The Relationship Between Emotion Regulation Difficulties and Comorbid Mental Disorders in Children and Adolescents with School Refusal Behavior

Abstract

Objective

We aimed to examine the comorbid mental disorders observed in children and adolescents with school refusal behavior (SRB), as well as the role of these disorders in their emotion regulation difficulties.

Method

95 healthy controls (HC) and 96 individuals with SRB were included. Revised Child Anxiety and Depression Scale (RCADS), School Refusal Assessment Scale-Revised (SRAS-R), Swanson, Nolan, and Pelham Teacher and Parent Rating Scale (SNAP-4), Difficulties in Emotion Regulation Scale (DERS), Strengths and Difficulties Questionnaire (SDQ), and Clinical Global Impression-severity subscale (CGI) were implemented to assess the comorbid psychopathologies and symptom severities.

Results

HC and individuals with SRB were matched on demographic variables. Total and subscores of all scales and symptom severities were significantly different between the groups. There were significant correlations between impulsivity subscore of DERS and hyperactivity/inattention,-emotional problems,-prosocial behaviour subscores of SDQ. Impulsivity subscore of the DERS was also correlated with SRAS total score.

Conclusion

Our findings indicated that individuals with SRB had more emotion regulation difficulties, anxiety symptoms and behavioural problems, also, impulsivity plays an important role on attention/hyperactivity, emotional problems, prosocial behaviour, and severity of SR in individuals with SR. Further longitudinal studies investigating the role of impulsivity in SR are needed.

Plain Language Summary

Why was the study done? This study looked at children and teenagers who refuse to go to school (called School Refusal Behavior or SRB) and compared them to children who do not have this problem. We wanted to understand whether children with SRB also have other mental health difficulties and whether these difficulties affect how they manage their emotions. What did we do? We studied 96 children and teenagers with SRB and compared them to 95 children without SRB. We used several questionnaires to measure symptoms such as anxiety, depression, attention problems, hyperactivity, behavior issues, and how well the children could control their emotions. What did we find? We found that children and teenagers with SRB had more emotional and behavioural difficulties than those without SRB. They also had more trouble managing their emotions. One specific difficulty, called impulsivity (acting quickly without thinking), was strongly linked to problems with attention, hyperactivity, emotional difficulties, and lower levels of positive social behavior. Impulsivity was also linked to how severe the school refusal was. What do these findings mean? These findings suggest that children and teenagers with SRB often face multiple challenges. Impulsivity seems to play an important role in these difficulties. Future studies that follow children over time could help us better understand how impulsivity affects school refusal and how best to support these young people.