Skip to main content
. Author manuscript; available in PMC: 2010 Apr 1.
Published in final edited form as: Child Dev Perspect. 2009 Apr 1;3(1):11–20. doi: 10.1111/j.1750-8606.2008.00070.x

Table 2.

Group Design Studies Evaluating Psychosocial Interventions for School Refusal Behavior in Youth

Study Sample Characteristics Conditions Outcome at Immediate Posttest Follow-up
Berg & Fielding (1978). N = 32, about 13 years old, 16 girls, (British) with school phobia. Problem defined using Berg, Nichols, & Pritchard’s (1969) criteria of difficulty attending school, emotional upset, staying home from school with parents knowing, no antisocial disorders. Randomized to 3-month (n=16) or 6-month (n=16) supportive psychotherapy, social skills training, milieu therapy, and family therapy delivered at a hospital (in- patient psychiatric unit). At posttest, there were no significant group differences on Junior EPI, Mother EPI, actual SADQ, or 3 subscales of the preferred SADQ (affection, communication, and travel). Mothers of children in the 3-month condition reported higher ratings on the preferred SADQ -assistance subscale. At the 6-, 12-, and 24- month follow-ups, the rates of “well or much improved” based on clinicians’ report were about 45%, 50%, and 55% respectively.
Blagg & Yule (1984). N = 66, ages 11 to 16 years, 33 girls (British). Problem defined using Berg et al.’s (1969) criteria. Behavioral treatment (BTA, n=30), hospitalization (HU, n=16), home tuition and psychotherapy (HT, n=20). Nonrandomized. Duration in weeks: BTA = 2.53, HU = 45.3, HT = 72.1. Posttest data were available from the BTA and the HU conditions. Both conditions improved on EPQ extraversion and neuroticism, with no differences between the two conditions. HU improved significantly on self-esteem but BTA did not. There were no significant improvements on EPQ psychoticism or lie scale scores. At 1-year follow-up, 93.3% in BTA, 37.5% in HU, and 10% in HT returned to school full time (BTA > HU; BTA > HT). No questionnaire data were reported.
Last et al. (1998). N = 56, ages 6 to 17 years, 28 girls, Caucasian (n=51), African American (n=2), Latino (n=2). DSM-III-R SP or SOP (n=23), SAD (n=13), AVD (n=2), OAD (n=2), panic (n=1). Problem defined as anxiety about attending school and school avoidance. Randomized to ICBT (n=32) or Education Support (n=24). Delivered at a university-based clinic. Duration: 12/12 sessions/weeks. From pretest to posttest, ICBT and Education Support improved on mean percentage of hours spent in class, STAIC and CDI with no differences between the two conditions. At 4-week follow-up, gains were maintained with no differences between conditions on attendance. STAIC and CDI data were not reported.
Kearney & Silverman (1999). N = 8, mean age = 11.2 years, 3 girls, Caucasian (n=6), African American (n=1), Caucasian- Hispanic (n=1) with DSM-IV SP (n=1), GAD (n=3), SAD (n=2), no diagnosis (n=1), SOP (n=1). Problem defined as child-motivated refusal to attend or stay in school. Prescriptive ICBT (n=4) or Nonprescriptive ICBT (n=4). Delivered at a university-based research clinic. Nonrandomized. Duration: Prescriptive = 3–10 sessions, Nonprescriptive = 5–7 sessions. From pretest to posttest, there were improvements in percentage of time out of school, FSSC-R, FSSC-R school items, RCMAS, CDI, PHSCS, child/parent daily anxiety ratings, child/parent daily depression ratings, CBCL-I/E, and TRF-I/E. At the 6-month follow-up, gains were maintained across all measures, except for parent daily anxiety ratings, parent daily depression ratings, and percentage of time out of school; but these remained below baseline levels.
King et al. (1998). N = 34, ages 5 to 15 years, 16 girls (Australian). DSM-III-R SAD (n=8), adjustment disorder (n=7), OAD (n=5), SP (n=3), SOP (n=2). Problem defined using Berg et al.’s criteria. Randomized to ICBT with Parent and Teacher Training (ICBT + PTT, n=17) or Waitlist (n=17). Delivered at a school refusal specialty clinic. Duration: 6/4 sessions/weeks. From pretest to posttest, CBT + PTT improved on number of full days present at school, SEQSS, RCMAS, FSSC-II, CDI, CBCL-I/E, and TRF-I/E compared with the waitlist. At 3-month follow-up, gains were maintained. King et al. (2001) reported 3- to 5-year follow-up data and gains on attendance were maintained.
Heyne et al. (2002). N = 65, ages 7 to 14 years, 28 girls (Australian) DSM-IV Adjustment disorder (n=24), SAD (n=6), SOP (n=6), Anxiety disorder NOS (n=9). Problem defined using Berg et al.’s criteria. Randomized to ICBT (n=21), ICBT + PTT (n=20), PTT (n=20) delivered at a medical center Duration: 8/16 session/weeks. From pretest to posttest, ICBT + PTT improved SEQSS, FSSC-II, RCMAS, CDI, and Fear Thermometer ratings tied to “Going to school the next day,” as did the other two intervention conditions. ICBT + PTT and PTT improved school attendance more than ICBT. At 2-week follow-up, gains were maintained across measures with no differences among conditions, not even in attendance.

EPI=Esyenck Personality Inventory (Esyenck, 1965); SADQ=Self Administered Dependency Questionnaire (Berg, 1974); EPQ=Esyenck Personality Questionnaire (Esyenck & Esyenck, 1975); SP=specific phobia; SOP=social phobia; SAD=separation anxiety disorder; AVD=avoidant disorder; OAD=overanxious disorder; ICBT=individual cognitive behavior therapy; STAIC-T=State Trait Anxiety Inventory for Children-Trait (Spielberger, 1973); CDI=Child Depression Inventory (Kovacs, 1992); GAD=generalized anxiety disorder; FSSC-R=Fear Survey Schedule for Children-Revised (Ollendick, 1983); RCMAS=Revised Children’s Manifest Anxiety Scale (Reynolds & Richmond, 1978); FSSC-II=Fear Survey Schedule for Children-Second Revision (Gullone & King, 1992); CBCL=Child Behavior Checklist (Achenbach, 1991a); SRAS=School Refusal Assessment scale (Kearney & Silverman, 1993); TRF-I/E=Teacher Report Form (Achenbach, 1991b); I/E = Internalizing/Externalizing; NOS= not otherwise specified; SEQSS=Self-Efficacy Questionnaire for School Situations (Heyne et al., 1998).