Psychosocial Interventions for School Refusal with Primary and Secondary Students: A Systematic Review. Campbell Systematic Reviews 2015:12
Author: Maynard, Brandy R.
Date: 2015-05-04
Type: Reports - Research
Subjects: Psychological Patterns,Student Behavior,Attendance,Stress Variables,Emotional Response,Fear,Anxiety,Depression (Psychology),Intervention,Behavior Modification,Cognitive Restructuring,Drug Therapy,Literature Reviews

School refusal is a psychosocial problem characterized by a student's difficulty attending school and, in many cases, substantial absence from school (Heyne &amp; Sauter, 2013). It is often distinguished from truancy, in part because of the severe emotional distress associated with having to attend school and the absence of severe antisocial behavior. Truancy, on the other hand, is not typically associated with emotional distress and is commonly associated with severe externalizing behavior. The emotional distress associated with school refusal is often in the form of fear or anxiety, and sometimes in the form of depression. School refusal occurs for about 1-2% of young people, and estimates among clinically referred youth are considerably higher. Significant adverse consequences may occur in the short- and long-term, including school dropout and problems with social adjustment. Family members and school staff are also affected by school refusal. The most commonly studied interventions for school refusal are behavioral approaches and cognitive-behavioral therapy (CBT). The overarching aim of these interventions is the reduction of the young person's emotional distress and an increase in school attendance to help the young person follow a normal developmental pathway (Heyne &amp; Sauter, 2013). Other interventions have been used to treat school refusal (e.g., psychodynamic treatment, family therapy, medication) but CBT has been the most studied intervention and most prior reviews have focused on CBT and/or behavioral interventions. While prior reviews have found some support for CBT and behavioral interventions for reducing anxiety and/or improving attendance, the reviews have been mixed (Maynard et al., 2013). No prior meta-analysis of interventions targeting school refusal has been located. The purpose of this review was to inform practice and policy by evaluating the effects of psychosocial interventions for school refusal. The following research questions guided this study: (1) Do psychosocial interventions targeting school refusal reduce anxiety; and (2) Do psychosocial interventions targeting school refusal increase attendance? A total of eight studies examining effects of interventions on anxiety or attendance with 435 school-age participants exhibiting school refusal were included in this review. Findings of the current review were mixed. While both the CBT only and CBT plus medication interventions found, on average, positive and significant effects on attendance compared to control, effects on anxiety at post-test across both sets of studies were not significantly different from zero. The current evidence provides tentative support for CBT in the treatment of school refusal, but there is an overall lack of sufficient evidence to draw firm conclusions of the efficacy of CBT as the treatment of choice for school refusal. Appendices include the following: (1) Documentation of Search Strategies in Electronic Databases; (2) Characteristics of Included Studies; (3) Excluded Studies; (4) Risk of Bias: Psychosocial Interventions; and (5) Risk of Bias: Psychosocial Interventions Plus Medication Studies.