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Abstract

Objectives: This study investigated the etiology of children and adolescents refusing to attend school and the psychopathologies of patients referred to the child and adolescent psychiatry outpatient clinic. Patients and Methods: Information of patients who had been referred to the Tekirdag State Hospital Child and Adolescent Psychiatry Clinic between 15.01.2011 and 15.01.2012 were reviewed retrospectively. The study was focused on sociodemographic characteristics and psychopathologies of the children and adolescents determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV) diagnostic criteria.Results: The mean age of the children (n:22) was 11.0 ± 4.5 (5.4 – 17.8). There was no statistically significant difference between the genders (45.5 % of girls, 54.5 % of boys) ( p> 0.05). The majority of girls (60 %) were in primary school and the boys (58.3 %) were in high school. Sixty-three point seven percent of the patients had anxiety disorder (n=14), 36.3 % had disruptive behaviour disorder (n=8), 13.6 % had mood disorder (n=3), 9 % had adjustment disorder (n=2).Conclusion: Refusing to attend school significantly affects the social and academic aspects of the child’s life. Managing of this problem is important for the family and the school staff. The factors underlying this behavior should be investigated in detail and existing psychopathology should be treated.

Keywords

• Adolescent, Child, School refusal behavior

Çocuk ve ergenlerde okul reddi davranışının nedenlerinin incelenmesi

Abstract

Amaç: Bu çalışmada, okul reddi davranışı nedeniyle çocuk ve
ergen psikiyatrisi kliniğine getirilen çocuk ve ergenlerde, okul reddi
nedenlerinin ve varsa altta yatan psikopatolojilerinin araştırılması
amaçlanmıştır.
Hastalar ve Yöntem: Tekirdağ Devlet Hastanesi, Çocuk ve
Ergen Ruh Sağlığı ve Hastalıkları Polikliniği’ne 15.01.2011 –
15.01.2012 tarihleri arasında okul reddi davranışı nedeniyle
başvuran çocuk ve ergenlerin dosya bilgileri geriye dönük olarak
incelenmiştir. Olguların sosyodemografik özelliklerine ve Mental
Bozuklukların Tanısal ve Sayısal El Kitabı, 4. baskı (DSM IV)
kriterlerine göre psikopatolojilerine odaklanılmıştır.
Bulgular: Okul reddi davranışı olan çocuk ve ergenlerin
(n=22) yaş ortalaması 11,0 ± 4,5 (5,4 – 17,8) olup, cinsiyetler arası
istatistiksel olarak anlamlı bir fark saptanmamıştır (%45,5 kız,
%54,5 erkek) ( p> 0,05). Okul reddi davranışı gösteren kız
çocukların çoğunluğunun (% 60) ilkokul döneminde, erkeklerin
ise (%58,3) lise döneminde olduğu görülmüştür. Okul reddi
davranışı olan çocukların % 63,7’si (n=14) anksiyete bozukluğu,
% 36,3’ü (n=8) yıkıcı davranış bozukluğu, % 13,6’sı (n=3)
duygudurum bozukluğu ve % 9’u (n=2) uyum bozukluğu tanılarını
almıştır.
Sonuç: Okul reddi davranışı, sosyal ve akademik açıdan
çocukların hayatını önemli ölçüde etkilemesi, aile ve okul
yönetimini oldukça zorlaması nedeniyle önemle ele alınması
gereken bir konudur. Bu neden ile, okul reddi davranışının altında
yatan etkenlerin detaylı olarak araştırılması ve mevcut
psikopatolojinin tedavi edilmesi gerekir.

Keywords

• Çocuk, Ergen, Okul reddi davranışı

References

1. Kearney CA. Forms and functions of school refusal behavior in youth: An empirical analysis of absenteeism severity. J Child Psychol Psychiatry 2007;48:53–61. doi: 10.1111/j.1469-7610.2006.01634.x
2. Kearney CA, Albano AM. The functional profiles of school refusal behavior: Diagnostic aspects. Behav Modif 2004;28:147–61. doi: 1177/0145445503259263
3. Evans LD. Functional school refusal subtypes: Anxiety, avoidence and malingering. Psychol Sch 2000;37:183-91. doi: 10.1002/(SICI)15206807(200003)37:2<183::AID-PITS9>3.0.CO;2-5
4. Berg I, Nichols K, Pritchard C. School phobia: Its classification and relationship to dependency. J Child Psychol Psychiatry 1969;10:123– doi: 10.1111/j.1469-7610.1969.tb02074.x
5. Alexander KL, Entwisle DR, Kabbani NS. The dropout process in life course perspective: Early risk factors at home and school. Teach Coll Rec 2001;103:760–822.
6. Fremont WP. School refusal in children and adolescents. Am Fam Physician 2003;68:1555-60.
7. Flakierska PN, Lindstrom M, Gillberg C. School phobia with separation anxiety disorder: a comparative 20- to 29-year followup study of 35 school refusers. Compr Psychiatry 1997;38:17-22. doi:1016/S0010-440X(97)90048-1
8. Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, Dördüncü Baskı (DSM-IV) . Çev. ed.: E Köroğlu. Ankara: Hekimler Yayın Birliği, 1995.

