lecture 6- school refusal Flashcards
(28 cards)
what factors contribute to school absenteeism
lllness- unavoidable
boredom- more fun elsewhere
anxiety/ fear
asthma- x3 more likely
what is school absenteeism
- School absenteeism is any absence from school for any legal or illegal reason
o 80%= legal/ legit reasons(illness/funerals)
o Most cases are temporary
what is school withdrawal
- School withdrawal is when parents deliberately keep child away from school:
o Reasons= maltreatment, economic support, comfort parents during crisis, protect child from estranged spouse, parent-based separation anxiety, to punish child
what is school resistance
- School resistance is when a child disrupts class or ‘plays truant’
what is school drop out
- School dropout, which is permanent withdrawal
o Often in adolescence when decide to leave,
o or other factors such as avoiding abuse, homelessness and no formal school arrangements
what is school refusal
- School refusal, our focus:
o Children’s deliberate and illicit refusal to go to school
o Sometimes known as “truancy” and “school phobia” – 2 main types of school refusal
what are the 2 types of school refusal
truancy and school phobia
describe truancy- a feature of school refusal
o Delinquent behaviour: Absence from school is not accompanied by emotional symptoms
o Often presence of conduct disorders
o Child stays away from home during school hours
o Parents have no knowledge of the absences
o Sometimes parents are aware but unable to change their child’s behaviour
• Undercontrolled-externalizing type (acting out behaviour, aggression, fighting, stealing)
describe school phobia- a feature of school refusal
- School phobia- anxiety based
o Eager to go to school but most cannot leave the house
o Symptoms of anxiety or panic when it is time to go to school (i.e., severe fear, temper tantrums)
o Somatic symptoms with no physical cause (i.e. headaches, dizziness, stomach aches)
o Can exhibit depressive symptoms
o Parents’ knowledge (if not the consent!)
o No significant antisocial disorders (i.e. delinquency)
o Separation anxiety
o Overcontrolled-internalizing type (fear, anxiety, depressive symptoms)
describe some of the prevelance features of school refusal
- 5-28% children/ adolescents = some aspect of school refusal
o Hard to consistently estimate as schools/ agencies use different criteria
• Peak age 11-13 years transition to high school critical
• Reading claims 5/6 and 10/11
• Boys/ girls same effected different reasons
• girls due to phobia and anxiety, boys more due to oppositional-conduct problems (‘truancy’).
• SES: lower income but mixed findings
• Most referrals for school refusal occur in the autumn months
• No relationship with school type
• The youngest or oldest child in a family of several children is more likely to be affected
• Varying incidence rates
• ADHD: 3 - 6%+ Depression: 0.4 - 7.8%
• School not meeting special education needs?
what does Kearny 2008 describe as some of the features which contribute to school refusal
- Family (significant change/loss/divorce/parental MH/ overprotective parents)
- Child factors (anxiety/fear of failure/worry over dependant parent)
- Environmental (homelessness/poverty/ pregnancy/maltreatment/alcoholism)
- School factors (bullting/ school transistion/ poor SEN/ school climate – feeling safe)
- Kerrny 2008: main reasons for leaving school
o 43.4%= missing too many days
o 38% = due to poor grades
in egger 2003 how many anx based SR had a psychiatric disorder
a community study associated with school refusal behaviour
o 165 youth showed anxiety-based school refusal
Of these, 24.5% had a psychiatric diagnosis, including depression (13.9%), separation anxiety disorder (10.8%), oppositional defiant disorder (5.6%), or conduct disorder (5.0%)
in egger 2003 how many truancy based SR had a psychiatric disorder
o 517 youths showed a truancy-type school refusal:
Of these, 25.4% had psychiatric diagnosis, including CD (14.8%), ODD (9.7%), depression (7.5%), or substance use (4.9%)
in McShane 2001 why would children want to stay at home
53% have parents with psych diagnosis
parents letting go/ children stay at home due to worry
in Kearny and albano 2004- what is the study design and results
o looked at a large clinical sample of 143 youths (5-17 years old) referred to an outpatient clinic for problematic absenteeism.
