Treatment of school refusal behavior in children with mixed functional profiles

doi:10.1016/S1077-7229(01)80037-7

Cognitive and Behavioral Practice

Volume 8, Issue 1, Winter 2001, Pages 3-11

https://doi.org/10.1016/S1077-7229(01)80037-7 Get rights and content

Many children refuse school for multiple reasons, although this complex type of absenteeism has not been largely addressed in the literature. This article presents two cases that were treated for complex school refusal behavior. Each case was subjected to functional analysis to determine what reasons were primarily maintaining the behavior. Following this process, a multicomponent prescriptive treatment approach was used to reintroduce the children to school. Treatment was effective, even at 1-year follow-up. Challenges in treating cases of complex school refusal behavior are discussed.

References (23)

ChorpitaB.F. et al.
A systematic replication of the prescriptive treatment of school refusal behavior in a single subject
Journal of Behavior Therapy and Experimental Psychiatry
(1996)
KearneyC.A. et al.
Functionally-based prescriptive and nonprescriptive treatment for children and adolescents with school refusal behavior
Behavior Therapy
(1999)
OllendickT.H.
Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R)
Behaviour Research and Therapy
(1983)
AchenbachT.M.
Manual for the Child Behavior Checklist/4–18 and 1991 profile
(1991)
AchenbachT.M.
Manual for the Teacher's Report Form and 1991 profile
(1991)
BuitelaarJ.K. et al.
Depressive and anxiety disorders in adolescence: A follow-up study of adolescents with school refusal
Acta Paedopsychiatrica
(1994)
HibbettA. et al.
Occupational outcomes of truancy
British Journal of Educational Psychology
(1990)
KearneyC.A.
School refusal behavior
KearneyC.A.
School refusal behavior in youth: A functional approach to assessment and treatment
(2001)
KearneyC.A. et al.
Therapist's guide to school refusal behavior
(2000)

KearneyC.A. et al.

Parent's workbook for school refusal behavior

(2000)

Cited by (26)

Differentiation Between School Attendance Problems: Why and How?
2019, Cognitive and Behavioral Practice
Citation Excerpt :
It should also be noted that support for the treatment utility of the SRAS is based on case studies and a small nonrandomized controlled study, whereas large-scale studies are yet to be conducted (Heyne et al., 2017). It is not uncommon for youth to have high scores on multiple SRAS functional conditions, as evidenced in case studies (e.g., Kearney, 2002a; Kearney, Pursell, & Alvarez, 2001; Tolin et al., 2009) and studies based on larger samples (Dube & Orpinas, 2009; Kearney & Albano, 2004). When the highest scoring functional conditions differ by less than 0.5 points on the 0-to-6 scale the young person is said to have a mixed functional profile (Kearney & Silverman, 1999) or multifunction school refusal behavior (Kearney, 2002a).
School attendance problems (SAPs) are heterogeneous with respect to etiology and presentation. The long history of conceptualizing SAPs has led to a vast array of terms and definitions as well as different perspectives on the most helpful approach to classification. For educators, practitioners, researchers, and policymakers, this presents a challenge in understanding, assessing, and intervening with SAPs. This paper outlines evolution in the conceptualization of SAPs, focusing on two contemporary approaches to differentiating between them. One approach draws on the longstanding differentiation between SAP types labeled school refusal, truancy, and school withdrawal. A fourth type of SAP, labeled school exclusion, is also considered. The other approach focuses on the function of absenteeism, measured via the School Refusal Assessment Scale (SRAS). Anecdotal and scientific support for the SAP typology is presented, along with the benefits and shortcomings of the SRAS approach to differentiation. The paper offers suggestions for how to differentiate between SAPs and introduces the SNACK, a brief screening measure that permits differentiation by SAP type.
Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series
2009, Cognitive and Behavioral Practice
The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week period. Treatment elements included cognitive-behavioral therapy with the adolescent, parent training sessions, or a combination of these strategies. Treatment was effective for 3 of 4 cases in the short term. At 3-year follow-up, all 3 of the acute treatment responders had switched to alternative educational programs, although parents rated them as significantly improved and less impaired compared to pretreatment. Obstacles to treatment, and recommendations for program improvement, are discussed.
School absenteeism and school refusal behavior in youth: A contemporary review
2008, Clinical Psychology Review
Absenteeism from school is a serious public health issue for mental health professionals, physicians, and educators. The prevalence of unexcused absences from school exceeds that of major childhood behavior disorders and is a key risk factor for violence, injury, substance use, psychiatric disorders, and economic deprivation. This article involves a contemporary research review on absenteeism prevalence, comorbid physical and psychiatric conditions, classification, contextual risk factors, cross-cultural variables, assessment, intervention, and outcome. Contextual risk factors include homelessness and poverty, teenage pregnancy, school violence and victimization, school climate and connectedness, parental involvement, and family variables, among others. A description of intervention includes medical, clinical, and systemic interventions. Medical professionals, community- and school-based mental health professionals, and educators are encouraged to fully understand the parameters of school absenteeism to develop better, consensual policies regarding definition, classification, assessment, and intervention of youths with problematic school absenteeism.
Separation anxiety disorder, panic disorder, and school refusal
2005, Child and Adolescent Psychiatric Clinics of North America
Intensive cognitive-behavioral treatment of school refusal behavior
2003, Cognitive and Behavioral Practice
The present investigation is a single-subject treatment of a preadolescent child with school refusal behavior. This study represents an A-B design in which treatment was designed to begin with a standard cognitive-behavioral approach and to continue with a functional analytic and intensively applied problem-solving strategy if difficulties arose during the implementation of cognitive behavioral treatment (CBT). Consistent with the design, systemic problems interfered with the implementation of traditional, office-based CBT and the intensive approach was applied. Under this design, problems were identified and mitigated using strategies beyond those employed in traditional manualized CBT. The participant was a 12-year-old female who was attending school sporadically and with great difficulty, and who was experiencing both separation anxiety and social anxiety in the school setting. Following the intensive treatment, she began to attend school more regularly, and her fear ratings decreased considerably; however, she continued to have difficulties with school attendance that appeared to be more related to systemic issues than anxiety. This study describes a potential method of increasing the clinical utility of manualized treatments for highly challenging cases through an intensive, functional analytic strategy, and also describes the challenges of working with anxiety disorder cases in which there are multiple variables in addition to the child's anxiety that contribute to clinical disturbance.
Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals: A Practitioner Review
2022, Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie

View all citing articles on Scopus

View full text

Treatment of school refusal behavior in children with mixed functional profiles

Journal of Behavior Therapy and Experimental Psychiatry

Behavior Therapy

Behaviour Research and Therapy

Manual for the Child Behavior Checklist/4–18 and 1991 profile

Manual for the Teacher's Report Form and 1991 profile

Depressive and anxiety disorders in adolescence: A follow-up study of adolescents with school refusal

Acta Paedopsychiatrica

Occupational outcomes of truancy

British Journal of Educational Psychology

School refusal behavior

School refusal behavior in youth: A functional approach to assessment and treatment

Therapist's guide to school refusal behavior

Parent's workbook for school refusal behavior