Paeds Vivas · growth-development-and-behaviour
School refusal and school attendance problems — branching viva
Branching viva on school refusal formulation, Kearney functions, graded return, CAMS/Melvin evidence, and certificate pitfalls.
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RACP DCEMRCPCH Clinical
Prompt
Clinic: parents of a 12-year-old with 6 weeks near-complete non-attendance, weekday morning pain, and a request for long-term medical certificates; school may phone mid-station.
Opening
Examiner: Define school refusal for a general paediatrics viva. [1]
Candidate: School refusal is a behaviour, not a freestanding diagnosis: difficulty attending school with emotional distress, usually with caregiver knowledge of the absence. I formulate drivers and maintaining functions rather than coding “school phobia.” [1] [2]
References8ShowHide
- [1]Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects. Behav Modif, 2004.PMID 14710711
- [2]Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry, 2003.PMID 12819439
- [3]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
- [4]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
- [5]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
- [6]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
- [7]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
- [8]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