Le refus scolaire [School refusal]

Pediatrician are often questioned by school refusal which relies on a wide range of psychopathological features and necessitates specific approaches. This disabling condition remains underestimated and is still increasing. A poor prognosis associated with a prolonged school absence is the common hallmark of school refusals, regardless of its heterogeneity. Its seriousness warrants early identification and prompt intervention by childhood healthcare professionals, teachers and social workers. A specialized treatment is needed, closely linked with families and school. Promising developments come from a functional rather than symptomatic concept of school refusal. They offer tailored interventions which fit the clinical diversity of school refusals. After a brief historical summary and current definitions of school refusal, the authors review the main clinical features and comorbidity before taking up treatment modalities.

Current status of research on school refusal

School refusal behavior refers to the avoidance of a child attending school and/or persistent difficulty staying in the classroom throughout the school day. Based on a review of the scientific literature, the aim of this study is to describe the current state of research on school refusal, differentiating between the findings and progress made in Spain from those achieved in the international field. For this purpose, the significance of this phenomenon, in addition to associated risk factors and variables, will be reviewed in the child and youth population. In turn, the commonly used assessment methods and most recommended treatment proposals, mainly based on cognitive behavioral therapy, are discussed. The results reveal several gaps and subjects for debate in some areas of knowledge about school refusal behavior, with differences being found between Spanish and international studies. In conclusion, future studies and challenges in this field are required.

Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics

Background: Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. Methods: A consecutive series of children (n = 100, aged 6-12 years) and adolescents (n = 100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology. Results: Children were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance. Limitations: Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner. Conclusions: The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more ‘adolescent-friendly’ is unlikely to sufficiently meet the needs of adolescents.

Perfeccionismo socialmente prescrito como predictor del alto rechazo a la escuela

El creciente interés en el estudio del comportamiento de rechazo a la escuela se debe a las consecuencias negativas asociadas a esta problemática. Conocer aquellas variables psicoeducativas que predicen esta conducta resulta de interés para la comunidad científica en la actualidad. El objetivo de esta investigación fue analizar la capacidad predictiva el Perfeccionismo Socialmente Prescrito sobre las altas puntuaciones en rechazo escolar. En este estudio participaron 537 estudiantes españoles entre 8 y 12 años. Los instrumentos utilizados fueron la School Refusal Assessment Scale Revised for Children (SRAS-R-C), para medir los cuatro factores que subyacen al comportamiento de rechazo a la escuela (I. Evitar la Afectividad Negativa; II. Escapar de la Aversión Social o Evaluación; III. Búsqueda de la Atención de otras Personas Significativas; IV. Búsqueda de Refuerzos Tangibles Fuera del Ámbito Escolar), y la Child and Adolescent Perfectionism Scale (CAPS), para evaluar la subescala de Perfeccionismo Socialmente Prescrito. A partir de los resultados obtenidos se confirma que la subescala de perfeccionismo evaluada actúa como un predictor positivo de altas puntuaciones en rechazo escolar para los factores II y III de la SRAS-R-C. Estos resultados deben ser valorados por psicólogos escolares y especialistas al evaluar la problemática del rechazo escolar siendo necesario proponer estrategias de prevención e intervención.

Estudio correlacional entre el afecto negativo y el rechazo escolar

El estudio del afecto y su relación con el comportamiento de rechazo a la escuela es un campo de investigación con escasos trabajos previos. El objetivo de estudio fue analizar la relación entre el Afecto Negativo y los distintos factores que justifican el rechazo escolar en estudiantes de Educación Primaria. La muestra estuvo compuesta por 476 estudiantes españoles con un rango de edad que osciló entre los 8 y los 12 años (M = 10.08; DE = 1.28). Las variables de este estudio fueron evaluadas mediante el 10-Item Positive and Negative Affect Schedule for Children (PANAS-C), para medir la subescala de Afecto Negativo, y la School Refusal Assessment Scale-Revised for Children (SRAS-R-C), para evaluar los cuatro factores que justifican el comportamiento de rechazo a la escuela (I. Evitar la Afectividad Negativa; II. Escapar de la Aversión Social o Evaluación; III. Búsqueda de la Atención de otras Personas Significativas; IV. Búsqueda de Refuerzos Tangibles Fuera del Ámbito Escolar). Los resultados revelaron que existían correlaciones positivas y significativas entre el Afecto Negativo y los tres primeros factores de la SRAS-R-C, mientras que no resultaron significativas para el cuarto factor. Los resultados obtenidos confirman la relación entre sentimientos de afectividad negativa y el rechazo escolar, aspecto que debe ser considerado en el estudio de estos casos.

