Practitioner review: School refusal: Issues of conceptualisation, assessment, and treatment
Abstract
Developments in the assessment and treatment of school refusal have often been hampered by a failure to recognise its essentially heterogeneous nature. This paper provides a review of major conceptual complexities that have helped to undermine developments in clinical practice. In particular, it considers the distinction between school refusal and truancy, and school phobia and separation anxiety. Common approaches to the assessment and treatment of school refusal are outlined. Although behavioural and cognitive behavioural approaches are now widely accepted as central to treatment, it is increasingly recognised that individually tailored programmes, utilising a range of approaches, are most likely to prove successful. An approach focusing upon the functions, rather than the symptoms, of school refusal is advocated as having most promise for assessment and the subsequent formulation of individual prescriptive treatment.
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TR youth's preference for more appealing activities outside of school may stem from lack of interest in schoolwork, which is likely associated with the educational difficulties frequently associated with TR.
“The TR youth's preference for more appealing activities outside of school (Elliott, 1999;Havik et al., 2015a;Kearney, 2008c) may well stem from the lack of interest in schoolwork, which is likely associated with the educational difficulties frequently associated with TR.”
From Differentiation between school attendance problems: why and how? (2019) · cites this paper as Elliott, 1999
Defiance of school authority has been associated with TR.
“Defiance of school authority has been associated with TR (Elliott, 1999)”
From Differentiation between school attendance problems: why and how? (2019) · cites this paper as Elliott, 1999
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Differentiation between school attendance problems: why and how?
Heyne, D., Gren-Landell, M., Melvin, G., & Gentle-Genitty, C. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.03.006 · Cited by 339 · see citing works
“Truants have been referred to as youth kept at home because of their benefit to parents (Berry & Lizardi, 1985; Elliott, 1999), even though this phenomenon had already been referred to as school withdrawal.”
BackgroundFamily therapy and systemic interventions for child‐focused problems: the current evidence base
Carr, A. (2018) · Journal of Family Therapy · doi:10.1111/1467-6427.12226 · Cited by 276 · see citing works
“Systematic reviews have concluded that behavioural family therapy leads to recovery for more than two-thirds of cases, and this improvement rate is significantly higher than that found for individual therapy (Elliott, 1999; Heyne et al. 2013; Kearney and Sheldon, 2017; King and Bernstein, 2001; King et al., 2000; Pina…”
ResultThe role of anxiety symptoms in school performance in a community sample of children and adolescents
Mazzone, L., Ducci, F., Scoto, M. C., Passaniti, E., D'Arrigo, V. G., & Vitiello, B. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-347 · Cited by 245 · see citing works
School factors associated with school refusal- and truancy-related reasons for school non-attendance
Havik, T., Bru, E., & Ertesvåg, S. K. (2015) · Social Psychology of Education · doi:10.1007/s11218-015-9293-y · Cited by 218 · see citing works
“2013), whereas truancy is believed to be related to anti-school sentiments and antisocial characteristics such as finding school boring and seeking more rewarding activities outside school (Reid 2012; Fremont 2003; Kearney 2008b; Kearney and Silverman 1993; Elliott 1999).”
BackgroundThe effectiveness of family therapy and systemic interventions for child‐focused problems
Carr, A. (2009) · Journal of Family Therapy · doi:10.1111/j.1467-6427.2008.00451.x · Cited by 303 · see citing works
“Systematic reviews have concluded that behavioural family therapy leads to recovery for more than two-thirds of cases, and this improvement rate is significantly higher than that found for individual therapy (Elliott, 1999; Heyne and King, 2004; King and Bernstein, 2001; King et al., 2000b).”
ResultCharacteristics of adolescents with school refusal
Mcshane, G., Walter, G., & Rey, J. M. (2001) · Australian & New Zealand Journal of Psychiatry · doi:10.1046/j.1440-1614.2001.00955.x · Cited by 199 · see citing works
“Today, school refusal is viewed as a symptom associated mainly with anxiety disorders in children and with anxiety and depressive disorders in adolescents [2].”
BackgroundThe evidence base for family therapy and systemic interventions for child‐focused problems
Carr, A. (2014) · Journal of Family Therapy · doi:10.1111/1467-6427.12032 · Cited by 184 · see citing works
“…have concluded that behavioural family therapy leads to recovery for more than two-thirds of patients and this improvement rate is significantly higher than that found for individual therapy (Elliott, 1999; Heyne and Sauter 2013; King and Bernstein, 2001; King et al., 2000; Pina et al., 2009).”
ResultPractitioner Review: School refusal: developments in conceptualisation and treatment since 2000
Elliott, J. G., & Place, M. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12848 · Cited by 162 · see citing works
“Many treatment approaches incorporate a focus upon contextual factors in both the home and in school that may increase or alleviate anxiety (see Elliott, 1999, p. 1007–1008, for an outline of important issues that school personnel should consider tackling school refusal).”
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“…refusal can affect students at any age, but in times of transition (e.g., from primary to secondary school) school non-attendance is more likely (Berg, 1997; Elliott, 1999; Fremont, 2003; King, Heyne, Tonge, Gullone, & Ollendick, 2001; Knollmann, Knoll, Reissner, Metzelaars, & Hebebrand, 2010).”
