School has an important function in providing the environment for young people to acquire many skills and knowledge required by contemporary life, but the problems of attachment to school and ...problematic attendance all over the world reveal an increasing statistic. It is thought that some negative processes such as anxiety sensitivity, social and adaptive functioning, and school refusal can affect this problem. On the other hand, it is considered that the academic resilience of young people has an important protective function in terms of these risk factors. For this purpose, the mediator role of academic resilience between anxiety sensitivity, social and adaptive functioning, and school refusal and school attachment were examined in a Turkish sample of 452 high school students. In the process of data collection, the school refusal assessment scale, social and adaptive functioning scale, and academic resilience scale were adapted and used in the Turkish culture. In the data analysis, the structural equation model was used to determine the direct and indirect predictive effects between the variables. The results of the study showed that academic resilience fully mediated the relationship between anxiety sensitivity and school attachment, whereas it partially mediated the relationship between social and adaptive functioning and school refusal and school attachment. Based on the results of the study, it was evaluated that high academic resilience has a strong protective function against the problems of negative school attachment and problematic school absenteeism among young people, and this finding was discussed within the context of literature.
There is a growing interest in quantifying the risk of presenting maladaptive behaviors through the use of multivariate prediction algorithms such as logistic regressions. The objective of this study ...was to analyze the predictive capacity of school refusal behavior on high levels of social anxiety. The study used a sample of 895 Chilean adolescents (54.3% girls) aged between 14 and 17 years. The School Refusal Assessment Scale-Revised (SRAS-R) and the Social Anxiety Scale for Adolescents (SAS-A) were administered. The results revealed that adolescents with school refusal presented significantly higher scores in social anxiety than their peers with low scores in school refusal. This is due to feelings of social aversion, negative affectivity, fear of evaluation, or the use of this behavior to pursue the attention of significant others. This type of school refusal was found to be a positive and statistically significant predictor of high scores for social anxiety. On the contrary, when school refusal is based on obtaining tangible reinforcement outside the school, this factor acts as a negative and statistically significant predictor of high scores for social anxiety. These findings are discussed with reference to the differences found according to the type of school refusal behavior and its impact on the appearance of high levels of social anxiety.
The term ‘school refusal,’ which first originated from Great Britain, is used to describe problems in children not going to school because of emotional difficulties. School refusal is a symptom and ...may be accompanied by several psychiatric disorders (such as anxiety disorder, disruptive behavior disorder and mood disorder). School refusal is common in the children of parents with psychological disorders. This supports the idea of genetic and environmental factors being involved in the development of school refusal. A separate therapeutic protocol must be established for each case through the detailed assessment of child-related, family-related and social environment and school-related factors. School refusal is more common in children 5, 6, 10 and 11 years of age. The aim of treatment must be to ensure a return to school as early as possible. Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it can be associated with several psychiatric disorders. Therefore it is necessary that youths who are school refusing receive an evaluation by a mental health professional. We discuss a case of school refusal in the older of two siblings with an age difference of 1 year who started school in the same class but who were subsequently assigned to different classes. The purpose of this report is to emphasize the importance of siblings of a similar age starting school in difference classes, similarly to twins, and to raise awareness of this.
Background
The Covid-19 pandemic has brought into sharp focus a school attendance crisis in many countries, although this likely pre-dates the pandemic. Children and young people (CYP) struggling to ...attend school often display extreme emotional distress before/during/after school. We term this School Distress. Here we sought to elucidate the characteristics of the CYP struggling to attend school in the United Kingdom.
Methods
Using a case–control, concurrent embedded mixed-method research design, 947 parents of CYP with experience of School Distress completed a bespoke online questionnaire (February/March 2022), alongside an age-matched control group (
n
= 149) and a smaller group of parents who electively home-educate (
n
= 25).