o 67.1% received a psychiatric diagnosis, including separation anxiety disorder (22.4%), generalised anxiety disorder (10.5%), ODD (8.4%), or depression (4.9%)
what does Esch 2014 conclude about MH dis
they are a predictor of dropout - and an outcome
externalising factors may be excacerbated by drop out
name some consequences of school drop out
- Impact on family
o Parent stays at home = income
o Legal issues with staying at home - Increased anxiety with prolonged dropout
o Anxiety worsens due to avoidance of the feared situation. Avoiding school reduces anxiety temporarily (negative reinforcement!) but increases longer terms anxiety (for the next day)
o This is also negatively reinforced by the child doing worse at school which reinforces fears of failure - Loss of routine
o Positively reinforces the use of endulgences eg gaing/ tv - Social isolation
o Loss of friends
o Emotional and social difficulties later in life - Likelyhood of negative consequences depends on:
o The severity of school refusal
o The age of onset
o How quickly the intervention is put in place
o Less effective if the school refusal has been prolonged ( 2 or more years)
1/3 of young people with school refusal face adjustment problems in later life
how do you assess school refusal
- Step 1: interview (/observe) the child and family*
o Interview/selfreport/ school refusal scale/ anxiety / reinforcers - Step 2: Teacher’s report
- Step 3: Integration of information
- *be aware of social desirability factors in an interview – self-report may not give us the full scale of the problem! For e.g., the child may wish to hide how bad it is.
- Self-report instruments: remember that may not give us an accurate picture of the problem. The child may , due to social desirability factors, not report the real situation and feelings. Scale: assesses 4 factors associated with difficulty in attending school
- Observation: it is a good idea to observe the child before the beginning of the school day
how can negative reinforcement explain school refusal behaviours
o Avoidance of negative situation (school) becomed reinforced as avoid it
o Avoidance provokes anxiety/ upset
o Escape from aversive social or evaluative situations: This includes situations where the child is anxious about their relationships with others (peers and adults). These situations often have an evaluative aspect (i.e. read aloud in front of the class).
how can positive reinforcement explain school refusal behaviours
o Staying away= reinforced by positive experience
o Attention seeking behaviour: School refusal leads to positive outcomes (attention, sympathy)
o Pursuit of tangible reinforcement outside of school: to pursue more positive reinforcers than school (watching TV, playing video games or sports, sleeping late
name some interventions for school refusal
- Depends on school
o Medication (e.g. SSRIs) might be useful in alleviating severe cases of anxiety and depression.
o Psychological techniques might include:
o Child-based techniques: to manage anxiety in a school setting (e.g. relaxation training, CBT, cognitive or exposure based therapy)
o Parent and family-based techniques: to manage contingencies for school attendance and nonattendance (e.g. establishing routines, reducing excessive child questioning)
o School-based techniques: work with school to arrange special support, anti-bullying measures etc. - when he misbehave and ignoring him when behaviour is appropriate
- Establishing fixed routines & consequences, e.g. time set for all basic activities (wake the child, sit alone, complete homework etc)
- Contracts
what happened in prevatt and Kelly 2003
reviewed intervention programs to prevent school dropout
- Programs that focused on academic enhancement and/or multi-component programs were the most promising.
- However, no intervention met criteria for empirically supported intervention no best practice even though some intervention seem promising.
- Main issues with literature:
o No clear definition of dropouts, school refusal etc
o Few controlled studies (good controls are difficult)
o No clear criteria for ‘at risk’ sample
o Often focused on one variable, but a lot more complicated than this treatment should look at severity of symptoms, comorbid diagnosis, family dynamic and function of school refusal behaviour etc. Not one-size-fits-all approach.
explain how heynes et al 2005 uses CBT to combat school refusal
- Common option
- As described by Heynes et al (2005), it might involve a comprehensive assessment and elements of intervention from different perspectives:
o Child: academic difficulties, co-morbid mood problems, somatic symptoms etc
o Family: parental MH (anxiety and depression) and response to non attendance
o School: teacher support, interaction with friends in playground etc. - CBT might incorporate the four D’s (Heyne & Rollings, 2002):
- Describing the cognitive therapy model
- Detecting cognitions (‘I know teacher does not like me because..’)
- Determining which cognitions to address
- Disputing maladaptive cognitions
- Discovering adaptive cognitions or coping statements
- Doing between session practice tasks
- Discussing the outcome of the tasks
what was the result of Mansdorf and Lukens (1987)
2 children who received an intervention with cognitive (how to use coping self statement) and behavioural (gradual exposure to school) elements.
Outcome: 3 month follow up: children back at school
