[Risk Factors for School Based Anxiety: An Empirical Study]. / Ergebnisse einer quantitativen Untersuchung an Schulen zu Risikofaktoren bei Schulangst.

Risk Factors for School Based Anxiety: An Empirical Study Abstract. This article deals with the phenomenon of school absenteeism, with a special focus on school refusal behavior and the self-efficacy of students. Risk factors may lead to avoidance and end up in disintegrative processes. For this reason, this quantitative study investigates potential influences on school absenteeism, addressing the hypothesis that anxiety in school and lower self-efficacy may lead to school-attendance problems. To this end, we interviewed students at schools in Lower Saxony.

School Refusal Behavior: Role of Personality Styles, Social Functioning, and Psychiatric Symptoms in a Sample of Adolescent Help-Seekers.

Objective: School refusal (SR) in adolescence represents an important risk factor associated with adverse consequences. Although many clinical features of adolescents presenting with SR have been studied, the relationship between SR and personality styles-specifically in the help-seeking population-remains unclear. The present study aimed at investigating differences in personality style, adaptive functioning, and symptomology between Italian help-seeking adolescents who refused (SRa) and did not refuse (non-SRa) to attend school, to provide preliminary evidence of personality patterns in adolescent help-seekers presenting with SR. Method: The study sample was comprised of 103 help-seeking adolescents (54 female, 49 male) aged 14-18 years. Participants were recruited during their first clinical visit and evaluated using the Shedler and Westen Assessment Procedure - Adolescent version (SWAP-A), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Maniac Rating Scale (MRS), the Global Assessment of Functioning (GAF), the Global Functioning Social Scale (GFSS), and the Global Functioning Role Scale (GFRS). Differences in the studied variables between SRa and non-SRa were measured and a multivariable logistic regression analysis was performed to identify possible predictive factors of SR. Results: SRa presented with more anxious and depressive symptomatology and worse social functioning compared to non-SRa. With respect to personality, SRa displayed more schizoid and schizotypal characteristics and fewer adaptive and healthy personality features. Irrespective of any differences between groups, SRa were largely characterized by inhibited-self-constricted and emotionally dysregulated personality styles. Conclusions: The results suggest that personality styles are clinical features that may contribute to broadening our knowledge of SR behavior and aid in the detection of SRa, also in the help-seeking population. The findings have clinical, social, and political implications for prevention, diagnosis, and treatment, in both clinical and non-clinical settings. However, more data are needed on personality features to clarify their contribution to the more complex phenomenon of school absenteeism.

Remote Teaching and School Refusal Behavior - Lessons Learned from the COVID-19 Pandemic.

When the Norwegian government closed down schools and kindergartens in response to the increased spread of COVID-19, the use of homeschooling raised concerns about students with school refusal behavior and the school system's ability to address their special needs in these circumstances. Six students referred to the school absenteeism team were interviewed about their circumstances, using an author-developed interview. The results indicate that the students rated homeschooling as very satisfactory. Students with school refusal behavior participated in homeschooling and their attendance continued during the initial reopening of schools.

Anxiety and school absenteeism without permission among adolescents in 69 low- and middle-income countries.

Background: Anxiety disorders are common among adolescents. In high-income countries, anxiety is a known contributor to truancy and school refusal, but this association has been understudied in low- and middle-income countries (LMICs). Methods: We used complex samples analysis to examine the association between self-reported worry-induced insomnia (an indicator of anxiety) and unauthorized school absenteeism among 268,142 adolescents from 69 LMICs that participated in the Global School-based Student Health Survey (GSHS). Results: The median proportion of students who reported experiencing symptoms of anxiety most or all of the time during the previous year was 11.4% (range: 3.6%-28.2%); in 44 of the 69 countries, girls had a significantly higher prevalence of anxiety than boys. The percentage of students reporting school absence without permission during the past month was 30.2% (range: 14.7%-56.0%); in 40 countries, boys were significantly more likely than girls to report that they had missed school without permission. In 53 countries, adolescents who reported frequent anxiety were significantly more likely to miss school than adolescents reporting infrequent anxiety; in most of those countries, the association was significant for both girls and boys. Conclusion: School-based interventions that help children and adolescents learn how to manage stress and refer students with symptoms of psychiatric disorders to healthcare services that can provide formal diagnosis and clinical treatment may be useful for improving both mental health and school attendance, thus contributing to achievement of Sustainable Development Goals related to both health (SDG 3.4) and education (SDG 4.1).

