The Functional Profiles of School Refusal Behavior

TLDR

School refusal behavior is a common problem seen by mental health professionals and educators, yet consensus on its classification, assessment, and treatment is lacking. The study aimed to identify the diagnoses most commonly associated with the proposed functions of school refusal behavior. Researchers assessed 143 youths with primary school refusal behavior and their parents to examine diagnostic associations with functional categories. Results revealed heterogeneity in diagnoses, with anxiety-related disorders linked to negatively reinforced refusal, separation anxiety to attention-seeking, and oppositional/ conduct disorders to pursuit of tangible reinforcement outside school. These findings are discussed in the context of classification, assessment, and treatment of school refusal behavior.

Abstract

School refusal behavior is a common problem seen by mental health professionals and by educators but little consensus is available as to its classification, assessment, and treatment. This study assessed 143 youth with primary school refusal behavior and their parents to examine diagnoses that are most commonly associated with proposed functions of school refusal behavior. As expected, results indicated that great heterogeneity in diagnoses marks this population. In general, anxiety-related diagnoses were associated more with negatively reinforced school refusal behavior; separation anxiety disorder was associated more with attention-seeking behavior; and oppositional defiant disorder and conduct disorder were associated more with pursuit of tangible reinforcement outside of school. These results are discussed within the context of classification, assessment, and treatment of this population.