Interventions for Positively Reinforced School Refusal Behavior

This chapter covers contingency management and family-based practices for children refusing school for positive reinforcement outside of school. Detailed recommendations are made for instituting morning routines, attending to appropriate behaviors, providing incentives and disincentives as needed, and altering parent commands. In addition, family work can include agreements for problem-solving and enhanced communication, such as contracts, as well as work with parents to modify academic requirements in line with a particular youth’s attendance status and potential pathway toward graduation. Other recommendations include escorting youth to school, increasing supervision, helping a youth refuse offers to miss school, and implementing attendance journals, among others.

Interventions for Negatively Reinforced School Refusal Behavior

This chapter covers intervention strategies for children with considerable anxiety about attending school, or refusing school for negative reinforcement. These strategies focus on the key response components of anxiety, including physical, cognitive, and behavioral aspects. Interventions for the physical aspect of anxiety include somatic management techniques such as muscle relaxation training and breathing retraining. Interventions for the cognitive aspect of anxiety include cognitive restructuring techniques that focus on developing more realistic thoughts and challenging negative thoughts. Interventions for the behavioral aspect of anxiety include different ways of gradually reintegrating a child into school, or exposure-based practices. These recommendations are specifically tailored to developmental levels and include those circumstances most characteristic of children with anxiety-based school refusal behavior, such as difficulty with a new school or teacher, increased academic work, transitions between areas of the school, and the school bus, to name a few.

Tier 1 and Tier 3 Strategies for Problematic Absenteeism

This chapter begins by covering Tier 1 strategies that refer to school-wide practices designed to reduce overall levels of absenteeism and improve attendance rates. These practices could be implemented in conjunction with existing programs, such as academic or antibullying programs, or they could be implemented as stand-alone techniques to specifically focus on school attendance. Important Tier 1 strategies can focus on improving school climate, enhancing parental involvement, implementing health-based and mental health-based strategies, promoting safety and social-emotional learning, and re-examining district-wide policies. The chapter also covers Tier 3 strategies that are designed to address severe and chronic cases of school refusal behavior. Important Tier 3 strategies can focus on alternative educational programs and schools, mentors, early education, family, and health services, court referral and community services, and a team approach.

School Refusal Behavior

This chapter provides a definition and description of the concept of school refusal behavior in children and adolescents. The chapter focuses on definitions of key terms, epidemiology, common behaviors and symptoms associated with problematic absenteeism, and short- and long-term outcomes of problematic absenteeism. However, a main focus is on how these characteristics pertain to, and illustrate, the real-life cases seen by the reader. Chapter 1 also include an overview of the book’s approach. The chapter discusses the purpose of this book and characteristics of youths with school refusal behavior. The chapter also presents a model for understanding school refusal behavior and for guiding assessment and intervention.

Assessing Cases of School Refusal Behavior

This chapter offers the reader an overview of methods to assess, on an initial and ongoing basis, youths with presenting school refusal behavior. These methods target youth who are just beginning to refuse school and/or have scattered absences, a few skipped classes, recurrent tardiness, premature departures from school during the day, excessive crying or resistance going to school, and noncompliance regarding school attendance, in addition to more subtle behaviors such as frequent student requests to leave class, visits to the school nurse, or escalating distress about attending school. Formal assessment methods are described, such as interview questions, questionnaires, and behavioral observation, but an emphasis is also placed on time-sensitive and highly efficient ways to gather substantial information about a youth’s school refusal behavior and related variables.

Contextual Variables and School Refusal Behavior

This chapter provides a summary of contextual variables that impact school absenteeism in children and adolescents. Child-oriented contextual variables surround key factors such as psychopathology, poor academic or social competence, history of absenteeism or learning disorder, grade retention, employment, pregnancy, and trauma. Parent-oriented contextual variables surround key factors such as in adequate parenting skills or problematic styles, psychopathology, poor communication with school officials, and low expectations of school performance. Family-oriented contextual variables surround key factors such as homelessness, poverty, problematic dynamics, and cultural and language barriers. Peer-oriented contextual variables surround key factors such as peer pressure or proximity to deviant peers as well as bullying. School-oriented contextual variables surround key factors such as poor school climate, tedious curricula, and minimal monitoring or consequences for absenteeism. Community-oriented contextual variables surround key factors such as economic pull factors and lack of educational support services.

Relapse Prevention, Difficult Parents, and Other Special Topics

This chapter covers techniques to maintain treatment gains and to prevent a relapse to school attendance problems. These techniques can include reminders following an intervention, practicing techniques from an intervention, addressing new obstacles to school attendance, preparing for the beginning of a new school year, booster sessions, reminders of a child’s success, and structured activities during a break. The chapter also covers recommendations for addressing difficult parents, such as increasing collaborative contact, meeting at school or home if possible, giving information about options, simplifying treatment procedures, addressing obstacles to interventions, expanding social support networks, and exploring a need for a referral. Special topics that impact school refusal behavior cases are discussed as well. Examples include beginning of a new school year, comorbid behavior problems, and medical problems.