School Refusal Behaviour - Literature review Example

School Refusal Behaviour: Literature Review Literature Review The central part of school refusal behaviour is to understand why and how school refusal happens. Having a model or theoretical framework for school refusal has advantages as it shows why young people miss school, how this could be explained and what are the recommendations for assessment for such behaviour. Research Questions The research questions for studying school refusal behaviour are as follows: Research Question 1. How pertinent or relevant is school refusal behaviour in schools ? Research Question 2. Is school refusal behaviour common in a certain population or common among men than women, among boys rather than girls? Research Question 3. What are the reasons given by children and their parents on school refusal behaviour? Research Question 4. What is the relationship among reported reasons for school refusal and parenting styles and do certain parenting styles encourage school refusal behaviour? It has been suggested by many researchers that children avoid school as they tend to avoid negative affectivity and problems at school. There is also an escapism involved as children try to escape aversive school based evaluative situations in which they are monitored, checked or controlled and sometimes they avoid school to pursue other activities that would give them positive self esteem (Kearney et al, 2004). Generally children from all racial backgrounds and income groups could avoid schools and there is no difference seen on the basis of demographic variables. Yet school refusal has been found to be more prevalent among young adolescents and among children who enter school for the first time. Generally refusal behaviour is high among children going to school for the first time and children who have changed schools and have to face a new school environment. In these cases they are prone to refuse going to school as a route to escape from the harsh school environment although this harshness may be all perceived. Children entering a new school as while moving from kindergarten to first grade or from middle to high school, there could be some refusal behaviour (Kearney, Lemos, & Silverman, 2004). However even if refusal problem is high among children, it takes at least 1 or 2 years for them to get diagnosed about the problem or receive any form of treatment. If the child stays out of school for a long time, they become habituated to their lifestyle without school and tend to stay away longer and researchers like Brand & O’Conner (2004) have suggested that girls show more refusal behaviour than boys. This has been explained with the separation anxiety being primarily female so girls feel unsafe and without support I school and may show refusal behaviour. However in another study Last & Francis (1988) suggested that phobic and anxious children tend to be male. Usually refusal symptoms may be seen in young people and usually begins after illness or holiday or after weekends and vacations when young people become used to their way of life. Some children may leave home to actually attend school but finally decide not to attend. According to Strauss (1990), phobic and anxious school refusers tend to have a later age of onset and show more pervasive school refusal compared with those school refusers with separation-anxiety. Certain characteristics such as phobias and anxieties are responsible for school refusal in boys and occur in late stages of life whereas separation anxiety in girls cause them to show school refusal early in life. Some school avoidant behaviours may be associated with severe depression (Kearney, 1993). However there could be triggers such as broken homes, family distress, legal and financial difficulties, family conflicts and disruption, traumatic personal experiences, transitions and illness, and these could cause depression among children and long term consequences such as economic deprivation and marital or professional problems and in some cases psychiatric counselling for social maladjustment (Kearney & Bates, 2005). School refusal show risk behaviour and could also show other underlying deviance or problem patterns such as violence, injury, substance abuse, economic deprivation and psychiatric disorders. According to King & Bernstein (2001) school absenteeism and refusal behaviour is seen among 5% of school children and it seems most school children would be happy about going to school. Heyne et al (2001) found that refusals are most common among 7th and 8th grade students at the ages of 12 through 14. School refusal has been often grouped with other associate problems of school phobia and separation anxiety and juvenile delinquency. School absenteeism is more often than not explanatory for long term school and in psychological behavioural analysis refusal behaviour is a form of absenteeism and that is how refusal behaviour is understood. However school refusal behaviour is till a vague field of study and there could have significant problems in developing a classification system that would explain refusal. School refusal could have many explanations and implications and multiple factors may be responsible that may not be easy to develop into a classification system (O‘Connor, 2004). There is no classification on subtypes of school refusal and there is also a lack of systematic information about school refusal behaviour thus making studies like this especially important in the understanding of children and their attitudes towards school. In fact categorizing may be quite difficult as the behaviour highly varies according to individual situations. There are however common traits of school refusal behaviour and these could be temper outburst, emotional upset, antisocial traits of lying and destructiveness and heightened distress and negative affect. School refusers are also at the same time labelled as truant, deviant, antisocial, phobic, or suffering from anxiety disorder (King et al, 2001). They may also exhibit poor academic progress as nothing in school interests or attracts them. In some children the fear may be specific and geared towards an object or person, for example when a child is afraid of the teacher at school or afraid of bullying by older members may not want to attend school any further (King et al, 2001). The functional model of school refusal suggested school going as a function and