We assessed whether treatment of children and adolescents with school refusal behavior is effective when based upon an individualized, functional analysis. Seven children and adoles-cents, who were currently experiencing difficulties attending school, were evaluated with the School Refusal Assessment Scale (SRAS), an instrument designed to identify maintaining variables surrounding school refusal behavior. These included specific fearfulness/general overanxiousness, escape from aversive social situations, attention-getting or separation anxious behavior, and tangible reinforcement. Prescriptive treatment was given in accordance with the assessed motivating condition and included systematic desensitization/relaxation training, modeling and cognitive restructuring, shaping and differential reinforcement of other behavior, and contingency contracting for each condition, respectively. Daily measures of anxiety, depression, distress, and school attendance were taken, as well as pretreatment, posttreatment, and 6-month follow-up child and/or parent questionnaires. Results indicated that 6 of the subjects maintained full-time school attendance by posttreatment and at the 6-month follow-up. All reported moderate improvements in daily levels of anxiety, depression, and/or distress. The implications of a prescriptive treatment approach for school refusal behavior are discussed.
Get full access to this article
View all access options for this article.
References
1.
Achenbach, T. (1978). The Child Behavior Profile: I. Boys aged 6-11. Journal of Consulting and Clinical Psychology, 46, 478-488.
2.
American Psychiatric Association . (1987). Diagnostic and statistical manual of mental disorders (3rd. ed., rev.). Washington, DC: Author.
3.
Atkinson, L. , Quarrington, B., & Cyr, J. J. (1985). School refusal: The heterogeneity of a concept. American Journal of Orthopsychiatry, 55, 83-101.
4.
Ayllon, T. , Smith, D., & Rogers, M. (1970). Behavioral management of school phobia. Journal of Behavior Therapy and Experimental Psychiatry, 1, 125-138.
5.
Beck, A. T. , & Emery, G. (1985). Anxiety disorders and phobias: A cognitivePerspective. New York: Basic Books.
6.
Bernstein, G. A. , & Garfinkel, B. D. (1986). School phobia: The overlap of affective and anxiety disorders. Journal of theAmericanAcademy of Child Psychiatry, 2, 235-241.
7.
Blagg, N. R. , & Yule, W. (1984). The behavioural treatment of school refusal: A comparative study. Behaviour Research and Therapy, 22, 119-127.
8.
Broadwin, I. T. (1932). A contribution to the study of truancy. American Journal of Orthopsy-chiatry, 2, 253-259.
9.
Burke, A. E. , & Silverman, W. K. (1987). The prescriptive treatment of school refusal. Clinical Psychology Review, 7, 353-362.
10.
Carr, E. G. , & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal ofApplied BehaviorAnalysis, 18, 111-126.
11.
Cautela, J. R. , Cautela, J., & Esonis, S. (1983). Forms for behavioral analysis with children. Champaign, IL: Research Press.
12.
Coolidge, J. C. , Hahn, P. B., & Peck, A. L. (1957). School phobia: Neurotic crisis or way of life?American Journal of Orthopsychiatry, 27, 296-306.
13.
Craddock, C. , Cotler, S., & Jason, L. A. (1978). Primary prevention: Immunization of children for speech anxiety. Cognitive Therapy and Research, 2, 389-396.
14.
Davidson, S. (1960). School phobia as a manifestation of family disturbance: Its structure and treatment. Journal of Child Psychology and Psychiatry, 1, 270-287.
15.
Durand, V. M. , & Crimmins, D. B. (1988). Identifying the variables maintaining self-injurious behavior. Journal ofAutism and Developmental Disorders, 18, 99-117.
16.
Edelbrock, C. , & Achenbach, T. (1984). The teacher version of the Child Behavior Profile: Boys aged 6-11. Journal of Consulting and Clinical Psychology, 52, 207-217.
17.
Garvey, W. P. , & Hegrenes, J. R. (1966). Desensitization in the treatment of school phobia. American Journal of Orthopsychiatry, 36, 147-152.
18.
Granell de Aldaz, E. , Vivas, E., Gelfand, D. M., & Feldman, L. (1987). Characteristics of Venezuelan school refusers: Toward the development of a high-risk profile. Journal of Nervous and Mental Disease, 175, 402-407.
19.
Gresham, F. M. , & Evans, S. E. (1987). Conceptualization and treatment of social withdrawal in the schools. Special Services in the Schools, 3, 37-51.
20.
Harris, S. R. (1980). School phobic children and adolescents: A challenge to counselors. School Counselor, 27, 263-269.
21.
Hayes, S. C. , Nelson, R. O., & Jarrett, R. B. (1987). The treatment utility of assessment: A functional approach to evaluating assessment quality. American Psychologist, 42, 963-974.
22.
