–127.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mukesh Prabhuswamy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prabhuswamy, M., Srinath, S., Girimaji, S. et al. Outcome of children with school refusal. Indian J Pediatr 74, 375–379 (2007). https://doi.org/10.1007/s12098-007-0063-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-007-0063-5

Key words

Navigation