Paeds Cases · growth-development-and-behaviour
Explain school refusal plan and possible SSRI to parents — OSCE
OSCE communication station: school refusal psychoeducation, functional return plan, CBT, SSRI monitoring, collaborative non-blaming family framing.
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Study tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parents of a 12-year-old with separation/social anxiety and 6 weeks of near-complete school non-attendance want a plain-language explanation of why this is not laziness, how graded return and exposure CBT work, why open-ended home schooling is unhelpful, when an SSRI such as sertraline might be considered, and how you monitor for activation and suicidal thoughts.
Candidate instructions
Explain school refusal as a treatable behaviour linked to anxiety (not bad parenting or laziness), outline exposure-based CBT and graded return-to-school, discuss reducing accommodation without blame, cover when an SSRI might be added and safety monitoring, check understanding, and respond to the request for indefinite home schooling. The examiner plays a parent. [1] [2] [5]
References8ShowHide
- [1]Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects. Behav Modif, 2004.PMID 14710711
- [2]Walkup JT, Albano AM, Piacentini J, Birmaher B, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med, 2008.PMID 18974308
- [3]Melvin GA, Dudley AL, Gordon MS, Klimkeit E, et al. Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial. Child Psychiatry Hum Dev, 2017.PMID 27485100
- [4]Bridge JA, Iyengar S, Salary CB, Barbe RP, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 2007.PMID 17440145
- [5]Heyne D, King NJ, Tonge BJ, Rollings S, et al. Evaluation of child therapy and caregiver training in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry, 2002.PMID 12049443
- [6]King NJ, Tonge BJ, Heyne D, Pritchard M, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adolesc Psychiatry, 1998.PMID 9549960
- [7]Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry, 2020.PMID 32439401
- [8]Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry, 2003.PMID 12819439