Perfiles de rechazo escolar: Identificación y comparación entre adolescentes ecuatorianos y chilenos / School Refusal Behavior Profiles: Identification and Comparison Between Ecuadorian and Chilean Adolescent

Resumen La relevancia psicológica, social y educativa del presente estudio reside en la escasez de trabajos previos que hayan evaluado el rechazo escolar en Latinoamérica y las elevadas tasas de deserción a las que se enfrentan en esta región. El objetivo de esta investigación consistió en examinar las diferencias en las puntuaciones medias de rechazo escolar y la formación de perfiles en adolescentes ecuatorianos y chilenos. Un total de 4266 estudiantes, entre 13 y 17 años de edad, procedentes de Ecuador (. = 14.83; SD = 1.86) y Chile (. = 15.23; SD = 1.26) fueron seleccionados mediante un muestreo aleatorio por conglomerados. El instrumento empleado para evaluar el rechazo escolar fue la School Refusal Assessment Scale-Revised. Las puntuaciones medias de rechazo escolar para Ecuador y Chile revelaron diferencias estadísticamente significativas de pequeña magnitud. Entre los estudiantes chilenos se registraron puntuaciones medias más altas de rechazo escolar, con el fin de captar la atención de sus seres queridos y obtener reforzadores tangibles externos a la escuela, en comparación con sus iguales procedentes de Ecuador. Los análisis de conglomerados confirmaron cuatro perfiles de rechazo escolar en ambos países: Rechazo Escolar Bajo, Rechazo Escolar Alto, Rechazo Escolar Ansioso y Rechazo Escolar Absentista. A pesar de que los adolescentes chilenos obtuvieron puntuaciones medias significativamente más altas que los ecuatorianos en algunas dimensiones del rechazo escolar, los resultados revelaron una pequeña variabilidad entre los perfiles de rechazo escolar encontrados en ambos países. Los resultados obtenidos se discuten atendiendo a las características culturales definitorias de cada uno de estos países.

Abstract School refusal behavior is defined as any child or youth's difficulty to attend classes or to remain in the school. This behavior could be based or not on anxiety and prevalence rates from 5 to 28 % if it is considered any type of rejection towards the school. Adolescents demonstrating school refusal behaviors are very likely to demonstrate poorer academic performance, more stress, behavior problems and family conflicts. The psychological, social and educational relevance of the present study is due to the scarce of previous studies that have evaluated the school refusal behavior in Latin America and the high dropout rates that they face in this region. This study is focused on two countries, Ecuador and Chile, in order to identify possible differences regarding school refusal behavior scores between adolescents in both countries. The aim of this investigation was to examine the mean differences scores on school refusal behavior and the formation of school refusal behavior profiles in Ecuadorian and Chilean adolescents to determine whether these results differ from one another based on the geographical origin. In this study participated a total of 4266 students aged between 13 and 17 years old from Ecuador (. = 14.83, SD = 1.86; N = 1588) and Chile (. = 15.23; SD = 1.26; N = 2678). These students were selected by cluster random sampling. The measure used to assess the school refusal behavior was the School Refusal Assessment Scale-Revised (SRAS-R). The SRAS-R is a self-report measure that assesses the relative strength of four proposed functions, or maintaining variables, of school refusal behavior: Factor I. Avoidance of school-based stimuli that provoke Negative Affectivity; Factor II. Escape from aversive Social/Evaluative situations at school; Factor III. Pursuit of Attention from Significant others; and Factor IV. Pursuit of Tangible Reinforcement outside of school. The SRAS-R was administered during the school day (a session of approximately 20 minutes) in groups who completed the scale anonymously in accordance with the ethical standards and also emphasizing the voluntary nature of the test. Regarding the results, mean differences scores on school refusal behavior revealed statistically significant differences of small magnitude with Chilean students reaching higher mean scores in school refusal behavior in order to pursuit the attention from significant others and to obtain tangible reinforces external to the school, in comparison with their equals from Ecuador. Cluster analysis confirmed four school refusal profiles in both countries: Low School Refusal Behavior (characterized by low school refusal behavior scores for the four factors of the SRAS-R), High School Refusal Behavior (characterized by high school refusal behavior scores for the four factors of the SRAS-R), Anxious School Refusal Behavior (profile that combines high scores on the first three factors of the SRAS-R and moderate scores for the fourth) and Absentee School Refusal Behavior (profile that combines moderate levels for the first three factors of the SRAS-R but high in the fourth factor). The results revealed a small variability between the school refusal behavior profiles across the countries. However, Chilean adolescents scored significantly higher than Ecuadorians in school refusal based on the search for tangible external reinforcements. The results of this research supported a low variability of the findings according to the country. The generalization of these results supports the transcultural validity of the SRAS-R and emphasizes that Ecuador and Chile share a similar situation regarding school refusal behavior. Some limitations of this work are considered, and they are proposed as future lines of research. To conclude, the results are discussed taking into account the defining cultural characteristics of each country.

