08 Jan Exploring the Effectiveness of Cognitive Behavioral Therapy in Addressing School Refusal
School refusal, also known as school avoidance, occurs when a youth routinely refuses to attend school or has trouble staying there. This behavior typically is based in anxiety or some other emotional distress. School refusal statistics are difficult to accurately determine, as youth may routinely miss school for many reasons. However, some researchers identify that school avoidance may occur in 1 to 7% of youth. This behavior results from mental health symptoms; therefore, the application of evidence-based interventions can be practical in helping to mitigate the impact on the youth’s academic and social success.
What Does School Refusal Look Like in the Early Stages?
Early identification of the warning signs is crucial for parents and educators to intervene effectively. Recognizing these signs can prevent the escalation of school refusal and help children return to a positive school experience. In its early stages, school refusal can manifest in various ways that seem unrelated to an aversion to school. Some key early warning signs to watch for include:
- Emotional Distress During School Hours: Children might cry or display intense anxiety when it’s time to go to school or during school hours.
- Disruptive Behavior: Some children may engage in disruptive behaviors intentionally to be sent home from school. This behavior might include acting out in class or refusing to follow instructions.
- Attention-Seeking Actions: Frequent attempts to contact parents during school hours, such as constant texting or calling, can indicate that the child is struggling to stay at school.
- Frequent Requests to Leave Class: Regular visits to the restroom, the nurse’s office, or requests to speak with a counselor can indicate that a child is trying to avoid classroom activities.
- Somatic Complaints: Children might frequently complain of physical ailments like stomachaches, headaches, or nausea, which can often be symptoms of anxiety or stress rather than actual medical conditions.
- Social Isolation: Avoiding peers and withdrawing from social interactions during school hours can be a red flag. This behavior often accompanies feelings of discomfort or fear associated with the school environment.
- Sudden Changes in Behavior or Personality: Any abrupt shift in a child’s usual behavior or mood, such as becoming unusually quiet, irritable, or angry, can signal something is amiss.
- Academic Decline: A noticeable drop in grades, incomplete homework, or a general lack of interest in schoolwork can be early signs of school refusal. Test anxiety might also become more apparent.
- Separation Difficulties: Younger children, in particular, might exhibit severe distress when separated from their parents, which can translate into refusal to attend school.
Understanding these early signs is the first step in addressing school refusal. It is essential to approach the situation with empathy and a proactive mindset, ensuring that children receive the support they need to feel safe and comfortable in their educational environment.
Cognitive-Behavioral Therapy (CBT) for School Refusal
Cognitive-behavioral therapy (CBT) is a well-established and effective approach for treating school refusal. Research published in the Journal of the American Academy of Child and Adolescent Psychiatry evaluated the efficacy of a 4-week CBT program for children aged 5 to 15 who refuse to go to school. The youth were randomly assigned to either CBT interventions or a waiting-list control condition. Treatment interventions included individual child cognitive-behavioral therapy and parent and teacher training in child behavior management skills.
The study’s key findings suggest that children who received cognitive-behavioral therapy (CBT) experienced significant improvements in school attendance and a reduction in emotional distress, including decreased fear, anxiety, and depression. These youth also demonstrated improved coping skills, and caregivers and clinicians reported significant improvements in the children’s emotional and behavioral problems and overall functioning. These therapeutic gains were sustained, as evidenced by positive outcomes in a follow-up assessment conducted three months later.
A review of research in Current Approaches in Psychiatry (2023) on the efficacy of CBT interventions for school refusal in children and adolescents found that CBT is an effective intervention for youth with this pattern of behavior. The review found that CBT interventions for school refusal predominantly used cognitive restructuring, exposure, psychoeducation, and social skills techniques. Eighty percent of the studies reviewed indicated that CBT-based interventions effectively address school refusal. Additionally, parental involvement was a component in 80% of the studies, and all reported positive outcomes.
Recognizing the early warning signs of school refusal to intervene effectively and prevent the situation from worsening is essential for schools and families. When school avoidance does occur, it is necessary to have options for treating it effectively to support the long-term success of young people. Research has shown that cognitive-behavioral therapy (CBT) is an effective intervention for addressing school refusal in children and adolescents. CBT can lead to improvements in school attendance, emotional distress, coping skills, and overall functioning. Early identification and evidence-based interventions like CBT are crucial in helping children have a positive school experience and succeed academically and socially.
References
Güngör, Beyza & KOÇTÜRK, Nilüfer. (2023). School Refusal and Cognitive Behavioral Therapy: A ReviewOkul Reddi ve Bilişsel Davranışçı Terapi: Bir Gözden Geçirme. Psikiyatride Guncel Yaklasimlar – Current Approaches in Psychiatry. 15. 1-11. 10.18863/pgy.1052813.
Heyne D, Brouwer-Borghuis M. Signposts for School Refusal Interventions, Based on the Views of Stakeholders. Contin Educ. 2022 May 18;3(1):25-40. doi: 10.5334/cie.42. PMID: 38774290; PMCID: PMC11104337.
King NJ, Tonge BJ, Heyne D, Pritchard M, Rollings S, Young D, Myerson N, Ollendick TH. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adolesc Psychiatry. 1998 Apr;37(4):395-403. doi: 10.1097/00004583-199804000-00017. PMID: 9549960.