School Refusal: behavioural and diagnostic profiles of a clinical sample

Background School refusal is characterized by severe difficulty in attending school with associated anxiety. Based on the primary symptoms, the affected child may be categorised within a range of diagnoses. Although the subject has been widely studied, no data is available on the characteristics of Sri Lankan children with school refusal.

Aims 1.To study the behavioural and diagnostic characteristics of children presenting to a specialist child mental health outpatient setting with school refusal 2. To assess the associated environmental influences and the outcome of intervention.

Methods The study sample consisted of children who presented to an outpatient mental health service (Jan 2004- April 2005) with school refusal for 2 weeks or more. Data on presenting symptoms, behavioural profiles and diagnosis was obtained retrospectively from clinical documents. All children attended mainstream education.

Results Data was available on 79 children. Mean age was 9.6 years. Majority were male. Mean duration of school non-attendance was 11.5 months. Somatic complaints (59.6%) and anxiety (50.6%) were the main clinical presentations. Low academic performance based on parents’ reports and school records was reported in 48.1%. The commonest diagnoses were anxiety disorder (31.6%) and Attention Deficit Hyperactivity Disorder (ADHD) (16.4%). Possible precipitants for school refusal were conflicts with peers (33%) and bullying (30.4%). A socially inhibited temperament was identified in 40.5% and aggressive tendencies in 29% of children. Statistically significant associations were not found between variables except between the gender and diagnosis (p<0.05).

Conclusions This study identifies clinical issues that need to be addressed in the assessment, early identification and management of children with school refusal.

DOI: http://dx.doi.org/10.4038/sljpsyc.v3i1.4453

SL J Psychiatry 2012; 3 (1):10-13