Improvements In School Attendance Research Articles

Cognitive-Behavioural Treatment of School-Refusing Children: Maintenance of improvement at 3- to 5-year follow-up

Although evidence is accumulating on the immediate or short-term efficacy of cognitive-behavioural strategies in the treatment of school refusal, no studies have been reported on the long-term efficacy of this treatment approach. An earlier randomized clinical trial conducted by the authors demonstrated the efficacy of a manual-based cognitive-behavioural treatment program for school refusal relative to waiting list controls. We now report findings of a 3- to 5-year follow-up investigation of the treatment group. In general, results support the long-term efficacy of the treatment program, with children showing maintenance of improvements in school attendance and school adjustment. Methodological limitations of the follow-up investigation are emphasized.

Cognitive‐Behavioral Treatment of School‐Refusing Children: A Controlled Evaluation

To evaluate the efficacy of a 4-week cognitive-behavioral treatment program for children who refuse to go to school. Thirty-four school-refusing children (aged 5 to 15 years) were randomly assigned to a cognitive-behavioral treatment condition or a waiting-list control condition. Treatment consisted of individual child cognitive-behavioral therapy plus parent/teacher training in child behavior management skills. Measures taken before and after treatment included school attendance, child self-report of emotional distress and coping, caregiver reports on emotional and behavioral problems, and clinician ratings of global functioning. Relative to waiting-list controls, children who received cognitive-behavioral therapy exhibited a significant improvement in school attendance. These children also improved on self-reports of fear, anxiety, depression, and coping. Significant improvements also occurred in relation to caregiver reports and clinician ratings. Maintenance of therapeutic gains was demonstrated at a 3-month follow-up assessment. Cognitive-behavioral treatment of school refusal was efficacious and acceptable. The relative contributions of child therapy and parent/teacher training require further study.

Efficacy and cost effectiveness of inhaled steroids in asthma in a developing country.

Eighty six children with troublesome wheezing were studied, in a semiprospective clinical trial with the patients acting as their own controls, to assess the efficacy and cost effectiveness of inhaled steroids. Improvement in school attendance, hospitalisations, breakthrough wheezing, and acute severe attacks were used to assess clinical efficacy. Expenditure for the family, on a cost of illness framework, before and after treatment, was used to estimate cost effectiveness. Highly significant numbers of patients showed improvement in clinical parameters, confirming efficacy. Mean monthly cost before inhaled steroid treatment was Rs 2652.33 (36.33 pounds) and Rs 449.42 (6.16 pounds) after starting treatment. The mean cost per unit satisfaction (cost utility value) which was Rs 255.54 (3.50 pounds) before starting prophylaxis came down to Rs 5.42 (0.07 pound) after starting treatment. There are no previous reports of cost-benefit assessment of inhaled steroids in childhood asthma. It is concluded that, even for developing countries with financial constraints, inhaled steroid treatment for prophylaxis of asthma is a cost effective and rational form of treatment.

Oral zinc supplementation in Down's syndrome: restoration of thymic endocrine activity and of some immune defects.

Eighteen non-institutionalized Down's syndrome (DS) children (mean age: 7.0 +/- 10/12 years) with a history of respiratory tract, auditory and skin infections, low plasma levels of a nonapeptide thymic hormone, i.e. Serum Thymic Factor (STF), high plasma levels of inactive zinc-unbound STF molecules, and reduced absolute number of circulating T-lymphocytes, were given an oral non-pharmacological supplementation of zinc sulphate (1 mg Zn++/kg body weight/day for 2 months; two cycles, 10 months apart) and monitored immunologically before and after each cycle. A dramatic increase of plasma STF level and concomitantly an almost complete disappearance of inactive STF molecules was observed after each cycle. The absolute number of circulating T-lymphocytes was significantly increased by zinc treatment. The marginal zinc deficiency was also corrected without any appreciable influence on copper plasma levels. A reduction of recurrent infections and an improvement in school attendance after zinc supplementation were recorded. These beneficial effects of zinc supplementation were also noted in those DS children who did not show an apparent zinc deficiency, as assessed by measuring zinc plasma level. The reduced number of circulating B lymphocytes and the impaired lymphocyte responsiveness to phytohaemagglutinin and concanavalin A were not restored. On the whole, these findings suggest that there exists a defect in the bio-availability and/or in the utilization of zinc in DS. This alteration, of unknown origin, can be underestimated on the simple basis of the zinc plasma level and can be corrected with moderate nutritional zinc supplementation.

Family Therapy for Chronic Childhood Asthma†

Family therapy has been increasingly advocated in the management of chronic severe childhood asthma. At the Adelaide Children's Hospital we are currently engaged in a trial of family therapy in chronic childhood asthma. Effectiveness of family therapy is judged with a twelve‐month follow‐up on reduction of symptoms, drug use, emergency physician visits and hospital admissions and on improvement in school attendance and social and family functioning compared to the previous two years experience of the treated patients and compared to a cohort of untreated patients Of similar severity. We are particularly interested in studying different patterns of conflict detouring (child centredness, triangulation and fixed coalition) and the different therapeutic strategies required.

FUNCTIONS OF A MENTAL HEALTH (MH) TEAM ON A PEDIATRIC ONCOLOGY UNIT

Since 1969, 400 patients were seen by the MH Team and 300 had psychometrics. In 1973, 50 were in individual and group play therapy and 50 parents were in group therapy over 6 months. There were over 300 multidisciplinary case presentations. Recurrent themes of emotional abandonment and symbiosis had clinical manifestations of poor or no attendance at school and acting-out behavior at home and in community: isolation, withdrawal, hopelessness, helplessness and regression. The MH Team's goal is prevention and rehabilitation. Clinical research was undertaken to institute and validate methods. Patients' systems were approached in all components (hospital, family, school, community) and followed by the MH nurse. Results are improvement in school attendance, participation in the community, survival of peer contact, improvement of self-esteem, development of trust, less anxiety and less fear. Parents learned acceptance and became active participants in hospital, school, community and in the therapeutic efforts. There was better understanding among other staff of rehabilitation techniques and MH concepts. They developed better systems of communication between patients and parents becoming familiarized with the concept of a therapeutic community. Clinical cases will be presented. Supported by NCI Grant #CA05826; ACS Pediatric Cancer Psychiatry Program; Acquavella Pediatric Fund #2160-545.