The functional assessment of school refusal behavior.

Abstract

School refusal behavior refers to child-motivated refusal to attend school and/or difficulty attending classes for an entire day (Kearney & Silverman, 1996). As such, the term represents an umbrella construct for many historical ones that have been used to describe youths with problematic absenteeism, including truancy, psychoneurotic truancy, school phobia, separation anxiety, and anxiety-based school refusal. School refusal behavior refers to a spectrum of problematic, illegitimate absenteeism that includes youths who miss school for extended periods of time, youths who miss school sporadically, youths who skip certain classes or who are tardy to school, youths with severe morning misbehaviors to attempt to miss school, and youths who attend school with great anxiety and somatic complaints that precipitate ongoing pleas to miss school in the future (Kearney, 2003). Keywords: School refusal behavior; truancy; school phobia. ********** School refusal behavior affects about 5-28% of school-aged youths at one time or another and is present fairly equally across gender, racial, and income groups (Kearney, 2001). The behavior is more common among students entering a certain school building for the first time. As such, youths entering kindergarten/first grade, middle school, and high school are particulary at risk. Attendance problems in this population generally occur for 1-2 years before treatment, but a large percentage of youths with school refusal behavior have attendance problems that last longer than two years (Bernstein, Svingen, & Garfinkel, 1990; Hansen, Sanders, Massero, & Last, 1998). A key characteristic of this population is its heterogeneity, as youths with school refusal behavior generally show a confluence of many internalizing and externalizing behavior problems. Common internalizing problems include general and social anxiety, fear, fatigue, depression and suicidality, and somatic complaints. Common externalizing problems include noncompliance to parents and teacher commands, defiance and aggression, running away from school or home, clinging, and temper tantrums (Kearney, 2001). Indeed, school refusal behavior is highly comorbid with many different mental disorders, particularly separation anxiety disorder, generalized anxiety disorder, oppositional defiant disorder, and depression (Kearney & Albano, 2004). School refusal behavior is often triggered by specific stimuli such as family and marital conflict and transitions, illness, school-based changes and threats, and traumatic experiences (e.g., Torma & Halsti, 1975). However, many cases of school refusal behavior are not triggered by any clear stimuli (Timberlake, 1984). School refusal behavior can be markedly debilitating for a child and family, and common consequences include distress, conflict, and problems with academics, legal standing, and finances (Kearney, 2001). Of course, extensive school refusal behavior is linked to potential dropout as well, which may lead to severe long-term economic, psychiatric, and interpersonal difficulties (e.g., Berg & Jackson, 1985; Hibbett & Fogelman, 1990). Because school refusal behavior is a serious and debilitating problem, proper assessment and treatment of these youths is critical. Unfortunately, the field has been fractured by a lack of theoretical focus as well as various terms and clinical strategies that apply to some but not all youths of this population. For example, many researchers have developed assessment and treatment procedures for youths with anxiety-based school refusal, but these procedures do not apply well to the many youths who refuse school without anxiety. In addition, the heterogeneous nature of this population presents obstacles to those who wish to categorize and assess these youths based on some stable form of school refusal behavior. A functional model of school refusal behavior To address these problems, a functional model of school refusal behavior has been developed that focuses more on the function or maintaining variables of the behavior rather than its myriad forms (Kearney & Silverman, 1996). …