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School Refusal

Epidemiology and Management

  • Therapy In Practice
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Abstract

School refusal is differentiated from other attendance problems such as truancy and school withdrawal. It is characterised by the child’s emotional upset at the prospect of going to school, parental awareness of and antipathy toward the problem, and an absence of significant antisocial behaviour in the child. The child’s emotional upset is frequently associated with an anxiety disorder, but it may also be associated with a mood disorder. School refusal affects approximately 1% of school children across the primary and secondary school levels. Severe and prolonged school refusal jeopardises the young person’s social, emotional and academic development, and may be associated with mental health problems in adulthood.

A first step in management involves efficient identification and the assessment of contributing and maintaining factors. Clinical outcome studies support the efficacy of cognitive behavioural therapy (CBT). The psychosocial approach encompassed in CBT incorporates anxiety management training with the young person, behaviour management training with parents and consultation with school personnel. Pharmacological treatments are commonly employed although empirical support for their use is limited. Tricyclic antidepressants and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the more commonly used agents, with the latter having fewer associated adverse effects. It is suggested that the first line of treatment should be CBT, with simultaneous or subsequent pharmacological treatment contingent upon the response to CBT.

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Acknowledgements

The manuscript is based, in part, upon research conducted with the support of the National Health and Medical Research Council (project grant 940572).

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Authors and Affiliations

  1. Victorian Child Psychiatry Training Department, Department of Psychiatry, Faculty of Medicine, Dentistry, & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

    David Heyne & Howard Cooper

  2. Faculty of Education, Monash University, Melbourne, Victoria, Australia

    Neville J. King

  3. Centre for Developmental Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

    Bruce J. Tonge

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  1. David Heyne
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Correspondence to David Heyne.

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Heyne, D., King, N.J., Tonge, B.J. et al. School Refusal. Paediatr Drugs 3, 719–732 (2001). https://doi.org/10.2165/00128072-200103100-00002

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