Exploring different types of school refusers through latent profile analysis and school-related stress associations.

Children experience significant number of stressful situations at school during their academic years. The aims of this study were to identify school refusers groups of children through latent profile analysis and to test their associations with school-related sources and manifestation of stress. Data were obtained from 755 schoolchildren (8-11 years) from public and private schools of Alicante and Murcia (Spain), using the School Refusal Assessment Scale-Revised (SRAS-R) and the School Situation Survey (SSS). In general, positive and statistically significant correlations were identified between school refusal behavior and school-related sources and manifestations of stress. School refusers groups were derived from the combination of high and low scores in the four functional conditions assessed by the SRAS-R. "Low School Refusal Behavior Profile,""School Refusal Behavior by Positive Reinforcement Profile" and "Mixed School Refusal Behavior Profile" were identified. The percentages of children within these profiles were 47.7%, 46.6%, and 5.7%, respectively. The Mixed School Refusal Behavior Profile was the group with the highest average scores in the school-related stress factors. In contrast, the group with the lowest mean scores was the Low School Refusal Behavior Profile. By comparing the Low School Refusal Behavior Profile with the Mixed School Refusal Behavior Profile, the largest effect sizes were found. Findings are discussed from a socio-ecological perspective considering the school context conditions as key elements in the development of school refusal behaviors.

School Refusal Behavior and Aggression in Spanish Adolescents.

In order to reduce school attendance problems and aggressive behavior, it is essential to determine the relationship between both variables. The aim of this study was twofold: (1) to examine the mean differences in scores on aggression, based on school refusal behavior, and (2) to analyze the predictive capacity of high scores on aggression, based on school refusal behavior factors. The sample consisted of 1455 Spanish secondary school students, aged 13-17 (M = 14.85; SD = 1.56). The School Refusal Assessment Scale-Revised (I. Avoidance of negative affectivity, II. Escape from aversive social and/or evaluative situations, III. Pursuit of attention from significant others, and IV. Pursuit of tangible reinforcement outside of school) and the Aggression Questionnaire (I. Physical Aggression, II. Verbal Aggression, III. Anger, and IV. Hostility) were used. Results indicated that students having high levels of Physical Aggression, Verbal Aggression, Anger, and Hostility received significantly higher scores on school refusal behavior. In most cases, school refusal behavior was found to be a positive and statistically significant predictor of aggression. Students that base their school refusal on the pursuit of tangible reinforcements outside of school earned higher scores, and other functional conditions underlying school refusal behavior were found to be associated with aggression issues. The role of aggression as a risk factor for school refusal behavior is discussed.

Affective Profiles and Anxiety or Non-Anxiety-Related Reasons for School Refusal Behavior: Latent Profile Analysis in Spanish Adolescents.

Little has been studied on the relationship between affect and school problems related with attendance. This study aims to identify different affective profiles and to determine whether these profiles differ from each other based on the four functional conditions of school refusal behavior. Participants comprised 1,816 Spanish adolescents aged 15-18 years (M = 16.39; SD = 1.05). The Positive and Negative Affect Schedule for Children-Short Form and the School Refusal Assessment Scale-Revised for Children (SRAS-R-C) were administered. Latent profile analysis revealed five affective profiles: low affective profile, self-fulfilling profile, low positive affect profile, self-destructive profile, and high affective profile. The self-destructive profile revealed the highest average scores in the first three factors of the SRAS-R-C, whereas the high affective profile reached the highest average score in the fourth factor. On the contrary, the self-fulfilling profile obtained the lowest average scores in the first two factors of the SRAS-R-C, whereas the low affective profile revealed the lowest average scores in the last two factors. Findings suggest the relevance of developing more adaptative affective profiles, such as the self-fulfilling profile, which would contribute to diminishing school attendance problems.

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.

Influence of Self-Esteem and Psychiatric Diagnosis on Health-Related Quality of Life in Children and Adolescents with School Refusal Behavior.

