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Effects of psychosocial interventions for school refusal with primary and secondary students
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Cognitive-Behavioural Therapy (CBT) for students with severe emotional distress increases school attendance but has no effect on anxiety.
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What is this review about?
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Students who have difficulty in attending school due to emotional distress may display school refusal. Unlike truancy, school refusal is a result of students’ fear, anxiety or depression. The review summarises studies of psychosocial interventions. These interventions are primarily behavioural therapy, involving relaxation or social skills training, or cognitive behavioural therapy.
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This review assessed whether psychosocial interventions for school refusal reduce anxiety and increase attendance.
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What is the aim of this review?
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This Campbell systematic review assesses the effects of psychosocial interventions for school refusal. The review summarizes the findings from eight studies.
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What studies are included?
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Eight studies, covering 435 school age participants with school refusal, are summarised in this review.
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The review included rigorous evaluations published between January 1980 and November 2013. Studies, which assessed effects of medications only, or studies conducted in residential treatment centres, were not included. All but one study assessed the effects of a variant of cognitive behavioural therapy, and most took place in a clinic setting.
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What are the main results in this review?
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Medium quality evidence shows that cognitive- behavioural therapy (CBT) increases school attendance but has no effect on anxiety.
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The effect of the psychosocial interventions on anxiety was not statistically significant. The effects on attendance were significant.
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Several risks of bias were present in most studies included in the review, which could upwardly bias the estimated effects. Many included studies did not clearly describe how they randomly assigned participants to treatment or control groups. Therefore, the current estimate of treatment effects from the eight rigorous studies should be treated with caution.
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What do the results mean?
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School is an important part of young people’s development. So it is important to address school refusal to ensure that all students engage with school appropriately. The most commonly studied interventions for school refusal are behavioural approaches and cognitive-behavioural therapy (CBT). The goal of these programs is to reduce the young person’s anxiety and increase attendance.
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The evidence provides tentative support for cognitive behavioural therapy (CBT) in the treatment of school refusal. But there is an overall lack of rigorous studies to draw a firm conclusion. Future studies should have larger sample sizes and pay attention to potential biases. Studies should also consider other types of interventions for rigorous evaluation. Assessing long-term effects may provide additional insights for the mixed findings of the effects of interventions on attendance and anxiety.
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How up-to-date is this review?
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This review started in November 2013, and was published in May 2015.