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.
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References
Elliott JG. Practitioner Review: School Refusal: Issues of conceptualization, assessment, and treatment. J Child Psychol Psychiatry 1999; 40: 1001–1012.
Broadwin IT. A contribution to the study of truancy. Am J Orthopsychiatry 1932; 2: 253–259.
Johnson AM, Falstein EI, Szurek SA, Svendsen M. School phobia. Am J Orthopsychiatry 1941; 11: 702–711.
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.
Berg I, Nichols K, Pritchard C. School phobia: its classification and relationship to dependency. J Child Psychol Psychiatry 1969; 10: 123–141.
Last CG, Strauss CC. School refusal in anxiety-disordered children and adolescents. J Am Acad Child Adolesc Psychiatry 1990; 29: 31–35.
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.
Mcshane G, Walter G, Rey JM. Characteristics of adolescents with school refusal. Aust N Z J Psychiatry 2001; 35: 822–826.
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.
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.
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.
Kearney CA, Silverman WK. The evolution and reconciliation of taxonomic strategies for school refusal behavior. Clin Psychol: Science and Practice 1996; 3: 36–54.
Last CG, Hansen C, Franco N. Cognitive behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry 1998; 37: 404–411.
Reich W, Todd R. Missouri Assessment of Genetics Interview for Children (MAGIC), St Louis, MO; Washington University School of Medicine, 1999.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV), 4th ed. Washington, DC: American Psychiatric Association, 1994.
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.
Jaideep T, Reddy YC, Srinath S. Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder. Bipolar Disord 2006; 8: 182–187.
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.
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.
Shaffer D, Gould SM, Brasic J. A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 1983; 40: 1228–1231.
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.
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.
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.
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.
Blagg NR, Yule W. The Behavioral Treatment of School Refusal-A comparative Study. Beh Res Therapy 1984; 22: 119–127.
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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
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DOI: https://doi.org/10.1007/s12098-007-0063-5