BACKGROUND: School refusal behavior (SRB), which is the refusal to attend or remain in school, has been associated with emotional, psychological, and other behavioral problems, as well as a lower health-related quality of life (HRQOL). However, the effects of self-esteem and a psychiatric diagnosis in students with SRB on HRQOL are not yet known. Understanding these relationships could help to develop more effective therapeutic interventions. METHODS: A total of 175 young people (aged 8-18 years old) who visited our medical centers and outpatient clinics participated in the study. This comprised the SRB group (n = 70) and an age- and sex-matched control group (n = 105). Information about any psychiatric diagnosis was collected from medical records, HRQOL was measured using the J-KIDSCREEN-52, SRB was assessed using the School Refusal Assessment Scale-Revised for Japanese Attendance at School, self-esteem was measured using the Rosenberg Self-Esteem Scale, children's mental health status was measured using the Strengths and Difficulties Questionnaire, and social support was measured using the Oslo 3-item Social Support Scale. We performed between-group comparisons and multiple regression analysis. RESULTS: The SRB had a significantly lower HRQOL than the control group in several of the KIDSCREEN-52 dimensions. In the SRB group, 35.7% had chronic disease and 35.7% of their parents had health problems and were receiving treatment. The multiple regression analysis revealed that, within the SRB group, a psychiatric diagnosis was associated with a lower HRQOL. However, this was not the case for a diagnosis of autistic spectrum disorder. Self-esteem positively affected HRQOL in six dimensions of the KIDSCREEN-52 within the SRB group. CONCLUSION: Our results could inform the development of support strategies for young people with SRB. Namely, support that enhances self-esteem could be used to increase HRQOL in young people with SRB. Furthermore, the presence of psychiatric disorders should be assessed as early as possible.

Subtyping of Adolescents with School Refusal Behavior: Exploring Differences Across Profiles in Self-Concept.

Not all adolescents with school attendance problems attribute their behavior to the same causes. Knowing the subtypes of students who reject school and their relationship with new variables, such as self-concept, is an unresolved task. This study aimed to identify different school refusal behavior profiles and to determine whether these profiles differed from each other based on the scores of the eleven dimensions of self-concept (Physical appearance, Physical abilities, Parent relations, Same-sex relations, Opposite-sex relations, Honesty, Emotional stability, Self-esteem, Verbal, Math, and General school). The participants were 1315 Spanish students (57.6% male) aged 12-18 years (M = 15.21; SD = 1.74). The School Refusal Assessment Scale-Revised and the Self-Description Questionnaire II-Short Form were administered. A latent class analysis revealed four school refusal behavior profiles: Moderately High School Refusal Behavior, Moderately Low School Refusal Behavior, Mixed School Refusal Behavior and Non-School Refusal Behavior. The results indicated that the Mixed School Refusal Behavior group was the most maladaptive profile and revealed the lowest mean scores on self-concept. In contrast, Non-School Refusal and Moderately Low School Refusal Behavior groups revealed the highest scores in all dimensions of self-concept. Implications for working toward the prevention of school refusal in students with low self-concept are discussed.

Identifying Risk Profiles of School Refusal Behavior: Differences in Social Anxiety and Family Functioning Among Spanish Adolescents.

School attendance problems negatively affect students' development. This study attempted to identify different school refusal behavior profiles and to examine their relationship with three dimensions of social anxiety (fear of negative evaluation, social avoidance and distress in new situations, and social avoidance and distress that is experienced more generally in the company of peers) and the perception of family functioning. Participants included 1842 Spanish adolescents (53% girls) aged 15-18 years (M = 16.43; SD = 1.05). The School Refusal Assessment Scale-Revised (SRAS-R), the Social Anxiety Scale for Adolescents (SAS-A), and the Family APGAR Scale (APGAR: Adaptation, Partnership, Growth, Affection, and Resolve) were administered. Latent class analysis revealed four school refusal behavior profiles: non-school refusal behavior, high school refusal behavior, moderately low school refusal behavior, and moderately high school refusal behavior. Analyses of variance (ANOVA) indicated that adolescents' with the profile of high school refusal behavior showed higher scores in all the subscales of social anxiety. In contrast, the non-school refusal behavior group revealed higher scores in the perception of good family functioning, whereas the high school refusal behavior profile obtained the lowest scores in this scale. These findings suggest that students who reject school are at a higher risk of developing social anxiety problems and manifesting family conflicts. These students should be prioritized in order to attend to their needs, promoting self-help to overcome social anxiety and family problems with the purpose of preventing school refusal behaviors.

