[Inpatient Schema Therapy for School Avoidance - A Case Study]. / Stationäre Schematherapie bei Schulvermeidung ­ ein Fallbeispiel.

Inpatient Schema Therapy for School Avoidance - A Case Study Abstract. After a short overview of the basic concepts and methods of schema therapy, we report a case study on the inpatient treatment of a 16-year-old youth with depression and chronic school avoidance. The scores on the Schema inventories and Depression questionnaires are compared before vs. after the treatment, and we then discuss the opportunities and limitations of schema therapy with school-avoiding youths.

[Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior]. / Verlauf von Schulabsentismus 1.5 bis 3 Jahre nach Erstvorstellung: Prädiktoren, psychosoziales Funktionsniveau und Inanspruchnahme von Hilfen.

Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior Abstract. Objective: To explore the course of patients with school absenteeism 1.5-3 years after their initial evaluation, including symptoms, school attendance, psychosocial functioning, and help-seeking behavior. Method: Of the 237 patients from specialized psychiatric units for youths displaying school absenteeism, we successfully contacted 108 of them 1.5-3 years after initial admission. We conducted a telephone interview with their parents (SDQ, school situation, help-seeking behavior). Among others, we analyzed the extent of school absenteeism, the scales of the Inventory of School Attendance Problems (ISAP; Knollmann et al., 2019), and the quality of school absenteeism (school refusal vs. truancy vs. mixed group) at admission as possible predictors. Results: The patients had received an extensive amount of youth-welfare measures and inpatient, daycare, and outpatient therapy. 46.3 % had elevated values in the SDQ total score at follow-up, mostly because of emotional problems or problems with peers. Psychosocial functioning, including school attendance, was described as poor for only about 30 %. School attendance problems were significantly predicted by having a conduct disorder and elevated scores on the ISAP-scales Aggression, Teacher Problems, and Peer Problems, though the effect sizes were weak. Conclusions: Externalizing symptoms and associated psychosocial problems seem to be predictive of a negative course of school absenteeism. Implications for prospective longitudinal studies are discussed.

Towards a comprehensive assessment of school absenteeism: development and initial validation of the inventory of school attendance problems.

School attendance problems (SAPs) become manifest in many ways and are associated with multiple risk factors, calling for comprehensive assessment methods. This study documents the development of the inventory of school attendance problems (ISAP), which assesses both the quality and the function of a broad spectrum of SAPs by first asking students with SAPs to rate the intensity of symptoms prior to or at school and then to rate their impact on school attendance. An empirically generated pool of 124 items was analyzed (explorative factor analysis) using a clinical sample of N = 245 students with SAPs (53.5% male; Mage: 14.4). The Youth Self Report (YSR), a German version of the School Refusal Assessment Scale (SRAS), and the extent of school absenteeism were used to determine construct validity. The resulting 48 items loaded on 13 factors. The 13 scales assess internalizing and externalizing symptoms (Depression, Social Anxiety, Performance Anxiety, Agoraphobia/Panic, Separation Anxiety, Somatic Complaints, Aggression, School Aversion/Attractive Alternatives) as well as emotional distress due to problems in the school or family context (Problems with Teachers, Dislike of the Specific School, Problems with Peers, Problems Within the Family, Problems with Parents). All scales showed good internal consistencies. Their correlations with the YSR and the SRAS indicated convergent and discriminant validity. Positive associations between most of the scales and the extent of school absenteeism were obtained. Although preliminary, these results support the usefulness of the ISAP for a comprehensive assessment of SAPs in clinical settings.

[Economic evaluation of a manual-based, multimodal cognitive behavioural therapy for school avoiding children with psychiatric disorder]. / Ökonomische Evaluation eines manualbasierten Therapiekonzeptes für psychisch kranke Kinder und Jugendliche mit schulvermeidendem Verhalten.

