Introduction
Detrimental nature of School Refusal
Need for targeted intervention for School Refusal
Parent involvement in interventions for School Refusal
Next Steps and Focus of Review
Method
Search Strategy
Study selection
School Refusal Definition
Screening and data extraction
Categorisation of parent factors
Parenting Factor (predictor)
|
Definitions
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Measures
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Sample Items
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Response Scale
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---|---|---|---|---|
Overall parental psychopathology | Broad range of psychological symptoms and psychiatric morbidity | SCL-90-Ra
SCID-Ib
| “For the past week, how much were you bothered by headaches?” “How did you react when (trauma) happened? (were you very afraid or did you feel terrified or helpless?)” | 5-point frequency scale: Not at all – Extremely. Clinician rated: Absent or false; subthreshold; threshold or true |
Parent depressive symptoms | Symptoms of depression currently present | BDIc
BDI-IId
| “Sadness (0) I do not feel sad; (1) I feel sad; (2) I am sad all the time and can’t snap out of it; (3) I am so sad and unhappy and I can’t stand it” “Pessimism (0) I am not discouraged about my future; (1) I feel more discouraged about my future than I used to; (2) I do not expect things to work out for me; (3) I feel my future is hopeless and will only get worse” | |
Parent anxiety symptoms | Symptoms of anxiety currently present | STAIe
BAIf
| “I am tense” “Indicate how much you have been bothered by numbness or tingling?” | 4-point frequency scale: Almost never – Almost always. 4-point scale: Not at all – Severely, it bothered me a lot. |
Family functioning | Overall social and structural properties of a family environment including interactions (levels of conflict and cohesion), adaptability, organisation and quality of communication | FAMg
FAD-GFh
FESi
| “We spend too much time arguing about what our problems are” “Planning family activities is difficult because we misunderstand each other” “Family members really help and support one another” | 4-point scale: Strongly agree – Strongly disagree. 4-point scale: Strongly agree – Strongly disagree. True; False |
Maternal overprotection – Affection | How much the mother prefers and encourages affection from their child | SADQj – Preference Scores (rate based on preference NOT actual) | “Does he/she [child] come close to you for affectionate contact (e.g. sitting on knee or putting arm around, do not include kissing)?” | 5-point frequency scale: Less than once a week or not at all – More than once a day (several times a day) |
Maternal overprotection - Communication | How much the mother prefers and encourages communication from their child | SADQj – Preference Scores (rate based on preference NOT actual) | “Did he/she talk things over with you and ask your help about what was going on at school? (exclude homework)” | 5-point frequency scale: Less than once a week or not at all – More than once a day (several times a day) |
Maternal overprotection - Assistance | How much the mother prefers and encourages their child to ask for assistance with daily tasks | SADQj – Preference Scores (rate based on preference NOT actual) | “Did you wash or bath him/her (not including hair washing?)” | 5-point frequency scale: Less than once a week or not at all – More than once a day (several times a day) |
Maternal overprotection - Travel | How much the mother prefers and encourages their child to travel away from home | SADQj – Preference Scores (rate based on preference NOT actual) | “Did he/she go on a bus without you?” | 5-point frequency scale: Less than once a week or not at all – More than once a day (several times a day) |
Parental self-efficacy | An individual’s appraisal of his/her competence in the parental role | SEQ-RSAPk
Parenting Sense of Competency Scale – Efficacy Subscale | “If my child has difficulty attending school, I know what can be done to address this.” “Being a parent is manageable, and any problems are easily solved.” | 4-point scale: Totally disagree – Totally agree. 6-point scale: Strongly agree – Strongly disagree. |
Risk of Bias
Domain | Summary | Prompting Items |
---|---|---|
Study Participation | The study sample adequately represents the population of interest | a. Adequate participation in the study by eligible persons |
b. Description of the source population or population of interest | ||
c. Description of the baseline study sample | ||
d. Adequate description of the sampling frame and recruitment | ||
e. Adequate description of the period and place of recruitment | ||
f. Adequate description of inclusion and exclusion criteria | ||
Study Attrition | The study data available (i.e., participants not lost to follow-up) adequately represent the study sample | a. Adequate response rate for study participants |
b. Description of attempts to collect information on participants who dropped out | ||
c. Reasons for loss to follow-up are provided | ||
d. Adequate description of participants lost to follow-up | ||
e. There are no important differences between participants who completed the study and those who did not | ||
Prognostic Factor (PF) Measurement | The PF is measured in a similar way for all participants | a. A clear definition or description of the PF is provided |
b. Method of PF measurement is adequately valid and reliable | ||
c. Continuous variables are reported or appropriate cut points are used | ||
d. The method and setting of measurement of PF is the same for all study participants | ||