Child and Adolescent Social Adaptive Functioning Scale: Factorial Invariance, Latent Mean Differences, and Its Impact on School Refusal Behavior in Spanish Children.

This study aims to examine the factorial invariance and latent mean differences across gender of the Spanish version of the Child and Adolescent Social Adaptive Functioning Scale (Study 1) and to value the function of social functioning as a protective ability of school refusal behavior (Study 2). Participants were Spanish students aged 8-12 years carefully chosen by simple random cluster, 345 for the first study (M = 9.17; SD = 1.03) and 1,032 students for the second study (M = 10.02; SD = 1.77). The measures used were the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) and the School Refusal Assessment Scale-Revised (SRAS-R). Results about the validation of the scale supported the model proposed in this study for the CASAFS, with 15 items and a four-factor structure (school performance, peer relationships, family relationships, and home duties/self-care). Findings revealed invariance across gender for this model and good internal consistency levels were exhibited in each of the four dimensions of the CASAFS (0.76, 0.72, 0.74, and 0.71). Latent mean differences did not report differences between boys and girls. Regarding the second study, the social functioning acted as a protective factor of school refusal behavior by negatively and significantly predicting high scores in school refusal behavior due to anxiety symptoms or feelings of negative affect linked to the obligation to attend school. Opposite results were found for those students who justify their refusal to attend school in pursuing tangible reinforcements outside the school setting. These findings strengthen the reliability and validity of the CASAFS and the idea of social functioning as a person's ability which could prevent school refusal behavior is discussed.

Latent Class Analysis of School Refusal Behavior and Its Relationship With Cyberbullying During Adolescence.

Cyberbullying is a common relational problem having negative repercussions on the academic performance of adolescents. Numerous questions remain to be answered with regard to the relationship between cyberbullying and school refusal behavior. This study examines school refusal profiles (measured by School Refusal Assessment Scale-Revised) and assesses whether these profiles vary with respect to the level of victimization, aggression, aggression-victimization, and observation of cyberbullying (measured with the Screening of Harassment among Peers). The sample consisted of 1,102 Spanish high school students, aged 12-18 (M = 14.30, SD = 1.71). Latent class analysis revealed three school refusal behavior profiles: non-school refusal behavior, school refusal behavior by negative reinforcements (oriented to the avoidance of social evaluation and negative affectivity in school situations), and school refusal behavior by positive reinforcements (oriented to obtaining the attention of others with significant or tangible reinforcements). The ANOVA found statistically significant differences for all cyberbullying behaviors. Students with school refusal by negative reinforcements had significantly higher mean scores as compared to the other profiles in victimization, aggression, aggression-victimization, and observation behaviors, while the levels of cyberbullying were similar between students without school refusal and students with school refusal behavior by positive reinforcements. These findings underscore the need to consider priority interventions to prevent cyberbullying in children who refuse school for the purpose of avoiding situations of anxiety and negative emotions.

Individual characteristics of students with autism spectrum disorders and school refusal behavior.

This study compared social, executive, emotional, and behavioral characteristics of students with autism spectrum disorder who did and did not display school refusal behavior. The participants were 62 students with autism spectrum disorder without intellectual disability aged 9-16 years attending inclusive schools. Parents first completed questionnaires assessing social and executive functioning as well as emotional and behavioral problems. They then documented their child's school refusal behavior for a period of 20 days. Compared to students without school refusal behavior (n = 29), students with school refusal behavior (n = 33) were significantly less socially motivated; displayed more deficits in initiating tasks or activities, in generating ideas, responses, or problem-solving strategies; and displayed more withdrawn and depressive symptoms. Assessing social and executive functioning, as well as emotional problems, may help professionals provide tailored interventions for students with autism spectrum disorder and school refusal behavior, which will further be valuable in recognizing characteristics associated with school refusal behavior.

[Adolescent sleep disorders associated with school absenteeism: The child and adolescent psychiatrist is often crucial for effective management in sleep consultation]. / Troubles du sommeil de l'adolescent associés à un absentéisme scolaire : le pédopsychiatre est souvent déterminant pour une prise en charge efficace en consultation de somnologie.