children avoid it to engage in other more attractive functions such as attending sports or pursuing hobbies. Some others may find the school environment hostile and uncomfortable whereas to others the transition of home to school could come as a sudden shock they are unable to cope with and they are most likely to cry and plea to take them to more familiar grounds as the home (Kearney et al., 2004). In some cases children may avoid evaluations, competitions, tests, examinations and refuse to go to school if they find it a harsh and competitive place. Situations that could potentially help children and older students to like their schools would be close relationships such as friendship, group activities such as barbecues, eating and playing together, etc. In many cases children miss school as there could be attractive other options and in some cases young people may work and earn money and drop out of school altogether. Attention seeking behaviour seems to be very common among school refusers (Kearney et al., 2004). In some cases students may be looking for immediate pleasures and can do drugs, watch television or seek group activities like riding and sailing and they find these options more interesting and especially show when these attitudes are supported by problems in the family. Parenting styles could have an impact on school refusal as such individuals show isolation and conflicts, detachment and lack of cohesion (Kearney, 2007). Absenteeism has been linked with alcoholism, as well as divorce and quality of living standards and neighbourhoods. Parental and family practices could have an impact on school based outcomes and child home environment seems to be related to child school environment substantially as far as the studies have shown (Spera, 2005). Adolescents looking for a sense of change, autonomy and self exploration may also find school environment restrictive. Authoritarian domineering parenting styles could be bad as also too permissive parenting styles although authoritative parenting styles in which children both love and respect their parents is likely to be most successful in motivating children to go back to school and reduce their absenteeism. With age, children however become more detached and become capable of happy, independent achievers (Bateman and Karr-Kidwell, 1995). Authoritative parents are able to bring about positive changes and positive adjustments in children suggesting that parenting styles have a lot of impact on school refusal behaviour. Authoritative parents are also more emotionally mature and emotionally secure and are able to instil a sense of comfort, security, independence in children so they develop courage to face adversities in all situations, including school situations and show minimal escapism. Kearney and Silverman (1995) described five familial relationship subtypes that could explain school refusal behaviour and these are the enmeshed family, mixed family, conflictive family, detached and isolated family and healthy family. The detached and isolated family members are likely to teach detachment to their children as well who could show school refusal behaviour. The conflictive and forever disturbed family could make children violent and disobedient and this would hinder their school attendance. The healthy and adjusted family would also promote adjustment in the children and they are least likely to show school refusal behaviour. Assessing the children who are likely to be school refusers would require the efforts of GPs and school staff, parents and mental health professionals and together they can prevent children from become delinquent or from sowing school refusal behaviour. When assessing refusal behaviour, it is important to consider all aspects including family interaction and conflicts, poor group communication, treatment targets and parent child relationships. During assessment of children and families about possible school refusal behaviour, (Kearney & Silverman, 1995) suggested that including multiple methods and sources of information, and developmentally sensitive and appropriate measures could be useful. Also whether assessing children, families, or both, the best assessment would include a range of such methods. Kearney (2001), assessed children and families and school refusal behaviour by asking questions on history, duration, impairment, internalizing, and externalizing symptomatology, external stressors, and other related issues. Assessments could include structured self-report or less structured methods and observations in an interviewing process. Treating young people with school refusal behaviour may be challenging and critical especially as this could have long ranging consequences and could be serious and debilitating for children and their families. In addition children may have to learn how to establish self control and also how to tackle their anxiety issues (Kearney & Bates, 2005). . Cognitive behaviour therapy and restructuring could help in modifying any irrational thoughts and aid in thinking realistically so children start liking instead of hating schools. Positive reinforcement associated with schools is also effective and exposure based techniques with students being exposed to the school situation would also be effective (Kearney & Albano, 2000) and could control their anxieties. Reducing assurance seeking behaviour and pursuing school attendance are useful strategies and parents are also taught to deal with children’s behaviour. Family based treatment methods would be communication and problem solving, supervision and peer refusal or tackling skills training. Children are taught how to react and defend themselves so that they do not become victims of incidents in school. Peer refusal techniques also help children to overcome suggestion and temptation from others to miss school as missing school is sometimes a planned group activity. The family dynamics is directly responsible for such change of behaviour. School refusal could have complex diagnostic patterns and the treatment focus should be on children as also on problems within the family if any. The therapeutic strategy helps in re-establishing parenting responsibility of instilling confidence in children. Some of the methods for treatment and assessment of school refusal behaviour are given as structured interviews, child self report measures, behaviour observation and parent-teacher