Introduction

Chapter 1 serves as an introduction to this parent workbook on treating school refusal behavior. School refusal behavior includes children aged 5 to 17 years who refuse to attend school and/or have trouble remaining in classes for an entire day. This is a common, difficult, and widespread problem, and can develop into a more serious one if left untreated. This introductory chapter covers the frequency and major features of school refusal behavior. Four reasons are outlined for school refusal behavior: (1) to stay away from objects or situations at school that make the child feel unpleasant physical symptoms or general distress; (2) to stay away from social or evaluative situations at school that are anxious for the child; (3) to receive attention from a parent or a significant other; and (4) to obtain tangible rewards outside of school that make skipping school more fun than staying in school.

Consultation Session and General Treatment Session Procedures

Chapter 3 covers what happens during a consultation session. The therapist usually summarizes assessment results and provides recommendations to the family about treatment. Some general points are presented regarding treatment sessions such as how long treatment will last and how to handle missed sessions. The importance of completing homework between sessions is discussed as well as the importance of gradually increasing the child’s school attendance. Parents are encouraged to discuss any issues with the therapist and to rely on the therapist for support throughout the treatment process. Parents are also encouraged to read all the chapters in this workbook no matter what their child’s reason for school refusal may be.

Assessment

Chapter 2 covers the assessment process for children with school refusal behavior. This includes the purpose and methods of assessment, monitoring daily progress, and contacting school officials. The purpose of formally assessing a child with school refusal behavior is to obtain answers to three critical questions: (1) What is the behavior problem? (2) What is maintaining school refusal behavior? (3) What is the best treatment for school refusal behavior? Recommended assessment methods such as interviews, child self-report measures, and parent and teacher checklists are presented. Forms are included at the end of the chapter.

Preventing Slips and Relapse

Chapter 8 describes slips and relapse and provides an overview of how to help children and families prevent a return to school refusal behavior. Activities to help with relapse prevention include taking photographs of the child during in vivo exposure practices; creating a poster, journal, or storybook of the child’s accomplishments using photographs of the child’s exposures; and asking the child’s help in producing a video “commercial” aimed at teaching other children how to overcome the problem of school refusal behavior. Special circumstances such as how to handle long breaks from school (like summer vacation) and starting a new school are discussed. For children with chronic or extremely severe school refusal behavior, relapse prevention can be challenging. Sample relapse prevention reminders for families are provided.

Children Refusing School to Escape Anxious Social and/or Evaluative Situations

Chapter 5 outlines the treatment for children whose anxiety in social, performance, and/or evaluative situations is so distressing that they cannot tolerate these situations. Instead, avoidance behavior takes over. Treatment for such children involves teaching them to identify what they tell themselves in anxiety-provoking situations and then to use a method to change negative thoughts to coping, helpful statements. Treatment involves graduated exposure to anxiety-provoking social or evaluative situations in session with the therapist and gradually increasing school attendance. It is important for the child to practice coping skills in real-life social and evaluative situations.

Children Refusing School for Tangible Rewards Outside of School

Chapter 7 outlines treatment procedures for children who refuse school for tangible rewards outside of school. Such children may be hiding school absences, displaying verbal and physical aggression, running away, spending an excessive amount of time with friends, and/or acting disruptively to stay out of school. Additional behaviors may include a hostile attitude, refusal to talk, drug use, or excessive sleep. The major focus of treatment is relevant family members, most likely parents and the child (more likely adolescent) refusing school. The major goal is to provide family members with a better way of solving problems, reducing conflict, increasing rewards for school attendance, and decreasing rewards for school absence. Ways of improving family communication, solving problems by establishing and sticking to contracts, and dealing with peers are discussed.

Children Refusing School for Attention

Chapter 6 outlines treatment procedures for children refusing school for attention. Such children may be refusing parent and/or teacher commands and showing overall disruptive behavior. Other behaviors may include clinging, refusal to move, tantrums, running away, constant telephoning or texting, and guilt-inducing behaviors. The major focus of treatment is the parents. The major goal of treatment is to shift parental attention away from school refusal behaviors and toward appropriate school attendance behaviors. Parents learn to issue unambiguous commands to the child without insulting or lecturing. They are encouraged to set up and adhere to a morning routine. The importance of identifying and consistently applying rewards and consequences is also emphasized.

Children Refusing School to Avoid Objects or Situations That Cause General Distress

Chapter 4 outlines the treatment for children with school refusal behavior who are motivated by a desire to avoid emotions such as fear, dread, anxiety, panic, or depression that can become associated with certain school-related objects or situations. For these children, the main goal of treatment is to change the child’s avoidance behavior and build coping and active school attendance behaviors. Detailed descriptions of each session are provided, along with homework assignments. The child is taught skills such as relaxation and deep breathing. Case vignettes and sample dialogues are included.