Should I Stay or Should I Go

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Steven R. Fricke

Should I Stay or Should I Go?

“Understanding School Refusal Behavior in Youth and How to Develop a Functionally-Based Treatment Plan”

Historical Perspectives on School Absenteeism and Truancy (Kearney, 2001)

Truant or truancy is a term derived from the old French word, truand, meaning "beggar," "parasite," "lazy person," "naughty child," or "rogue." In early literature dating back to 1927, the term truant referred to an unlawful and unwilling "absence from school without the knowledge and consent of the parent".

School Phobia was defined in 1941, as a type of psychoneurotic disorder characterized predominantly by overlapping phobic and obsessive tendencies. By the 1950's, the problem was more accurately described as a type of separation anxiety present before the advent of school with comorbid problems, including somatic complaints, depression, and family conflict.

School Refusal is "child-motivated refusal to attend school or difficulties remaining in class for an entire day; the term refers to children and adolescents aged 5-17 years who are: (a) completely absent from school; (b) attend but then leave school at some time during the day (i.e., skip classes); (c) attend school following severe misbehaviors in the morning (e.g., tantrums, clinging, aggression, running away, refusal to move, dawdling); (d) attend school under great duress that may precipitate pleas for future nonattendance to parents or others, or a combination of the above. The term is meant to incorporate the primary aspects of the terms truancy, psychoneurotic truancy-school refusal, and school phobia".

Etiology & Subtypes of School Refusal Behavior - "…academic and communicative frustration and the adolescent's resulting inability to meet the academic and social demands in the school environment may play a role in the etiology of school refusal" (King & Bernstein, 2001)

Perceived causes (Kearney, 2001):

"avoidance of stimuli that provoke negative affectivity" (meaning fear, anxiety, or depression related)

resulting antisocial or disruptive behaviors

Maintaining variables (Strickney & Miltenberger, 1998; Lee & Miltenberger, 1996):

1) to avoid school-related objects or situations that cause general distress such as anxiety, depression, or physiological symptoms (negative affectivity)

2) to escape aversive social situations and/or academic performance situations (tests, oral presentations)

3) to receive attention from primary care giver(s) or significant others outside of school

4) to pursue tangible reinforcement outside of school (engage in alternative, more desirable activities)

Diagnosis & Assessment (Kashdan & Herbert, 2001; Kearney, 2001; King & Bernstein, 2001; Elliott, 1999)

Best Practices - a comprehensive evaluation would include:

	child self-report and self-monitoring,
	complete medical history
	a semi-structured diagnostic interview of child and parent;
	evaluation of factors maintaining the school refusal behaviors through behavioral observation at home and in school;

	ratings of severity of anxiety and depression from self report, parent, clinician, and teacher perspectives;
	assessment of family functioning;
	psycho-educational and language assessment; and
	a review of school attendance

A brief list of self-report, parent and teacher rating scales and checklists:

· School Refusal Assessment Scale (SRAS; Kearney & Silverman, 1993) - Child and Parent versions each consist of 16 items designed to assess the maintaining variables, or four motivating conditions, of the school refusal behavior

· Social Anxiety Scale for Children-Revised (SASC-R; La Greca & Stone, 1993) - primarily used with elementary age children, a 22-item measure which assesses fear of negative evaluation and social avoidance and distress

· Social Anxiety Scale for Adolescents (SAS-A; La Greca & Lopez, 1998) - identical in format to the SASC-R but correlates with various measures of social functioning slightly more developmentally appropriate for adolescents

· Children's Depression Inventory (CDI; Kovacs, 1981, 1985) - a 27 item measure of thoughts and behaviors indicative of depression; commonly used as a screening instrument.

· Child Behavior Checklist (CBCL; Achenbach, 1991) - children who refuse school to escape aversive social or evaluative situations show significantly higher scores on the Withdrawn and Somatic Complaints factors, as well as the overall Internalizing score

Early Indicator's of School Refusal Symptoms (McEwan, 1998)

· Complaints about fellow students and teachers

· Difficulty in getting out of bed; dawdling to and from school/class

· Waiting until the last minute to do school-related tasks

· A pattern of absences on Mondays and Fridays

· Constant negative self-talk about school performance

· Disinterest in what is being worn to school and personal grooming

· Problems with sleeping; nightmares; regression to bed-wetting

· Eating disorders

· Calls from the school nurse with non-specific complaints (for example, headaches or stomachaches with no fever)

Treatment Approaches

SRB Resources