questionnaires. Structured interviews would follow the DSM IV criteria and would be about conducting interviews with parents and the children (Silverman & Albano, 1996). Interviews could be on questions regarding school based anxiety, stimuli that is causing fear or avoidance, reasons of avoidance or escapism, intensity, frequency of absenteeism. Interviews will have to consider developmental and other personal differences of children and it has been noted that school refusal behaviour is critical component of school behaviour. Kearney and Silverman’s Functional Model of School Refusal (1996) assesses the functions that are most relevant to a particular case of school refusal behaviour. These could be related to sense of negative affectivity; escaping aversive or violent and unpleasant school-based social and/or evaluative situations; pursuing attention to and from significant others, or pursuing tangible hobbies and other distractions. Child self report measures are also equally potent and child self reports examines the level of fear and social anxiety, depression and externalizing behaviour problems that are often associated with absenteeism. Some of the self report tools sued for this purpose are given as Fear Survey Schedule for Children-Revised (Ollendick, 1983); Social Anxiety Scale for Children-Revised (La Greca & Stone, 1993; Multidimensional Anxiety Scale for Children (March, 1997) ; and the Youth Self Report (Achenbach & Rescorla, 2001). The children are encouraged to provide their reasons for staying away from school and share their experiences and concerns in such self reports. The Parent /Teacher questionnaires help in assessing the internalized and externalized behaviour problems associated with school refusal and some examples of parent/teacher questionnaires and surveys are the Child Behavior Checklist and Teacher’s Report Form (Achenbach & Rescorla, 2001) and the Conners’ Parent and Teacher Rating Scales (Conners, 1997). Understanding child behaviour and issues by reviewing school records is also a viable method of analysis and assessment of school refusal behaviour. Accessing school based records and interviewing knowledgeable personnel and people or other students would provide key insights and reasons for which children show refusal behaviour. This information could be derive form attendance records, records on children’s preferences, friends, grades, disciplinary actions etc. Finally behavioural observation are used as assessment techniques to study refusal behaviour amongst school children and the method is to rate the child’s behaviour even before he goes to school. This would help in prediction of school refusal behaviour. A child with a dislike for school will naturally take more time to get dressed and show some resistance to school going. The child’s natural environment is taken into consideration s there is no chance of experimental manipulation and a large amount of data could be obtained from behavioural observations. However substantial time and resources would be needed for this kind of observation and both external and internal observations with multiple functions and variance could explain school refusal behaviour. According to family patterns, parents of troubled children may be provided advice on how they could reinforce attendance by decreasing their excuses of child behaviour or how they could provide the most appropriate attention to their children (Kearney & Silverman, 1995). As researchers have suggested there should be clearly defined boundaries. In many conflictive families with emotional issues school refusal behaviour is common and can be addressed by assessment and monitoring (Zigler, Taussig, and Black, 1992) and the rate of change in school attendance is the focal point of treatment. Treatment should be about the whole family and addressing inter parent or parent child hostility and conflict (Foster, 1989) is also a major issue and can be done with communication and reattribution. In case of detached families that have very weak ties, constant communication would be important in reducing child’s school refusal behaviour and other therapeutic techniques would be necessary. Detached families should focus on improving communication skills and contacts between parents and children. Kearney and Silverman (1995) suggested that isolated families prevent interaction of children with peers and a therapeutic possibility would be to increase the child’s integration in participating in extracurricular activities. Children in isolated families should also receive social skills training, costive behavioural therapy, role play, and family’s attendance at therapy could have positive effects. Within the healthy and mixed families, relaxation training, systematic desensitization, and encouraging to return to school, whether gradually or suddenly, are effective techniques in treating school refusal behaviours among children. The treatment focus should be on problematic and absentee behaviours and clinicians have to address problematic family subsystems and maladaptive behavioural patterns. Some of the treatment methods indicated for child school refusal behaviours are Cognitive behavioural therapy, Medical and pharmacological treatment, and Treatment in school. Cognitive Behavioural Therapy: According to Heyne, King, Tonge, and Cooper (2001), cognitive behavioural therapy (CBT) should be the first option for treatment of school refusal cases as CBT could be potentially the most effective method of treatment. Also along with CBT, adjunctive, complementary, additional, supplementary or successive pharmacological treatment should be used. King et al. (1998b) found that short term cognitive-behavioural intervention could be very efficacious on treatment of all aspects of refusal behaviours (King, Heyne, Tonge, Gullone, Ollendick, 2001). In an intensive 4-week CBT treatment program that was studied and conducted by King et al. (2001), the long-term and also the short term benefits of CBT, its applications in behavioural changes were observed in 15 of 17 school refusing children. CBT has been supported as the most effective therapeutic method in such cases as it focuses on corrective behaviour. Medical and pharmacological treatment: As far as using medication or pharmacological methods, the main goal of treatment with medication is to use these products on children with school refusal and facilitate their early return to