Jablensky, A. (1985). Approaches to the definition and classification of anxiety and related disorders in European psychiatry. In A. H. Tuma & J. Maser (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ: Lawrence Erlbaum.
23.
Johnson, A. M. (1957). School phobia. American Journal of Orthopsychiatry, 27, 307-309.
24.
Johnson, A. M. , Falstein, E. I., Szurek, S. A., & Svendsen, M. (1941). School phobia. American Journal of Orthopsychiatry, 11, 702-711.
25.
Keamey, C. A. , & Silverman, W. K. (1988). Measuring the function of school refusal behavior: The School Refusal Assessment Scale (SRAS). Paper presented at the Meeting of the Association for Advancement of Behavior Therapy, New York.
26.
Kearney, C. A. , Silverman, W. K., & Eisen, A. R. (1989). Characteristics of children and adolescents with school refusal behavior. Paper presented at the Meeting of the Berkshire Association of Behavior Analysis and Therapy, Amherst, MA.
27.
Kennedy, W. A. (1965). School phobia: Rapid treatment of 50 cases. Journal of Abnormal Psychology, 70, 285-289.
28.
Kovacs, M. , & Beck, A. T. (1977). An empirical-clinical approach toward a definition of childhood depression. In J. G. Schultebrandt & A. Raskin (Eds.), Depression in children: Diagnosis, treatment, and conceptual models. New York: Raven.
29.
La Greca, A. M. , Dandes, S. K., Wick, P., Shaw K., & Stone, W. L. (1988). The development of the Social Anxiety Scale for Children (SASC): Reliability and concurrent validity. Journal of Clinical Child Psychology, 17, 84-91.
30.
Last, C. G. , & Francis, G. (1988). School phobia. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology. New York: Plenum.
31.
Last, C. G. , Strauss, C. C., & Francis, G. (1987). Comorbidity among childhood anxiety disorders. Journal of Nervous and Mental Disease, 175, 726-730.
32.
Lazarus, A. A. , Davison, G. G., & Polefka, D. A. (1965). Classical and operant factors in the treatment of school phobia. Journal ofAbnormal Psychology, 70, 225-229.
33.
Leal, L. L. , Baxter, E. G., Martin, J., & Marx, R. W. (1981). Cognitive modification and systematic desensitization with test anxious high school students. Journal of Counseling Psychology, 28, 525-528.
34.
Luiselli, J. K. (1978). Treatment of an autistic child's fear of riding a school bus through exposure and reinforcement. Journal of Behavior Therapy and Experimental Psychiatry, 9, 169-172.
35.
McKnight, D. L. , Nelson, R. O., Hayes, S. C., & Jarrett, R. B. (1984). Importance of treating individually assessed response classes in the amelioration of depression. Behavior Therapy, 15, 315-335.
36.
Miller, L. C. , Barrett, C. L., & Hampe, E. (1974). Phobias in children in a prescientific era. In A. Davids (Ed.), Child personality and psychopathology: Current topics. New York: John Wiley.
37.
Moos, R. (1975). The family environment scale. Palo Alto, CA: Consulting Psychologists Press.
38.
Morris, R. J. , & Kratochwill, T. R. (1987). Dealing with fear and anxiety in the school setting: Behavioral approaches to treatment. Special Services in the Schools, 3, 53-68.
39.
Ollendick, T. H. (1983). Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R). Behaviour Research and Therapy, 21, 685-692.
40.
Ollendick, T. H. , & Mayer, J. A. (1984). School phobia. In S. M. Turner (Ed.), Behavioral theories and treatment of anxiety. New York: Plenum.
41.
Piers, E. V. (1984). Piers-Harris Children's Self-Concept Scale: Revised manual 1984. Los Angeles: Western Psychological Services.
42.
Reynolds, C. R. , & Richmond, B. O. (1978). What I think and feel: A revised measure of children's manifest anxiety. Journal ofAbnormal Child Psychology, 6, 271-280.
43.
Shapiro, T. , & Jegede, R. O. (1973). School phobia: A babel of tongues. Journal ofAutism and Childhood Schizophrenia, 3, 168-186.
44.
Silverman, W. K. , & Nelles, W. B. (1988). The Anxiety Disorders Interview Schedule for Children. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 772-778.
45.
Sperling, M. (1967). School phobias: Classification, dynamics, and treatment. Psychoanalytic Study of the Child, 22, 375-401.
46.
Spielberger, C. D. (1973). Manualfor the State-TraitAnxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press.
47.
Vaal, J. J. (1973). Applying contingency contracting to a school phobia: A case study. Journal of Behavior Therapy and Experimental Psychiatry, 4, 371-373.
48.
Watson, J. B. , & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1-14.
49.
Wolpe, J. (1973). The practice of behavior therapy (2nd. ed.). New York: Pergamon.
