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School Refusal: Clinical Features, Diagnosis and Treatment

Year 2010, Volume: 2 Issue: 3, 362 - 383, 01.09.2010

Abstract

Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child's inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child's academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of psychiatric disorders or that they are more likely to require psychological assistance. It is for these reasons that the treatment of school refusal is increasingly gaining impor-tance. The major aim of the treatment is to help the child return to school at the shortest time possible. The treatment should be carried out in cooperation with the child's parents and the school personnel. A widely accepted approach to the treatment of school refusal is one that is concerned with the application of a multi-faceted treatment. Psychosocial and psychopharmacological approaches constitute the crucial parts of the therapeutic process. Today, cognitive behaviour therapy and medication are the most frequently employed approaches in the treatment of school refusal.

References

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  • Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry 2003; 42:797-807.
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  • Kearney CA, Silverman WK. Family environment of youngsters with school refusal behavior: a synopsis with implications for assessment and treatment. Am J Fam Ther 1995; 23:59–72.
  • Gordon DA, Young RD. School phobia: a discussion of aetiology, treatment and evaluation. Psychol Rep 1976; 39:783-804.
  • Galloway D. Truants and other absentees. J Child Psychol Psychiatry 1983; 24:607- 611.
  • Berg I. School avoidance, school phobia, and truancy. In Child and Adolescent Psychiatry: A Comprehensive Textbook (Ed M Lewis): 1104-1110. Baltimore, Williams and Wilkins, 1996.
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  • Kahn JH, Nursten JP. School refusal: a comprehensive view of school phobia and other failures of school attendance. Am J Orthopsychiatry 1962; 32:707-718.
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Okul Reddi: Klinik Özellikler, Tanı ve Tedavi

Year 2010, Volume: 2 Issue: 3, 362 - 383, 01.09.2010

Abstract

Toplumun eğitim ve okula devam etme gibi beklentilerini karşılamak için çocuklar düzenli ve gönüllü olarak okula gitmektedir. Okula devam etme yasalar ile de zorunlu hale getirilmiştir. Bununla birlikte, bazı çocuklar için okula gitmek beklenenin ötesinde sıkıntı verici bir durumdur. Bu çocuklar okula devam etmede güçlük çekmekte ve/veya okula gitmeyi reddetmektedir. Günümüzde okul reddi, çocukların anksiyete ve depresyon gibi duygusal sorunlar nedeni ile okula devam edememesi olarak tanımlanmaktadır. Okul reddinin yaygınlığı tüm okul çağındaki çocuklar için yaklaşık % 1 ve kliniğe başvuran tüm çocuklar için % 5 olarak bildirilmektedir. Okul reddi erkek ve kız çocuklarda eşit oranda görülmektedir. Okul hayatının herhangi bir döneminde ortaya çıkabilmektedir. Okul reddinin tüm sosyoekonomik düzeylerde görülebildiği bildirilmektedir. Okul reddi klinik bir tanı olmayıp bir belirti olarak değerlendirilmektedir. Anksiyete bozuklukları başta olmak üzere birçok ruhsal bozukluğun belirtisi olabilmektedir. Ayrılma anksiyetesi bozukluğu, yaygın anksiyete bozukluğu, sosyal fobi, özgül fobi ve anksiyete ile giden uyum bozukluğu okul reddi ile birlikte en sık görülen tanılardır. Tanılarda yaşa bağlı eğilimler görülmektedir. Ayrılma anksiyetesi bozukluğu genelde yaşça daha küçük çocuklardaki okul reddi ile ilişkilendirilirken, diğer anksiyete bozuklukları özellikle de fobiler ergenlerdeki okul reddi ile ilişkilendirilmektedir. Ruhsal bozukluğu olan ebeveynlerin çocuklarında okul reddi sık görülmektedir. Bu, genetik ve çevresel faktörlerin okul reddi gelişimindeki rolünü desteklemektedir. Okul reddi bir çocuk ruh sağlığı acilidir. Kısa ve uzun dönemde olumsuz sonuçlar doğurduğu için ciddi bir sorun olarak değerlendirilmektedir. Okul reddi olan çocukların uzun süreli izlem çalışmalarında, genel toplum ya da kontrol gruplarına göre daha yüksek oranda ruhsal bozuklukların bulunduğu ya da ruhsal yardıma gereksinim duyma olasılıklarının daha yüksek olduğu gösterilmiştir. Bu nedenlerden dolayı okul reddinin tedavisi çok önem kazanmaktadır. Tedavide temel amaç çocuğun en kısa süre içerisinde okula dönmesini sağlamaktır. Tedavi ebeveyn ve okul personeli ile işbirliği içinde yürütülmelidir. Tedavide genel kabul gören yöntem çok eksenli bir tedavi yaklaşımı uygulamaktır. Psikososyal ve psikofarmakolojik yaklaşımlar tedavinin önemli ayaklarını oluşturur. Günümüzde bilişsel davranışçı terapi ve ilaç sağaltımı tedavide en sık kullanılan yaklaşımlar olarak öne çıkmaktadır.

