TREATMENT COMPONENTS FOR EACH FUNCTION OF
SCHOOL REFUSAL BEHAVIOR

Function or Reason

Treatment Components

Escape from negative affect
(Sadness, the blues, fears, generalized anxiety and worry, separation anxiety, various phobias)

bullet Somatic management skills such as breathing retraining or progressive muscle relaxation training
bullet Gradual reintroduction (exposure) to school
bullet Self-reinforcement and building self efficacy

Escape from aversive social and evaluative situations
(Social phobia, test anxiety, public speaking fears, shyness, social skills deficits)

bullet Cognitive restructuring of negative self-talk
bullet Role play practice
bullet Graded exposure tasks involving real-life situations
bullet Social skills training and problem-solving skills training
bullet Building coping templates

Attention-seeking behavior
(Tantrums, crying, clinging, separation anxiety)

bullet Parent training in contingency management
bullet Changing parent commands
bullet Establishing routines
bullet Use of rewards and punishers for school attendance and school refusal
bullet Forced attendance, if necessary and under special circumstances

Positive tangible reinforcement
(Lack of structure or respect for house rules and responsibilities, free access to reinforcement, disregard for limits)

bullet Contracting with parents to increase incentive for school attendance
bullet Curtail social and other activities as a result of nonattendance
bullet Provide the family with alternative problem-solving strategies to reduce conflict
bullet Communication skills and peer refusal skills are also sometimes added to this process