School refusal, depression and suicidality in an adolescent girl- the interplay of stress and vulnerability: a case report

The stress vulnerability model emphasizes the interplay of genetic vulnerability, personal characteristics and psychosocial factors in the causation of mental illness. The index case highlights the genesis of psychiatric illness in an adolescent female with a family history of bipolar disorder and substance dependence leading to impaired family interaction and family dynamics. Individual psychotherapy, family therapy and pharmacological management proved beneficial in the index case.

Kampo Therapies for Children Difficult to Attend School who Were Presenting Somatic Complaints / 日本東洋医学雑誌

We experienced 8 cases of children who presented with somatic complaints and found it difficult to attend school successfully treated with Kampo medicine. We evaluated them objectively by using the evaluation scale in the guideline for medical care of school refusal. Four cases were orthostatic dysregulation, 2 cases were migraine, 1 case was involuntary movement in upper abdomen and the other case was autonomic dysfunction. Kampo medicines were selected according to conventional method, so-called sho. Among 8 cases, 5 cases had a major response, 2 cases had a minor response and one case had no beneficial response. These results suggest that Kampo therapy can be effective therapeutic means. Kampo therapy is quite personalized and beneficial especially for children who find it difficult to attend school and need individualized care. This is the first report evaluating many cases objectively by using the evaluation scale and there have been no reports similar to ours. We have to continue to enlighten general pediatricians about the effectiveness of Kampo therapy.

Recusa Escolar: um Estudo de Caso em Ludoterapia Comportamental / School Refusal: a Case Study in Behavioral Play Therapy / Rechazo a la Escuela: un Estudio de Caso en Ludoterapia del Comportamiento

Resumo Recusa Escolar é o termo que refere-se à dificuldade do estudante (criança ou adolescente) em permanecer total ou parcialmente no ambiente escolar, gerando angústia e sofrimento. Ludoterapia comportamental foi utilizada no atendimento de Rita, uma menina (oito anos) que recusava ir à escola. O atendimento consistiu em avaliação (entrevistas e observação) e intervenções (alteração do padrão de brincar e orientações aos pais). Rita apresentou mudanças em termos de complexidade do lúdico e aceitação da escola. Teoria da motivação de Dember e Earl foi utilizada para explicar as escolhas lúdicas na direção hipotetizada; foi discutida a carência de detalhamento sobre a tomada de decisão em ludoterapia comportamental. É sugerido um modelo de tomada de decisão clínica que descreva como o psicólogo analisa as interações da criança com seu ambiente. Tal modelo de tomada de decisão deve ser capaz de incluir as características principais do conceito de lúdico presentes na teoria de Dember-Earl....(AU)

Abstract “School refusal” is the term that is used to express students (child or adolescent) struggling with staying wholly or partly within the school environment, generating anguish and suffering. Behavioral Play Therapy was used to treat Rita, a girl (8 years old) who refused to go to school. Treatment consisted of assessment (interviews and observation) and interventions (change in the pattern of play and guidelines to parents). Rita showed changes in the complexity of play and agreed to go to school. The Motivation Theory by Dember and Earl was used to explain ludic choices in the hypothesized direction; the lack of details on the decision making in Behavioral Play Therapy was also discussed. A model of clinical decision-making that describes how the psychologist analyzes the child’s interactions with his environment is suggested. This decision-making model should be able to include the main features of the concept of play presented by Dember and Earl in their theory....(AU)