Objective: Untreated school refusal increases the risk of a premature discontinuation of the educational career. The aim of this study is the economic evaluation of a manual-based treatment for school refusal in comparison to the standard treatment. Method: Within the cost-minimisation analysis, resource use is measured retrospectively for six months using the CSSRI questionnaire. Unit costs for most health care services are derived from published standard prices. Costs are calculated from the societal perspective based on prices compiled in 2011. The cost comparison during the one-year intervention period applies a difference in differences Approach. Results: The most common diagnoses among the 112 participants are phobic and emotional disorders. The average cost per patient during the intervention period amounts to 7197 € (95 %-CI: 4746 € ­ 10 079 €) for the manual group and 9294 € (95 %-CI: 6313 € ­ 12 878 €) for the control group. The difference in adjusted costs of 1453 € in favour of the manual group is not statistically relevant. Conclusions: The manual-based treatment is equivalent if not slightly advantageous compared to the standard treatment considering the clinical outcomes and cost of illness.

[The School Refusal Assessment Scale: Psychometric properties and validation of a modified version]. / Die Einschätzungsskala der Schulverweigerung: Psychometrische Gütekriterien und Validierung einer modifizierten Version.

Objective: Psychometric properties of the original and a modified version of the «Einschätzungsskala der Schulverweigerung¼ (German version of the School Refusal Assessment Scale, SRAS; Kearney & Silverman, 1993; Overmeyer et al., 1994) were analyzed in order to identify alternative ways to revise the SRAS/ESV compared to the existing revision SRAS-R (Kearney, 2002). The SRAS/ESV consists of a parent and a child version and measures four functions of school refusal (avoidance of negative affect related to school settings, escape from aversive social or evaluative situations, attention-getting behavior, positive tangible reinforcement). Method: Data from N = 124 (parent version) respectively N = 156 (child version) patients of a specialized psychiatric outpatient unit for children and adolescents with school-avoiding behavior were obtained. Analyzes included characteristics of items and scales, face-, factorial-, and construct-validity (correlations with other questionnaires, e. g., YSR, CBCL were analyzed). Results: Many items seem to measure overall anxiety instead of the functional aspects of school refusal, one item measures expansive behavior. Four factors were obtained, but they did not reflect the assumed structure of the ESV (e. g., overlap of the two avoidance-related scales). Post-hoc-analyzes with a modified version (elimination of several items with problematic content validity) suggested three factors, convergent and discriminative validity of the modified version was confirmed. Because only some of the afore-mentioned problems have been addressed in the revised version (SRAS-R; Kearney, 2002), a new revision and extension of the German version of the questionnaire covering more aspects of school avoidance behavior (e. g., bullying, depression, somatic complaints, psychosocial factors) is discussed.

[The differential classification of school avoidance- a cluster-analytic investigation]. / Differentielle Klassifikation schulvermeidenden Verhaltens.

OBJECTIVE: We investigated subtypes of school-avoiding children and adolescents in a German sample using cluster analysis. METHOD: 169 outpatients of a specialized outpatient unit for children and adolescents with school-avoiding behavior were subjected to cluster analysis using factor scores (principal factoring, varimax-rotation: measures of internalizing and externalizing symptoms, e.g., CBCL, YSR, and variables indicating the quality of school avoiding behavior, such as initial parental knowledge of school absence, activities during school absence). The resulting clusters were compared to other variables such as parental mental health problems, parental divorce, bullying in school, class repetition, and IQ. RESULTS: Three groups were identified: "school refusers" with low externalizing symptoms who mainly stayed at home with their parents and were informed about their school absence from the beginning. Second, the "truants" with strong externalizing symptoms who spent school time alone or together with peers outside their home and were absent in school without initial parental knowledge. In a third cluster, children showed more externalizing problems than the school refusers and less externalizing problems than the truants. Most of their parents were informed about the school absence from the beginning, although the dominant activity was staying at home alone. Internalizing symptoms had no impact on cluster formation. Comparisons of the three groups, however, showed higher internalizing problems for school refusers and the third cluster, which was then labeled "school avoidance with mixed symptoms." RESULTS AND CONCLUSIONS: In most cases, significant differences regarding potential stressors at home (e.g., parental mental health problems) or in school (e.g., bullying, class repetition) were not obtained.

