Treatment of school refusal: one-year follow-up.
ABSTRACT To conduct a 1-year follow-up of anxious-depressed school-refusing adolescents who participated in an 8-week study of imipramine versus placebo, each in combination with cognitive-behavioral therapy.
Sixty-five percent (41 of 63) of the randomly assigned subjects returned for follow-up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questionnaire regarding interim treatments and school programs.
From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety disorder and 33.3% met criteria for a depressive disorder. Remission rates and acquisition rates for specific anxiety and depressive disorders were determined. In the follow-up period, 67.5% received at least one psychotropic medication trial and 77.5% had outpatient therapy. Higher level of somatic complaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p = .029).
In this naturalistic follow-up study, there was high utilization of mental health interventions. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. Investigation of duration of acute treatments and evaluation of maintenance treatments for school refusal is needed.
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ABSTRACT: School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.Clinical Child and Family Psychology Review 12/2013; DOI:10.1007/s10567-013-0160-0 · 4.75 Impact Factor
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ABSTRACT: The present study utilized systematic review methods and meta-analysis to quantitatively synthesize research and systematically examine the effects of indicated intervention programs on school attendance behaviors of elementary and secondary school students. A comprehensive search strategy resulted in the identification 11 randomized studies, 9 quasi-experimental studies and 13 single group pre-post test studies that met inclusion criteria. Effect sizes data and study, participant, and intervention characteristics were coded and analyzed. Analyses of the randomized and quasi-experimental studies were performed separately from the single group pre-post test studies. The meta-analytic findings showed overall positive and moderate effects of indicated attendance interventions on attendance outcomes. There was, however, significant heterogeneity found between studies. Moderator analyses were conducted to examine potential variables related to study, participant and intervention characteristics that may explain the variability in effect sizes. Behavioral interventions were found to be more effective than other interventions and, when combined with parental interventions, demonstrated greater effects than behavioral interventions alone. Attendance groups were also found to be effective, especially when combined with attendance monitoring and contracting/awards. Court-based, school-based and clinic-based programs produced similar effects. The available evidence did not support the use of family therapy or mentoring as indicated interventions. The findings of this meta-analysis also did not support the use of multi-modal or collaborative programs over simpler, non-collaborative interventions, even though multi-modal and/or collaborative interventions are often recommended as best practice. Although the interventions demonstrated a moderate mean effect, the mean absence rates at post-test for the majority of the studies remained above 10%; thus it appears that the majority of interventions are falling short in their attempts to improve student attendance to the point of achieving an acceptable level of regular attendance. In addition to evaluating the effects of interventions, this systematic review and meta-analysis uncovered a number of methodological shortcomings, absence of important variables and data as well as gaps in the evidence base. The author calls for a critical analysis of the practices, assumptions and social-political context underlying the extant evidence base. Implications for practice, policy and research are discussed as well as limitations of the present study.
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ABSTRACT: Prolonged school non-attendance in adolescence poses a significant public health concern. Adverse outcomes for adolescents who have missed out on the social and academic benefits of high school include mental health disorders and economic, social and relationship difficulties that may persist into adulthood. Healthcare professionals are often consulted in cases of prolonged school non-attendance. Diagnosis and management of specific physical and mental health problems must be the health professional's initial priority, with the subsequent development of a management plan to assist with school reintegration. Using a specific framework, an understanding of the factors contributing to a young person's school non-attendance can be developed. Intervention leading to a successful return to school has the potential to lower the risk of associated long-term adverse health outcomes.Archives of Disease in Childhood 06/2014; 99(10). DOI:10.1136/archdischild-2013-304595 · 2.91 Impact Factor