Intensive cognitive-behavioral treatment of school refusal behavior

Abstract

The present investigation is a single-subject treatment of a preadolescent child with school refusal behavior. This study represents an A-B design in which treatment was designed to begin with a standard cognitive-behavioral approach and to continue with a functional analytic and intensively applied problem-solving strategy if difficulties arose during the implementation of cognitive behavioral treatment (CBT). Consistent with the design, systemic problems interfered with the implementation of traditional, office-based CBT and the intensive approach was applied. Under this design, problems were identified and mitigated using strategies beyond those employed in traditional manualized CBT. The participant was a 12-year-old female who was attending school sporadically and with great difficulty, and who was experiencing both separation anxiety and social anxiety in the school setting. Following the intensive treatment, she began to attend school more regularly, and her fear ratings decreased considerably; however, she continued to have difficulties with school attendance that appeared to be more related to systemic issues than anxiety. This study describes a potential method of increasing the clinical utility of manualized treatments for highly challenging cases through an intensive, functional analytic strategy, and also describes the challenges of working with anxiety disorder cases in which there are multiple variables in addition to the child's anxiety that contribute to clinical disturbance.