References

  • Holzer L, Halfon O. The school refusal. Arch Pediatr 2006; 13:1252-1258.
  • Broadwin IT. A contribution to the study of truancy. Am J Orthopsychiatry 1932; 2:253-259.
  • Johnson AM, Falstein EI, Szurek SA, Svendsen M. School phobia. Am J Orthopsychiatry 1941; 11:702-711.
  • Hersov LA. Refusal to go to school. J Child Psychol Psychiatry 1960; 1:137-145.
  • King N, Bernstein GA. School refusal in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2001; 40:197–205.
  • Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry 2003; 42:797-807.
  • Bowlby J. Attachment and Loss, Separation Anxiety and Anger. New York, Basic Books, 1973.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 4th Ed. Washington, American Psychiatric Association, 1994.
  • Berg I, Nichols K, Pritchard C. School phobia: its classification and relationship to dependency. J Child Psychol Psychiatry 1969; 10:123–141.
  • Berg I. Absence from school and mental health. Br J Psychiatry 1992; 161:154–166.
  • Kearney CA, Silverman WK. Family environment of youngsters with school refusal behavior: a synopsis with implications for assessment and treatment. Am J Fam Ther 1995; 23:59–72.
  • Gordon DA, Young RD. School phobia: a discussion of aetiology, treatment and evaluation. Psychol Rep 1976; 39:783-804.
  • Galloway D. Truants and other absentees. J Child Psychol Psychiatry 1983; 24:607- 611.
  • Berg I. School avoidance, school phobia, and truancy. In Child and Adolescent Psychiatry: A Comprehensive Textbook (Ed M Lewis): 1104-1110. Baltimore, Williams and Wilkins, 1996.
  • Hersov L. School refusal. In Child and Adolescent Psychiatry: Modern Approaches, 2nd Ed. (Eds M Rutter, L Hersov): 382-389. Oxford, Blackwell, 1985.
  • Kahn JH, Nursten JP. School refusal: a comprehensive view of school phobia and other failures of school attendance. Am J Orthopsychiatry 1962; 32:707-718.
  • Last CG, Francis G. School phobia. In Advances In Clinical Child Psychology (Eds BB Lahey, AE Kazdin): 193-222. New York, Plenum Pres, 1988.
  • Burke AE, Silverman WK. The prescriptive treatment of school refusal. Clin Psychol Rev 1987; 7:353-362.
  • Last CG, Strauss CC. School refusal in anxiety-disordered children and adolescents. J Am Acad Child Adolesc Psychiatry 1990; 29:31-35.
  • Ollendick TH, Mayer JA. School phobia. In Behavioral Treatment of Anxiety Disorders (Ed SM Turner): 367-411. New York, Plenum Pressi 1984.
  • Honjo S, Kasahara Y, Ohtaka K. School refusal in Japan. Acta Paedopsychiatr 1992; 55:29-32.
  • Granell de Aldaz E, Vivas E, Gelfand DM, Feldman L. Estimating the prevalence of school refusal and school-related fears. A Venezuelan sample. J Nerv Ment Dis 1984;
  • Heyne D, King NJ, Tonge BJ, Cooper H. School refusal: Epidemiology and management. Paediatr Drugs 2001; 3:719-732.
  • Smith SL. School refusal with anxiety: A review of 63 cases. Can Psychiat Ass J 1970; 15:257-264.
  • Bahalı K, Tahiroğlu AY, Avcı A. Okul reddi olan çocuk ve ergenlerin klinik özellikleri. Anadolu Psikiyatri Dergisi 2009; 10:310-317.
  • Kearney CA, Eisen AR, Silverman WK. The legend and myth of school phobia. Sch Psychol Q 1995; 10: 65-85.
  • Last CG. Anxiety disorders in childhood and adolescence. In Internalizing Disorders in Children and Adolescents (Ed WM Reynolds): 61-106. New York, John Wiley, 1992.
  • Last CG, Francis G, Hersen M, Kazdin AE, Strauss CC. Separation anxiety and school phobia: a comparison using DSM-III criteria. Am J Psychiatry 1987; 144:653-657.
  • Hersov L. School refusal. In Child and Adolescent Psychiatry: Modern Approaches (Eds M Rutter, L Hersov): 455-486. Oxford, Blackwell, 1977.
  • Hersov L. School refusal: An overview. In Why Children Reject School Views from Seven Countries (Eds C Chiland, JG Yound): 16-41. New Haven, Yale University Press, 1990.
  • Bahalı K. Okul reddi olan çocuk ve ergenlerin ailesel özellikleri (Uzmanlık tezi). Adana, Çukurova Üniversitesi, 2008.
  • Elliott JG. School refusal: Issues of conceptualisation, assessment, and treatment. J Child Psychol Psychiat 1999; 40:1001-1012.
  • Torma S, Halsti A. Factors contributing to school phobia and truancy. Psychiatria Fennica 1975; 75:209-220.
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There are 106 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

Kayhan Bahalı This is me

Ayşegül Yolga Tahiroğlu This is me

Publication Date September 1, 2010
Published in Issue Year 2010 Volume: 2 Issue: 3

Cite

AMA Bahalı K, Tahiroğlu AY. Okul Reddi: Klinik Özellikler, Tanı ve Tedavi. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. September 2010;2(3):362-383.

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