Academic journal article The International Journal of Behavioral Consultation and Therapy

Moving from Assessment: To Treatment of School Refusal Behavior in Youth

Academic journal article The International Journal of Behavioral Consultation and Therapy

Moving from Assessment: To Treatment of School Refusal Behavior in Youth

Article excerpt

School refusal behavior is a difficult problem faced by many parents, educators, and mental health professionals. A functional model to guide classification, assessment, and treatment of this population has evolved in recent years. In this article, step-by-step recommendations are made for synthesizing assessment information from a particular case toward the development and confirmation of a functional hypothesis. An illustrative example is also provided.

Keywords: School refusal behavior, functional assessment, youths.


School refusal behavior is a pernicious problem that disrupts the lives of many children and families and can lead to damaging short- and long-term consequences. In a previous article, the characteristics and functional assessment of school refusal behavior were outlined (Kearney, Lemos, & Silverman, 2004). The reader is also referred to other sources for general information about this population as well as our functional model (Kearney, 2001; 2003; 2005; Kearney & Albano, 2000; Kearney & Silverman, 1996). In this article, we discuss steps for synthesizing assessment materials to assign appropriate, prescriptive treatment for a particular child with school refusal behavior. An illustrative case example is also provided.

According to the functional model, school refusal behavior is generally maintained by one or more of the following conditions:

* To avoid school-based stimuli that provoke a general sense of negative affectivity (anxiety and depression)

* To escape aversive school-based social and/or evaluative situations

* To pursue attention from significant others

* To pursue tangible reinforcers outside of school

Functional assessment of this population generally involves interviews, child self-report and parent/teacher measures, direct observations, and consultations with school officials to determine which of these reasons are primary and secondary for a particular child who refuses school (see Kearney et al., 2004). Information is thus collected from multiple sources about multiple areas of functioning. A clinician is then faced with the task of integrating this information to generate hypotheses about maintaining functions of school refusal behavior, or to derive a functional profile. We recommend several steps in this process.

Step 1: Examine ratings from versions of the School Refusal Assessment Scale

The first recommended step toward understanding the functional profile of a particular child with school refusal behavior is to examine ratings from child and parent versions of the School Refusal Assessment Scale (revised edition; SRAS-R) (Kearney, 2002). The SRAS-R is designed to measure the relative strength of the four functional conditions listed above and is typically given to the child (if appropriate) and to both parents. Item means for each functional condition are then calculated from each version and averaged to derive an initial functional profile (see Kearney et al., 2004). This method obviously weights the profile toward parent input if two parents are available, but we have found this to be desirable in many cases. A clinician may also separately compare item means from the child version to each parent version or to a compilation of both parent versions to derive more specific information.

As this convergence of ratings is completed, a clinician may find one of two patterns. First, substantial agreement across the versions may be evident. Hopefully such agreement will pertain to the precise order of relative strength for each functional condition, but this is rare. More likely, agreement will occur for the primary reason a child is refusing school and perhaps the secondary reason. One should ensure that similar ratings did not result from coercion or some other confound, but in general such agreement portends well for the assignment of appropriate, prescriptive treatment. …

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