Results
In 94.3% of cases, school attendance problems were underpinned by significant emotional distress, with often harrowing accounts of this distress provided by parents. While the mean age of the CYP in this sample was 11.6 years (StDev 3.1 years), their School Distress was evident to parents from a much younger age (7.9 years). Notably, 92.1% of CYP currently experiencing School Distress were described as neurodivergent (ND) and 83.4% as autistic. The Odds Ratio of autistic CYP experiencing School Distress was 46.61 95% CI (24.67, 88.07). Autistic CYP displayed School Distress at a significantly earlier age, and it was significantly more enduring. Multi-modal sensory processing difficulties and ADHD (among other neurodivergent conditions) were also commonly associated with School Distress; with School Distress CYP having an average of 3.62 NDs (StDev 2.68). In addition, clinically significant anxiety symptomology (92.5%) and elevated demand avoidance were also pervasive. Mental health difficulties in the absence of a neurodivergent profile were, however, relatively rare (6.17%). Concerningly, despite the striking levels of emotional distress and disability reported by parents, parents also reported a dearth of meaningful support for their CYP at school.
Conclusion
While not a story of exclusivity relating solely to autism, School Distress is a story dominated by complex neurodivergence and a seemingly systemic failure to meet the needs of these CYP. Given the disproportionate number of disabled CYP impacted, we ask whether the United Kingdom is upholding its responsibility to ensure the “right to an education” for all CYP (Human Rights Act 1998).
School refusal (SR) can result in decreased academic achievement, impaired social connections, and family stress. Current interventions for SR include behavioral and cognitive-behavioral treatments ...that are not always effective. Incorporating multidisciplinary work that includes therapeutic and educational interventions may enhance outcomes for youth displaying SR. The In2School program fosters a working partnership between mental health clinicians and teachers. It was designed to meet the needs of young people missing more than 50% of school in the previous 6 weeks due to mental health disorders, including anxiety or depression. This paper reports on an action research study in which the In2School program was piloted. Over a 14-week period, therapeutic and educational interventions were integrated into the learning environment via a transitional classroom to support youths’ return to school. Outcomes of this program are reported for the first cohort of 7 youth. Of these youth, 6 returned to mainstream schooling with attendance levels being maintained for 6 months after completing the intervention. Progress was observed in mental health recovery, quality of life reports, increased social interactions with peers, and positive experiences at school. The preliminary results presented in this paper suggest that a multidisciplinary, home-school-clinic intervention holds promise for helping school-refusing youth to return to school.
•School refusal is a complex issue which requires multidisciplinary approaches.•Wraparound models of care may address the complex range of factors linked to school refusal.•In2School is a wraparound model involving mental health and education staff in a ‘transitional’ classroom.•Improved school attendance, mental health and quality of life suggest In2School is a promising model of care.
School Refusal Behaviours (SRBs) is potentially a risk factor for students’ academic and mental wellbeing. Effective management of SRBs demands that the heterogeneity of underlying motives/reasons ...for refusing school among students are taken into consideration. Yet there is inadequate empirical findings on the SRBs profiles and the SRBs risk and protective psychosocial factors among the Nigerian adolescent. Anchored on the bio-ecological agency framework, we aimed to identify SRBs profiles among Nigerian adolescents by employing a person-centered approach, as well as to determine how students in the identified profiles differed on risk and protective psychological/social factors. Using a cross-sectional research design, we surveyed a total of 539 (48.4% = male; 51.6% = female) adolescent students in secondary schools in Anambra State. We used the latent profile analysis (LPA) to identify four profiles among our population: moderate SRB profile, low SRB profile, mixed SRB profile, and high SRB Profile. Regarding the outcome variables, significant differences existed on students’ test anxiety, perceived parent, teacher, classmate supports, and demanding parenting styles. We concluded that adolescents who reported SRBs are not monolithic, and that students who reported higher SBRs could be affected by multiple factors. Our finding is significant given the fact that it points to the need to take into consideration multiple factors in mounting intervention programmes.
Although, there has been a growing number of studies on school refusal in Western cultures, the underlying factors that contribute to school refusal in Chinese adolescents remain unclear. This study ...aimed to better understand why Chinese adolescents refuse to go to school and to further interpret what they want to express through their school refusal behaviors.