Revisión bibliométrica del rechazo escolar: perspectivas de investigación y su análisis

El rechazo escolar es una de las problemáticas educativas que interfiere negativamente en el desarrollo social y educativo del niño. El objetivo de este estudio fue analizar la productividad científica sobre rechazo escolar durante el periodo 2004- 2013, con la finalidad de ofrecer una descripción global del estado actual de la investigación sobre rechazo a la escuela y comunicar las últimas aportaciones científicas. La búsqueda bibliográfica se realizó mediante cuatro bases de datos internacionales obteniendo una muestra de 345 trabajos. Los resultados obtenidos indicaron un crecimiento progresivo de los niveles de productividad y destacan el interés científico por los estudios dirigidos al tratamiento del rechazo escolar y los factores de riesgo asociados al absentismo. Este estudio bibliométrico permite conocer la evolución que ha seguido la investigación sobre rechazo escolar durante la última década, sirviendo como marco de referencia para futuras investigaciones que precisen conocer aquellas tendencias de estudio más desarrolladas junto a las líneas de investigación emergentes, las cuales requieren ampliar sus estudios y una consolidación científica.

Diferencias en perfeccionismo socialmente prescrito en función del rechazo escolar

La relación existente entre el perfeccionismo y el rechazo a la escuela es un ámbito de investigación con escasos estudios. El objetivo de este trabajo fue analizar la relación entre Perfeccionismo Socialmente Prescrito (PSP) y rechazo a la escuela en función de los factores II (escapar de la aversión social y/o situaciones de evaluación de la escuela) y III (búsqueda de la atención de otras personas significativas) que justifican esta conducta. La muestra estuvo compuesta por 733 estudiantes españoles entre 8 y 12 años (M= 10.03, DE= 1.25). Los instrumentos utilizados para establecer esta relación fueron la Child and Adolescent Perfecctionism Scale, para medir el perfeccionismo, y la School Refusal Assessment Scale-Revised for Children, para evaluar el rechazo escolar. Los resultados revelaron que los estudiantes que presentaron altas puntuaciones en rechazo escolar, debido a la necesidad de escapar de la aversión social y/o situaciones de evaluación, presentaron puntuaciones significativamente más altas en PSP. Igualmente, los estudiantes con alto rechazo escolar basado en la búsqueda de atención de sus seres queridos, presentaron puntuaciones significativamente más altas en PSP. Así, los resultados apoyaron que existe una relación positiva entre estas dos variables. Estos resultados podrían ser considerados por docentes y psicólogos escolares o clínicos a la hora de diseñar estrategias de prevención e intervención ante casos de rechazo a la escuela.

Group cognitive -behavioral therapy for heterogeneous anxiety disorders in children and adolescents: A multiple baseline study

This study investigated the efficacy of Group Cognitive-Behavioral Therapy (GCBT) in the treatment of heterogeneous anxiety disorders in children. A partially nonconcurrent multiple baseline across groups design was used to assess the effects of the treatment on 12 clinically referred children and adolescents between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included Obsessive Compulsive Disorder, Simple Phobia, Separation Anxiety Disorder, Social Phobia, and Generalized Anxiety Disorder, with three of the children also presenting with school refusal behavior. Duration of baseline for each of the three groups varied and ran for one, two, or three weeks. Dependent measures included diagnostic status, child and parent-completed reports, and daily child and parent ratings of child anxiety severity. Results indicated that GCBT was efficacious in reducing anxious symptoms in children and adolescents treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders. ^