BackgroundTreatment for School Refusal Among Children and Adolescents
Maynard, B. R., Heyne, D., Brendel, K. E., Bulanda, J. J., Thompson, A., & Pigott, T. D. (2018) · Research on Social Work Practice · doi:10.1177/1049731515598619 · Cited by 134 · see citing works
“Prior narrative reviews have described positive effects of cognitive and/or behavioral treatments for school refusal (Elliott, 1999; King & Bern-stein, 2001; King, Tonge, Heyne, & Ollendick, 2000), but the current review represents a rigorous extension of existing work.”
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“Others distinguish between SR and truancy because of the different characteristics of these phenomena (e.g. Berg 1997; Elliott 1999; Fremont 2003; Hersov 1990; McShane, Walter, and Rey 2001; Place, Taylor, and Davis 2000; Shilvock 2010; Smith 2011).”
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“Conversely, gradual exposure is built over time to allow a smooth process of desensitisation, but it is important to control positive reinforcement in the home environment, to make it less attractive to the child, while making school attendance more attractive (Elliott, 1999).”
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“A number of controlled investigations that used medication found that those pupils (labelled ‘school refusers’) who received drugs were no better off at the end of intervention than a ‘placebo’ group of ‘school refusers’ (Elliott, 1999).”
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“…and labeling of different categories of students with behavior most commonly referred to as “school refusal” (Bernstein & Garfinkel, 1986; Elliott, 1999; Granell de Aldaz, et al., 1994; Kearney, Eisen, & Silverman, 1995; Last, et al., 1987; Ollendick & Francis, 1988; Paige, 1996;…”
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“It is confusing because, as revealed to varying extents in valuable reviews by Berg (1992), Elliott (1999), Kearney (2003), King and Bernstein (2001), Lauchlan (2003) and Lyon and Cotler (2007), for both truancy and school phobia/refusal there is limited agreement about terminology, identification,…”
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“Many of these variables can accumulate, where a pupil perceives the school as a hostile environment, thereby choosing to avoid the institution (Elliott 1999; Evans 2000).”
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“These symptoms may be present in a morning before it is time to leave for school, but may disappear if a child is permitted to stay at home (Elliott, 1999; Kearney, 2002).”
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“…describe positive effects of cognitive and/or behavioral interventions for school refusal, many also point to mixed results and the overall lack of evidence for any one treatment modality (Elliot, 1999; King & Bernstein, 2001; King et al., 2000), which is consistent with the results of this review.”
ResultFunctional outcome of adolescents with ‘school refusal’
Mcshane, G., Walter, G., & Rey, J. M. (2004) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104504039172 · Cited by 61 · see citing works
“K E Y WO R D S anxiety disorders, depressive disorders, outcome, school refusal ‘ S C H O O L R E F U S A L’ IS a problem affecting approximately 1–2% of school-aged children and 5% of clinic-referred children and adolescents (Elliott, 1999; King, Ollendick, & Tongue, 1995).”
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“Somatic complaints such as headache and abdominal pain as well as chronic illness are also commonly reported in children with school absenteeism (Elliott, 1999; Breuner, Smith, & Womack, 2004; Thornton, Darmody, & McCoy, 2013).”
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“Separation anxiety symptoms (SAS) have received the most attention by clinicians and educators among different anxiety symptoms related to school refusal (Elliott, 1999; Heyne et al., 2001) because SAS has been considered the most important reason for school refusal.”
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Elhaggagi, C. E. (2009) · ePrints Soton (University of Southampton)
Functional outcomes in school refusal
Bonavitacola, L. (2015) · doi:10.7282/t3nk3h06
Bahalı, K., & Kadin, M. (2010)
Skolevegring: foreldre til skolevegrere og deres opplevelser med skolen
Grue, N. T. (2013) · NORA - Norwegian Open Research Archives
McKenzie, S. A. (2017) · ePrints Soton (University of Southampton)
O’Neill, E. (2019) · Ulster University Research Portal (Ulster University)
Robbed of Academic Freedom – Imposition of a Coercive Attendance Policy on Students
Sengupta, E. (2020) · Emerald Group Publishing Limited eBooks · doi:10.1108/s2055-364120200000034004
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- Authors
- Elliott, J. G.
- Affiliations
- University of Sunderland (GB)
- Corresponding author
- Elliott, Julian G.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 1999-10
- Volume
- 40
- Issue
- 7
- Pages
- 1001-1012
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2144495956
- Cited by
- 128
- References
- 0
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 7 · 2017: 2 · 2016: 2 · 2015: 11 · 2014: 9 · 2013: 9 · 2012: 5
- FWCI
- 12.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Youth Substance Use and School Attendance
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- school refusal, truancy, school anxiety, separation anxiety, conceptualization, assessment, treatment, cognitive behavioral therapy, behavioral approach, personalized treatment
- MeSH terms
- Adolescent, Anxiety Disorders, Behavior Therapy, Child, Female, Humans, Male, Phobic Disorders, Student Dropouts, Cognitive Behavioral Therapy
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