Resumen “Rechazo a la escuela” es el término que se utiliza para denotar la dificultad del alumno (niño o adolescente) para permanecer total o parcialmente en el ámbito escolar, generando angustia y sufrimiento. La ludoterapia del comportamiento se utilizó para tratar a Rita, una niña (8 años) que se negaba a ir a la escuela. El tratamiento consistió en una evaluación (entrevistas y observación) y algunas intervenciones (cambio en el patrón de juego y directrices para los padres). La niña mostró un cambio en el nivel de complejidad del juego y aceptó ir a la escuela. La Teoría de la Motivación de Dember y Earl se utilizó para explicar las opciones lúdicas empleadas en la dirección hipotética; se señaló la falta de detalle en la toma de decisiones en ludoterapia del comportamiento. Se sugiere un modelo de toma de decisiones clínicas que describa cómo el psicólogo analiza las interacciones del niño con su entorno. Este modelo de toma de decisiones debe ser capaz de incluir las principales características del concepto de juego presente en la teoría Dember-Earl....(AU)

Development of the School Refusal Behavior Questionaire for Children / 中国心理卫生杂志

Objective:To develop a Child School Refusal Behavior Rating Scale(SRBQC)and examine its reliabilities and validities. Methods:Based on literature review,interview,and open-ended questionnaire,124 origi-nal items were developed. Totally 573 students were recruited to complete the test version. After item and explorato-ry factor analysis,the formal scale-SRBQC was got. Totally 946 students were tested with formal version for further confirmatory factor analysis,internal consistency reliability and composite reliability. The criterion validity was test-ed with the Social Anxiety Scale for Child (SASC). Totally 41 students were retested for test-retest reliability with 2 weeks interval. Results:The formal version of SRBQC included 19 items. Exploratory factor analysis generated 5 factors which account 59. 793% of the variance in all,the results of confirmatory factor analysis showed that SR-BQC had a good construct validity (χ2 =329. 51,df=142,χ2/df=2. 32,CFI=0. 97,GFI=0. 93,IFI=0. 97,NFI=0. 95,NNFI=0. 96,RMSEA=0. 05,SRMR=0. 05). The SRBQC scores were positively correlated with the SASC scores (r=0. 18-0. 34,Ps<0. 05 ). The Cronbach coefficients were 0. 87 for the total questionnaire and 0. 55 -0. 78 for the 5 factors. The test-retest reliabilities were 0. 84 for the total questionnaire and 0. 66 -0. 78 for the 5 factors. Conclusion:The reliability and validity of the School Refusal Bevior Questionaire for Children(SRBQC) meet the needs of psychometrics.

Parental Issues Contributing To School Refusal: A Case Report

Objective: This case report aims to highlight the importance of parental contribution to the school refusal problem. Methods: We report a case of a 9-year old boy who presented with school refusal behaviour. Results: There was no psychiatry diagnosis made in this patient. Parental issues such as ineffective and inconsistent parenting, and parental marital disharmony contribute significantly to the school refusal behaviour. Conclusion: Parents in particular are important team players in the management of school refusal. Parental issues need to be explored and managed accordingly to ensure good outcome.

School refusal reason inventory for children and adolescents: development, reliability and validity / 中华行为医学与脑科学杂志