school. It is also noted that physicians should avoid writing excuses for children to stay out of school unless, of course, a medical condition makes it necessary for the child to stay at home so that children are not encouraged to stay at home and avoid school without a proper medical reason. In some cases children who refuse to go to school and comes up with an excuse may also show physical symptoms and it is the duty of the physicians to inform their parents that the physical symptoms in the children are a result of underlying psychological distress or a manifestation of school avoidance behaviour and not a sign of any authentic physical illness (Fremont, 2003). However when considering medication or pharmacological treatment for school refusal, researchers have suggested that medication should never be used as a sole intervention and medication can only be used as complementary to or in conjunction with other behavioural or psychotherapeutic interventions (Fremont, 2003). Treatment in school: A prescriptive treatment package considers the functional model of school refusal as the child’s school refusal depends on a function served. The functions from refusal behaviour may be perceived advantages of not attending schools and the children may feel regained comfort or more time for play when they refuse to attend school. Treatment packages in school would seek to eliminate any reinforcement that is derived from school refusal behaviour and would aim to enhance the skills that are necessary for anxiety management to overcome possible anxiety syndrome while attending school and would also focus on family problem solving so that the family has a greater contribution to the child‘s well being (Kearney et al., 2004). The treatment package serves as a functional model and in some cases parents are made aware of the child’s refusal behaviour and participate actively in providing treatment to the child along with the school management. Kearney and Bates (2005) suggest that parents should be notified of child behaviour and a good strategy for notifying parents of possible absenteeism in children could be a “letter of concern” that would delineate the problems, current situation, risks of non-attendance and possible measures as well as an invitation to parents to participate in a consultation. Effective school based programs targeting at risk youth or you who may be showing school refusal behaviours suggest that these programs must focus on developing self esteem. If self esteem is developed in school children, academic achievement would improve. Students would also successfully reach high school or higher if they are instilled with self esteem and along with reducing school refusal behaviour, students would be able to actually enjoy school and achieve accordingly. It is considered critical that educators should not only be made aware of the programs that are available in their schools, but should know and judge how and why these programs are implemented and what methodologies are involved (Bateman & Karr-Kidwell, 1995). Self esteem builds self respect and with increasing self respect there would be increased academic and personal achievement. In these self esteem programs students participate in diverse activities and such students showed fewer social problems and fewer school refusal cases. They are also socially adjusted with other students at school or neighbourhood which gives them a positive sense of belonging to the school community. The increase in student self-esteem also had a positive impact on school climate, on home environment and on the attitudes of the students (Bateman & Karr-Kidwell, 1995). Some of the programmes as studied or described by researchers as being effective in reducing school refusals are: Power of Positive Students (POPS). This program developed by William Mitchell, is a structured, planned program and focuses on a variety of activities that students perform or participate in that aimed at elevating young peoples’ self-esteem. Striving to Achieve Resiliency for Adolescents (STAR). This program was developed by the Texoma Council on Alcoholism and Drug Abuse in 1990. The aim of the program is to reduce the risks of substance abuse by incorporating group participation of adolescents or children at risk of refusal behaviour and substance abuse in structured, curriculum-based activities. Esteem Team. This is an experiential program from Texan Camp Fire which Is targeted at 7th grade students. The objective of this program is to promote self-esteem in students by empowering young people to take decisions and teaching them to be positive role models for their peer group and other students at school. Success Strategies for At-Risk Students. This program was developed by the Center for Success in Learning and is centred on learning style theory. This program advocates teaching appropriate learning style to at risk students that could help improve academic achievement. According to the program, this improvement could lead to a better self-concept, and thus enhance self-esteem. Natick, Massachusetts School District. The program utilizes a prevention-intervention approach and is applicable for students at the elementary, middle, and high school levels. The program encourages independence and prepares all students to function independently and successfully while they study at different grades or levels. (Bateman & Karr-Kidwell, 1995). Program started by Christine Nolen, Special Education Instructor of the Whitesboro ISD. This program developed by Ms. Nolen recognized the need for TLC among students at risk. Unlike other programs, this supports the emotional needs of the students and was built for children of 6th through 8th grades. The program identifies 6-10 students who are in danger of failures or school refusal behaviours and parents are notified and then a self esteem creating routine is followed among them (Bateman and Karr-Kidwell, 1995). This literature review highlighted on potential causes, manifestation, treatment and control methods for school refusal behaviour in children and adolescents. The next stage of the analysis discusses the methodology for this study. References American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2001). 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Early childhood intervention: A promising preventative for juvenile delinquency. American Psychologist, 47, 997-1006. Read More