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Paeds Vivasadolescent-and-young-adult-medicine

Paeds Vivas · adolescent-and-young-adult-medicine

School refusal, bullying and social exclusion — branching viva

Branching viva on the three overlapping drivers of adolescent school disengagement: formulation, bully-role assessment, suicide risk, graded return and SSRI evidence.

branching clinical structured oral3 min readVerification in progress

Target exams

RACP DCEMRCPCH Clinical
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Target exams

RACP DCEMRCPCH Clinical
Prompt
Clinic: a 14-year-old with 6 weeks of near-complete non-attendance, weekday morning nausea, cyberbullying via a group chat, and a parental request for long-term certificates and home schooling; the school welfare lead may phone mid-station.

Opening

Examiner: Frame the adolescent whose attendance collapses after bullying. Why is this one problem with three drivers, not three separate problems? [1] [9]

Candidate: Because school refusal, bullying victimisation and social exclusion overlap and reinforce each other through a shared mechanism — lost school connection drives internalising distress, which deepens avoidance. The adolescent may be an anxious refuser, a cyber-victim and excluded from the peer group at the same time. I assess all three, formulate all three, and move on all three the same week. [1] [9]

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References12ShowHide
  1. [1]Kearney CA, Albano AM The functional profiles of school refusal behavior. Diagnostic aspects. Behavior Modification, 2004.PMID 14710711
  2. [2]Egger HL, Costello EJ, Angold A School refusal and psychiatric disorders: a community study. Journal of the American Academy of Child and Adolescent Psychiatry, 2003.PMID 12819439
  3. [3]Heyne D, King NJ, Tonge BJ, Rollings S, et al. Evaluation of child therapy and caregiver training in the treatment of school refusal. Journal of the American Academy of Child and Adolescent Psychiatry, 2002.PMID 12049443
  4. [4]King NJ, Tonge BJ, Heyne D, Pritchard M, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. Journal of the American Academy of Child and Adolescent Psychiatry, 1998.PMID 9549960
  5. [5]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 and Human Development, 2017.PMID 27485100
  6. [6]Walkup JT, Albano AM, Piacentini J, Birmaher B, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 2008.PMID 18974308
  7. [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. [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. Journal of the American Academy of Child and Adolescent Psychiatry, 2020.PMID 32439401
  9. [9]Holt MK, Vivolo-Kantor AM, Polanin JR, et al. Bullying and suicidal ideation and behaviors: a meta-analysis. Pediatrics, 2015.PMID 25560447
  10. [10]Moore SE, Norman RE, Suetani S, et al. Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis. World Journal of Psychiatry, 2017.PMID 28401049
  11. [11]Klomek AB, Kleinman M, Altschuler E, et al. Suicidal adolescents' experiences with bullying perpetration and victimization during high school as risk factors for later depression and suicidality. Journal of Adolescent Health, 2013.PMID 23790199
  12. [12]Fraguas D, Díaz-Caneja CM, Ayora M, et al. Assessment of School Anti-Bullying Interventions: A Meta-analysis of Randomized Clinical Trials. JAMA Pediatrics, 2021.PMID 33136156
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