9. Kearney CA.School refusal behavior in youth: A Functional Approach to Assessment and Treatment. Washington. DC: American Psychological Association, 2001.
10. Pina AA, Zerr AA, Gonzales NA, Ortiz CD. Psychosocial interventions for school refusal behavior in children and adolescents. Child Dev Perspect 2009;3:11–20. doi: 10.1111/j.1750-8606.2008.00070.x
11. Heyne D, King NJ, Tonge BJ, Cooper H. School refusal: Epidemiology and management. Paediatr Drugs 2001;3:719-32. doi:2165/00128072-200103100-00002
12. Nishida A, Sugiyama S, Aoki S, Kuroda S. Characteristics and outcomes of school refusal in Hiroshima, Japan: proposals for network therapy. Acta Med Okayama 2004;58:241-9.
13. Beidas RS, Crawley SA, Mychailyszyn MP. Cognitive-behavioral treatment of anxious youth with comorbid school refusal: Clinical presentation and treatment response. Psychol Topics 2010;19:255-71.
14. Bahalı K, Tahiroğlu AY. Okul reddi: klinik özellikler, tanı ve tedavi. Psikiyatride Güncel Yaklaşımlar 2010;2:362-83.
15. Özcan Ö, Kılınç BG, Aysev A. Okul korkusu yakınması olan çocukların ana babalarında ruhsal bozukluklar. Turk Psikiyatri Derg 2006;17:173
16. Masi G, Mucci M, Millepiedi S. Separation anxiety disorder in children and adolescents: Epidemiology, diagnosis and management. CNS Drugs 2001;15:93-104. doi: 10.2165/00023210-200115020-00002
17. Christopher A, Kearney CA, Bensaheb A. School absenteeism and school refusal behavior: A review and suggestions for school-based health professionals. J Sch Health 2006;76:3-7. doi: 10.1111/j.1746152006.00060.x
18. Turkbay T, Sohmen T. Psychopathology in parents of children with school phobia. Turk J Child Adolesc Ment Health 2001; 8:77-84.
19. Ingul JM, Nordahl HM. Anxiety as a risk factor for school absenteeism: what differentiates anxious school attenders from non-attenders? Ann Gen Psychiatry 2013;12:25-33. doi:10.1186/1744-859X-12-25
20. Özcan Ö, Aysev A. Okul fobisi olan çocuklarda ruhsal bozuklukların sıklığının araştırılması. Inonu Univ Tip Fak Derg 2009;16:13-7.
21. Wood JJ, Lynne SD, Langer DA, et al. School attendance problems and youth psychopathology: Structural cross-lagged regression models in three longitudinal datasets. Child Dev 2012;83:351–66. doi 1111/j.1467-8624.2011.01677.x
22. Fernando SM, Perera H. School refusal: behavioural and diagnostic profiles of a clinical sample. SL J Psychiatry 2012;3:10-3. doi:10.4038/ sljpsyc.v3i1.4453
23. Kashikar-Zuck S, Johnston M, Ting TV, et al. Relationship between achool absenteeism and depressive symptoms among adolescents with juvenile fibromyalgia. J Pediatr Psychol 2010;35:996–1004. doi: 1093/jpepsy/jsq020
24. Prabhuswamy M, Srinath S, Girimaji S, Seshadri S. Outcome of children with school refusal. Indian J Pediatr 2007;74:375-9. doi:1007/s12098-007-0063-5
25. Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry 2003;42:797-807. doi:10.1097/01.CHI.0000046865.56865.79
26. Hersov L. School refusal. In: Rutter M, Hersov L, editors. Child and Adolescent Psychiatry: Modern Approaches. 2nd Ed. Oxford: Blackwell, 1985:382-9.
27. Bernstein GA, Garfinkel BD. Pedigrees, functioning and psychopathology in families of school phobic children. Am J Psychiatry 1988;145:70-4.
28. Bernstein GA, Borchardt CM. School refusal: family constellation and family functioning. J Anxiety Disord 1996;10:1-19. doi:10.1016/08876185(95)00031-3
29. Bahali K, Tahiroglu AY, Avci A, Seydaoglu G. Parental psychological symptoms and familial risk factors of children and adolescents who exhibit school refusal. East Asian Arch Psychiatry 2011;21:164-9.
30. İlköğretim ve Eğitim Kanunu ile Bazı Kanunlarda Değişiklik Yapılmasına Dair Kanun. 11 Nisan 2012 Çarşamba, Remi Gazete, sayı 282 http://www.resmigazete .gov.tr/eskiler /2012/04/20120411-8. htm// adresinden 20.06.2013 tarihinde indirildi.