e. Adequate proportion of the study sample has complete data for the PF | ||
f. Appropriate methods of imputation are used for missing PF data | ||
Outcome Measurement | The outcome of interest is measured in a similar way for all participants | a. A clear definition of the outcome is provided |
b. Method of outcome measurement used is adequately valid and reliable | ||
c. The method and setting of outcome measurement is the same for all study participants | ||
Statistical Analysis and Reporting | The statistical analysis is appropriate, and all primary outcomes are reported | a. Sufficient presentation of data to assess the adequacy of the analytic strategy |
b. Strategy for model building is appropriate and is based on a conceptual framework or model | ||
c. The selected statistical model is adequate for the design of the study | ||
d. There is no selective reporting of results |
Data Analysis
Results
Characteristics | No. of Studies | |
---|---|---|
Country | Australia | 1 |
England | 1 | |
Netherlands | 1 | |
Turkey | 2 | |
USA | 3 | |
Child Age Range | Primary School (> 4–12 years) | 1 |
Secondary School (> 11–19 years) | 3 | |
Mixed | 3 | |
Unknown | 1 | |
Child Gender | < 50% Male | 3 |
> 50% Male | 3 | |
Unknown | 2 | |
Parent Gender | < 50% Male | 5 |
> 50% Male | 0 | |
50% − 50% | 3 | |
School Refusal Group Recruited From | In-patient clinic | 1 |
Out-patient clinic | 5 | |
Community | 1 | |
Unknown | 1 | |
Comparison Group Recruited From | In-patient clinic | 0 |
Out-patient clinic | 1 | |
Community | 6 | |
Unknown | 0 | |
Not Applicable | 1 |
Studies | Study participation | Study attrition | Prognostic factor Measurement | Outcome Measurement | Statistical Analysis and Reporting |
---|---|---|---|---|---|
Bahali et al. [44] | Moderate | n/a | Low | Moderate | Low |
Berg and McGuire [45] | High | n/a | Moderate | High | Low |
Bernstein and Garfinkel [46] | Moderate | n/a | Low | Moderate | Low |
Carless et al. [47] | Low | n/a | Low | Low | Low |
Hansen et al. [48] | Low | n/a | Low | Low | Low |
Heyne et al. [27] | Low | Moderate | Low | Low | Low |
Last and Strauss [49] | Low | n/a | Low | Moderate | Low |
Ozcan et al. [50] | Moderate | n/a | Low | Moderate | Low |
Studies | Child Participants | Parent Participants | School Refusal Definition Banding | Parent Factors Examined | Measure/s | Main findings |
---|---|---|---|---|---|---|
Bahali et al. [44] | Over the age of 5 School-refusing (clinical sample), n = 55a
Control (community sample), n = 56a
| Parents of school-refusers, n = 110 Parents of controls, n = 112 | Band 2 | Overall Psychopathology Depressive Symptoms Anxiety Symptoms | Symptom Checklist-90 Revised Beck Depression Inventory State-Trait Anxiety Inventory |
p < 0.02 Mothers, p < 0.0001 Fathers, p < 0.0003 Mothers, p < 0.0001 Fathers, p < 0.0001 |
Berg and McGuire [45] | Secondary school – no age range reported School-phobic (clinical sample), n = 39 Non-school-phobic (other psychiatric cases), n = 58 Controls (community sample), n = 128 | Parents of school-phobics, n = 39a
Parents of non-school-phobics, n = 58a
Parents of controls, n = 128 | Band 2 | Maternal Overprotection | Self-administered Dependency Questionnaire – Preference scores | Affection subscale, p < 0.05 Communication subscale, p < 0.001 Assistance subscale, p > 0.05 Travel subscale, p > 0.05 |
Bernstein and Garfinkel [46] | Aged between 7–18 School phobia (clinical sample), n = 6 Other disorders (clinical sample), n = 5 | Parents of school phobics, n = 12 Parents of other disorders, n = 10 | Band 2 | Family Functioning Parent psychopathology but no data reported | Family Assessment Measure – third revision |
p < 0.04 |
Carless et al. [47] | Aged between 12–17 School-refusing (clinical sample), n = 60 School-attending (community sample), n = 46 | Parents of school refusers, n = 60 Parents of school attenders, n = 46 | Band 1 | Depressive symptoms Anxiety symptoms Parental self-efficacy Family Functioning | Beck Depression Inventory – II State-Trait Anxiety Inventory Parenting sense of competence scale – efficacy subscale Family Assessment Device – General Functioning Scale | p < 0.01
p < 0.01
p < 0.01
p < 0.01 |
Hansen et al. [48] | Aged between 6–17 School-refusing (clinical sample), n = 76 | Parents of school refusers, n = 76a
| Band 2 | Family Functioning | Family Environment Scale |
p < 0.001 |
Heyne et al. [27] | Aged between 11–17 School-refusing adolescent, n = 20 | Parents of school refusers, n = 32 | Band 1 | Parental self-efficacy | Self-efficacy Questionnaire for Responding to School Attendance Problems | Mothers, p = 0.153 Fathers, p = 0.636 |
Last and Strauss [49] | Aged between 7–17 School-refusing (clinical sample), n = 63 Control (community sample matched for age and sex, never psychiatrically ill), n = 63 | Parents of school refusers, n = 63a (only 54 completed SADQ) Parents of controls, n = 63a
| Band 2 | Maternal Overprotection | Self-administered Dependency Questionnaire – Preference scores | Affection subscale, N/R (non-significant) Communication, N/R (non-significant) Assistance, p = 0.04 Travel, N/R (non-significant) |
Ozcan et al. [50] | Aged between 6–12 School phobia (clinical sample), n = 25 Control (community sample – matched for age and sex, free of any psychiatric diagnosis), n = 25 | Parents of school phobics, n = 50 Parents of controls, n = 50 | Band 2 | Overall Psychopathology Depressive Symptoms Anxiety Symptoms Social Anxiety | Structured Clinical Interview for DSM-I Beck Depression Inventory Beck Anxiety Inventory Liebowitz Social Anxiety Scale | Mothers, p = 0.002 Fathers, p = 0.017
p < 0.001
p < 0.001
p < 0.001 |