We performed a qualitative study using an interpretative phenomenological analysis. Twenty adolescents with school refusal experiences were recruited from the clinical psychology department of two mental health hospitals in Shanghai, China. They participated in semistructured, face-to-face in-depth interviews. The interviews were transcribed verbatim and analyzed according to the guidelines of interpretative phenomenological analysis.
Five main superordinate themes emerged from data analysis: (a) competition-oriented social environment; (b) family living space dominated by conflicts; (c) personal living space lacking meaningful support; (d) conflict between the pros and cons of being labeled with a psychiatric diagnosis; and (e) reintegration in school life.
Our analysis emphasized the complex interacting effects of the social environment, family interpersonal conflicts, personal psychological factors and mental health complaints on the development and maintenance of Chinese adolescents' school refusal. These factors contributed to school refusal at each level and influenced each other's effects on school refusal behaviors. Therefore, interventions for Chinese teenagers with school refusal may need to integrate strategies that inspire reorganization and changes in different ecosystems, such as strategies related to government policy, peer relationships, family systems and individual inner dynamics.
Cognitive behavioral therapy (CBT) is often effective in the treatment of school refusal (SR). Its usefulness is limited, however, if youth displaying SR also refuse to attend treatment sessions. In ...these cases parents and school staff may consider using school-based interventions that do not rely on face-to-face assessment and treatment with the young person. The current study examined the effectiveness of a school-based intervention applied in Japan to achieve rapid return to school among adolescents displaying SR. Between 2009 and 2015, the parents of 62 adolescents displaying SR were invited to implement a school-based rapid return approach. Thirty-nine parents agreed to implement the approach and 23 decided to wait until their child spontaneously attended school. Of the 39 cases in which the approach was implemented, 28 adolescents (72%) resumed attendance at their original school, 2 (5%) transferred to another school, and 9 (23%) did not resume attendance. In contrast, all 23 non-intervention cases continued to refuse to attend school for 3 months or longer, and none of these adolescents returned to regular school attendance within 9 months. This study tentatively suggests that the rapid return approach may be an effective form of intervention for adolescents displaying SR and simultaneously refusing to attend individual therapy. Because this approach is ethically complex, involving forced school attendance in adolescence, it should only be employed under specific circumstances. These circumstances are discussed.
This study aims to explore the psychological characteristics, related emotional problems and potential NIR brain function mechanism of adolescents who refuse to attend school.
The study included 38 ...adolescents (12-18 years old) who were not attending school and 35 healthy controls (12-18 years old) who are attending school regularly. Participants completed (1) general demographics, (2) Eysenck Personality Questionnaire (EPQ), (3) Zung Self-Rating Depression Scale (SDS), (4) Zung Self-Rating Anxiety Scale (SAS), and (5) Symptom Checklist-90 (SCL-90). In addition to the clinical tests, participants completed functional near-infrared spectroscopy (fNIRS). Mental health, personality, and emotional state were evaluated in both groups to explore the differences and to understand the underlying mechanisms of school refusal during adolescence.
Adolescents who did not attend school had higher neuroticism scores on the Eysenck Personality Questionnaire than healthy controls (p(FDR) < 0.001), introversion and concealment scores were lower than those of healthy controls (p(FDR) < 0.001), there was no significant difference in psychoticism scores between groups. SDS, SAS, SCL-90 scores and factor scores were higher than those of healthy control group (p(FDR) < 0.001), NIR functional brain imaging was different from healthy control group in the 12 and 27 channels (p(FDR) = 0.030, p(FDR) = 0.018), and no difference was found in the remaining channels (p(FDR) > 0.05). There were statistically significant differences in age and gender between the adolescents who refused school and the control group (p(FDR) < 0.001).
School refusal adolescents are relatively introverted and sensitive and need more attention in daily life. Although the adolescents' emotional problems did not reach the diagnostic criteria of depressive disorder and anxiety disorder, their scores were still higher than those of the control group, suggesting that we should pay more attention to their emotional problems in order to better help them return to school. Using fNIRS, it was found that abnormalities in frontal lobe regions in adolescents with school refusal behaviors, which would contribute to early diagnosis and timely intervention of school refusal behaviors.
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