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Pediatric Drugs
Published in: Pediatric Drugs 10/2001

01-10-2001 | Therapy In Practice

School Refusal

Epidemiology and Management

Authors: Dr David Heyne, Neville J. King, Bruce J. Tonge, Howard Cooper

Published in: Pediatric Drugs | Issue 10/2001

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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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Metadata
Title
School Refusal
Epidemiology and Management
Authors
Dr David Heyne
Neville J. King
Bruce J. Tonge
Howard Cooper
Publication date
01-10-2001
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 10/2001
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.2165/00128072-200103100-00002