Augmenting cognitive behavior therapy for school refusal with fluoxetine: a randomized controlled trial
Open accessAbstract
This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.
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School refusal may be more associated with primary or early secondary grades, whereas truancy may be more associated with later secondary grades.
“School refusal may be more associated with primary or early secondary grades, whereas truancy may be more associated with later secondary grades”
From Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1) (2019) · cites this paper as Melvin et al., 2017
Very few studies have compared combined therapy to either treatment alone.
“Very few studies have compared combined therapy to either treatment alone [47–49].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [48]
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- Authors
- Melvin, G. A., Dudley, A. L., Gordon, M. S., Klimkeit, E., Gullone, E., Taffe, J., & Tonge, B. J.
- Affiliations
- Monash Health (AU)
- Corresponding author
- Melvin, Glenn A.
- Venue
- Child Psychiatry & Human Development
- Published
- 2016-08-02
- Volume
- 48
- Issue
- 3
- Pages
- 485-497
- ISSN
- 0009-398X (ISSN-L)
- 1573-3327
- OpenAlex
- W2488839582
- Cited by
- 52
- References
- 43
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 8 · 2017: 4
- FWCI
- 23.68
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- Child Psychiatry & Human Development (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (545968)
- beyondblue
- Financial Markets for Children
- Topics
- Social Sciences › Education › Youth Substance Use and School Attendance
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- school refusal, cognitive behavioral therapy, fluoxetine, augmentation therapy, adolescents, anxiety disorders, depression, school attendance, treatment satisfaction, self-efficacy
- MeSH terms
- Adolescent, Adolescent Behavior, Combined Modality Therapy, Female, Fluoxetine, Humans, Male, Phobic Disorders, Psychotherapy, Group, Schools, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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