Objective measurement of attention deficit hyperactivity disorder symptoms outside the clinic using the QbCheck: Reliability and validity.

Objective measurements of ADHD symptom levels can be a highly valuable complement to ratings. However, sometimes it is not feasible to bring patients into the clinic/lab for assessment. The aim of the present study was therefore to evaluate the psychometric properties of the QbCheck, an online computerized test that measures errors and reaction time as well as activity during testing using the computer's built-in web camera. Study I (n = 27 adolescents/adults) investigated test-retest reliability and concurrent validity of the QbCheck. Study II included 142 adolescents/adults (69 with ADHD/73 controls) and investigated convergent and diagnostic validity, as well as usability, of the QbCheck. In Study I, the QbCheck showed high test-retest reliability and high concurrent validity. In Study II, high convergent validity was observed when studying associations between the QbCheck performed in the home and the QbTest performed at the clinic. In addition, the QbCheck discriminated well between patients with ADHD and controls, with a sensitivity of 82.6 and a specificity of 79.5. The QbCheck appears to be a valuable test with good psychometric properties and will thereby enable assessment of ADHD symptom levels in adolescents and adults outside the clinic in the home setting.

[School refusal and psychiatric disorders in childhood and adolescence: findings from an outpatient sample of a psychiatric "school refusal ambulance"]. / Schulverweigerung und psychische Störungen: Merkmale von schulverweigernden Kindern und Jugendlichen und ihren Familien einer kinder- und jugendpsychiatrischen "Schulverweigererambulanz".

Based on a review of medical reports, a sample of 89 patients of a specialized school refusal outpatient unit of the Department of Child and Adolescent Psychiatry in Essen, Germany, is described. Variables included psychiatric diagnoses and treatment recommendations as well as individual and family characteristics such as type of school absence (school refusal vs. truancy), intelligence, anxiety, school career, parental occupational status, and parental divorce. Furthermore, differences between three groups of patients (anxious school refusers, truants, mixed school refusers) were explored. The results showed a high prevalence of psychiatric disorders and associated risk factors in the sample. Although some of the expected differences between the groups were obtained, the results yielded much overlap between anxious school refusers and truants and thus tended to stress the similarities among children who refuse to attend school.

The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness.

BACKGROUND: 5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders. METHODS: 112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life. RESULTS: In both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, p< 0.001; OR for MT versus TAU 1.05, 95% CI 0.58-1.90, p = 0.875). The improvement persisted 12 months after inclusion. CONCLUSION: In accordance with earlier studies, we found that manual-based multimodal treatment did not improve school avoidance to any greater extent than treatment as usual. Future studies should focus on the conditions for successful reintegration in school and on the differential indicators for outpatient versus inpatient treatment.

School avoidance from the point of view of child and adolescent psychiatry: symptomatology, development, course, and treatment.

BACKGROUND: A considerable percentage of children and adolescents who avoid school have mental illnesses. This article reviews the typical manifestations, classification, development, course, and treatment of school-avoiding behavior. METHODS: Based on a selective review of recent literature, we present findings on the psychopathologically relevant features of school-avoiding children and adolescents, including psychiatric diagnoses, developmental, family-related, and psychological test variables. The emphasis is placed on our own studies of the subject. RESULTS: Although the evidence from the studies that have been performed to date is not definitive, the available findings show that school avoidance is associated with poor mental health and with unfavorable consequences onward into adulthood. Its causes include a number of individual and social stressors that place excessive demands on the affected children and adolescents and lead them to avoid school as a coping attempt. CONCLUSIONS: Many preventive and therapeutic interventions are now available, but the existing measures need to be better coordinated, and more effort needs to be directed to the early recognition and treatment of school-avoiding behavior. Physicians should consider the possibility of mental illness. Rather than writing sick notes or prescribing mother-child treatments at health resorts, which rather tend to sustain the problem, they should refer patients promptly to a child and adolescent psychiatrist.