INTRODUCTION: Adolescent sleep is characterized by a physiological delayed sleep phase disorder frequently exacerbated by the intensive use of information and communication technologies. The sleep restriction thus induced during schooling has consequences on the physical and psychological health of the adolescent. On the other hand, the sleep complaint may correspond to psychiatric disorders in the adolescent. Thus, when this complaint is associated with school absenteeism, the management of sleep alone is often insufficient. In order to understand the reason for this inefficiency, we wanted to better characterize the profile of these adolescents. METHOD: We have developed a somnological and psychiatric "screening kit" resulting in a management decision tree. This kit was tested in 2017 as part of joint consultations at the Lyon Sleep Center in adolescents who presented a complaint of sleepiness or insomnia associated with school absenteeism. RESULTS: These preliminary results on 11 patients show the predominance of a delayed sleep phase syndrome or an absence of sleep diagnosis associated in more than 90 % of cases with anxiety-depressive difficulties ranging from the mood depressive disorder to the school refusal behavior and underlying anxiety disorders. Somatization is also common. CONCLUSION: These first data seem to confirm the need for a child and adolescent psychiatric assessment to deal with the psychological difficulties of these adolescents in parallel with their sleep complaint so as to offer them the best chances of improvement, re-schooling and social insertion.

Functional profiles of school refusal behavior and their relationship with depression, anxiety, and stress.

Negative emotional states are common among youth with problematic school absenteeism, but little is known about their presence across different school refusal behavior profiles. The aim of this study was twofold: to identify different cluster solutions across functional profiles of school refusal behavior (I. Avoidance of Negative Affectivity, II. Escape from Social and/or Evaluative Situations, III. Pursuit of Attention, and IV. Pursuit of Tangible Reinforcement) and to determine whether these profiles differ from each other based on dimensions of depression, anxiety, and stress. The sample consisted of 1582 Ecuadorian adolescents aged 12-18 years (M = 14.83; SD = 1.86) who completed the School Refusal Assessment Scale-Revised (SRAS-R) and the Depression, Anxiety and Stress Scale-21 (DASS-21). Latent class analysis revealed three school refusal profiles: non-school refusal behavior, school refusal behavior by tangible reinforcements, and school refusal behavior by multiple reinforcements. The last group displayed the most maladaptive profile and revealed highest mean scores on the three dimensions of the DASS-21 compared to other groups. To promote mental health in this group it is a necessary goal due to their link with these negative emotional states. Prevention measures to strengthen emotional self-regulation should be considered in these cases.

A Systematic Review of Pharmacologic Treatments for School Refusal Behavior.

OBJECTIVE: School refusal is an important pediatric problem with significant negative short- and long-term outcomes. Specific psychosocial treatments appear effective in reducing school refusal, but many children do not respond to these treatments. Although systematic reviews have examined the efficacy of psychological interventions for school refusal, no systematic reviews on pharmacological interventions exist. METHODS: We conducted a comprehensive literature search of MEDLINE, PsycINFO, Scopus, and Embase for randomized controlled trials (RCTs) or quasi-experimental pharmacologic trials in children and adolescents with school refusal reported in English or Spanish until July 1, 2017. Two authors screened study titles and abstracts for eligibility. Data regarding the population, intervention, comparison, and outcomes for each trial were extracted and reported. Effect sizes for school attendance are presented. RESULTS: The search identified 6 articles, including 7 trials (6 RCTs and 1 open label) and 306 youths. Pharmacologic treatments investigated for school refusal included antidepressants (imipramine, clomipramine, and fluoxetine) and benzodiazepines (alprazolam). All pharmacotherapies studied had pretreatment to posttreatment improvements on school refusal, depression, and anxiety symptoms. However, included trials were severely underpowered and did not demonstrate significant improvement compared to placebo. CONCLUSIONS: Data regarding pharmacological treatments for school refusal are sparse. Most trials in this area were conducted before development of newer antidepressants, were underpowered, and have significant methodological limitations that are characteristic of the time in which they were conducted. This systematic review highlights the need for more trials with newer pharmacologic agents, larger sample sizes, and improved systematic assessments of school refusal and comorbidities. School refusal represents an important functional outcome for many children, especially those with anxiety and depression. Future pharmacologic studies of anxiety and depression in children may benefit from incorporating specific school refusal measures as secondary outcomes.

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.

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.