ObjectiveTo develop school refusal reason inventory (SRRI)for children and adolescents in China and assess its reliability and validity.MethodsThe primary SSRI was made based on clinical interviews and literatures.Pretest was carried out in a small sample from a clinic.Then the final SSRI was developed after qualitative analysis and item analysis.SRRI,the Screen for Child Anxiety Related Emotional Disorders(SCARED) and Child Depression Inventory(CDI) were administered to school refusers from 7 schools in Shenyang.All the schools were selected from Shenyang City and its countryside by cluster sampling.Some of the students were retested after one month.Descriptive statistics and exploratory factor analysis were carried out to examine the reliability and validity of SRRI based on all the data.Results Item analysis indicated correlation coefficients between all the items and the total marks were higher than 0.3,and they were significant.All the critical ratios of the items were higher than 0.3.The 43 items were divided into six factors ( educational modality,factor of teachers,relationship with classmates,separated anxiety,study attitude and study environment) by exploratory factor analysis.The factor loading values were 0.372 ～0.848.The cronbach's α of each factor was 0.827,0.831,0.759,0.623,0.821 and 0.808.Retest reliability was 0.644 (P ＜ 0.01 ).Its correlation coefficient with SCARED was 0.452 and 0.548 with CDI.ConclusionAccording to Chinese cultural back ground,the SSRI corresponds with psychometric indexes.There are good reliability and validity.It is helpful to understand the reasons of school refusal behavior in children and adolescents.

Exploration of factors to child and adolescent with school refusal behavior / 中华行为医学与脑科学杂志

Objective To explore the related factors of school refusal behavior in child and adolescent.Methods Investigated 141 students who had school refusal behavior in the department of psychiatry as the case group. 109 students were chosen randomly from 3 different grades in different schools as the control group. Two experienced psychiatrists made diagnosis according to DSM-Ⅳ criteria, the case group completed the direct factor investigation of School Refusal and the general condition questionnaires. The control group completed the general condition questionnaire only. Results 61 (43.7%) of the case group were diagnosed mental disorder according to DSM-Ⅳ ,17(28.91% ) of them were diagnosed mood disorder, which was the most in all kinds of mental disorder in case group. The results showed that age (P = 0.0003 ), location (P = 0. 035 ) and family income (P ＜ 0. 01 )were the most important factors for school refusal behavior in child and adolescent. The opinions of child and parent on the school refusal factors were quite different (P ＜ 0. 05 ). The former three direct reasons of school refusal were study pressure (6.47%) ,much more examinations and homework( 6.03% ) ,and willing to stay at home only (5.63%). Conclusion Mental disorder is the main causation of school refusal behavior. Age, location and family income are related closely to school refusal behavior. Study pressure, peer difficulty and poor parent-child relationship are direct factors of school refusal behavior.

Environment and Psychological Status in School Refusing Adolescents / 신경정신의학

OBJECTIVES: School refusal can result from various causes; temperament, familial influences, and school experiences have been identified. This study was to compare family, school and psychological functioning in school-refusing adolescents and non-refusing ones. METHODS: Twenty-four school refusing outpatients aged 13-17 years were evaluated from May, 1998 to January, 1999. They completed self-report questionnaires, including Parent Bonding Instrument, Family Environment Scale, Index of Marital Satisfaction, Scales for School-related Distress, Center-for Epidemiological Studies-Depression, The Failure and Criticism Factor of Fear Survey Schedule from Children-revised. Their scores were compared with nonrefusers. RESULTS: The results were as follows: 1) School refusers perceived their family as more independence and achievement-oriented than nonrefusers. 2) School refusers did not differ significantly from nonrefusers in school-related distress. 3) School refusers had more depression than nonrefusers. 4) School refusers claimed more fear of having to go to school, and having to stay after school than nonrefusers. On the other hand, nonrefusers expressed greater apprehension about situations such as Being called on by the teacher, Getting poor grades, Failing a test, and Taking a test. CONCLUSION: The results suggested two postulated mechanisms of school refusals (overprotection and demanding of independence of parents) and possible causes of each result were discussed.

A case of child seperation anxiety disorder with severe weight loss and school refusal / 영남의대학술지

Seperation anxiety disorder(SAD) is characterized by excessive anxiety about being apart from the individuals to whom a child is most attached. We noticed a case of a 13 year old boy's SAD with symptoms of nausea/vomiting, stomachache, school refusal, and severe weight loss. His mother was overanxious and overdependent but her'dependency was frustrated due to family problem. We investigated this case from a point of developmental aspect and family dynamics and tried to attempt therapeutic approach.