When Children Refuse School: Therapist Gude

Abstract

Problematic school absenteeism is the primary focus of When Children Refuse School: A Cognitive-Behavioral Therapy Approach, Therapist Guide. Youths who complete high school are more likely to experience greater success at social, academic, occupational, and economic aspects of functioning than youths who do not. Youths with problematic school absenteeism are at risk for lower academic performance and achievement, lower reading and mathematics test scores, fewer literacy skills, internalizing and externalizing behavior problems, grade retention, involvement with the juvenile justice system, and dropout. The treatment program presented here is designed for youths with primary and acute school refusal behavior. The program is based on a functional model of school refusal behavior that classifies youths on the basis of what reinforces absenteeism. For children who refuse school to avoid school-based stimuli that provoke negative affectivity, the treatment uses child-based psychoeducation, somatic control exercises, gradual reintroduction (exposure) to the regular classroom setting, and self-reinforcement. For children who refuse school to escape aversive social and/or evaluative situations, the treatment uses child-based psychoeducation, somatic control exercises, cognitive restructuring, gradual reintroduction (exposure) to the regular classroom setting, and self-reinforcement. For youths who refuse school to pursue attention from significant others, parent-based treatment includes modifying parent commands, establishing regular daily routines, developing rewards, reducing excessive reassurance-seeking behavior, and engaging in forced school attendance. For youths who refuse school to pursue tangible rewards outside of school, family-based treatment includes contingency contracts, communication skills, escorting the child to school and from class to class, and peer refusal skills.