Recusa escolar em adolescentes: caracterização e situação 27 a 60 meses após a admissão em hospital de dia

Introdução: A recusa escolar, definida como ausência escolar por causas emocionais, é o motivo de encaminhamento mais frequente para o Hospital de Dia de Adolescentes da Clí- nica da Juventude. Objectivos: Este estudo pretendeu caracteri- zar os jovens admitidos por recusa escolar e avaliar a sua situação 27 a 60 meses após a sua admissão no Hospital de Dia da Clínica da Juventude. Métodos: Consulta dos processos clínicos de todos os doentes admitidos entre 01 de Janei- ro de 2010 e 31 de Julho de 2012, de modo a avaliar as variáveis: motivo de admissão, sexo, idade, retenções escolares prévias, diag- nóstico, presença de psicopatologia parental, duração do seguimento e número de sessões efectivadas. Foi, ainda, realizado um ques- tionário por via telefónica a todos os doentes que tinham sido admitidos por recusa esco- lar, 27 a 60 meses após a admissão, de modo a apurar a situação escolar/laboral actual, manutenção de seguimento psiquiátrico e sintomatologia emocional e comportamen- tal actual.

A cognitive model of binge drinking: The influence of alcohol expectancies and drinking refusal self-efficacy

While binge drinking-episodic or irregular consumption of excessive amounts of alcohol-is recognised as a serious problem affecting our youth, to date there has been a lack of psychological theory and thus theoretically driven research into this problem. The current paper develops a cognitive model using the key constructs of alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) to explain the acquisition and maintenance of binge drinking. It is suggested that the four combinations of the AE and DRSE can explain the four drinking styles. These are normal/social drinkers, binge drinkers, regular heavy drinkers, and problem drinkers or alcoholics. Since AE and DRSE are cognitive constructs and therefore modifiable, the cognitive model can thus facilitate the design of intervention and-prevention strategies for binge drinking. (C) 2003 Elsevier Ltd. All rights reserved.

The HYP program - Targeted motivational interviewing for adolescent violations of school tobacco policy

Objective. To evaluate the efficacy of a short-term tobacco-focused intervention for high school students referred by school administrators because of tobacco use. Method. A sample of 56 adolescents (66% male, mean age 15 years) was recruited through referrals from three state high schools. Participants were randomly assigned to a one-hour motivational interview (MI) session or to standard care (advice/education). The two groups were followed up at one, three, and six-month intervals. Results. The MI intervention resulted in significant short-term reductions in quantity and frequency of smoking relative to standard care, however, effects were not maintained at 3- and 6-month follow-up. Improvements in refusal self-efficacy were significant relative to standard care. Conclusion. For adolescents who are established smokers and at high risk of other problems, motivational interviewing was associated with modest short-term gains relative to standard care. (c) 2006 Elsevier Inc. All rights reserved.

Time trends and predictors of initiation for cigarette and waterpipe smoking among Jordanian school children: Irbid, 2008-2011

Smoking prevalence among adolescents in the Middle East remains high while rates of smoking have been declining among adolescents elsewhere. The aims of this research were to (1) describe patterns of cigarette and waterpipe (WP) smoking, (2) identify determinants of WP smoking initiation, and (3) identify determinants of cigarette smoking initiation in a cohort of Jordanian school children. ^ Among this cohort of school children in Irbid, Jordan, (age ≈ 12.6 at baseline) the first aim (N=1,781) described time trends in smoking behavior, age at initiation, and changes in frequency of smoking from 2008–2011 (grades 7–10). The second aim (N=1,243) identified determinants of WP initiation among WP-naïve students; and the third aim (N=1,454) identified determinants of cigarette smoking initiation among cigarette naïve participants. Determinants of initiation were assessed with generalized mixed models. All analyses were stratified by gender. ^ Baseline prevalence of current smoking (cigarettes or WP) for boys and girls was 22.9% and 8.7% respectively. Prevalence of ever- and current- any smoking, cigarette smoking, WP smoking, and dual cigarette/WP smoking was higher in boys than girls each year (p<0.001). At all time points, prevalence of WP smoking was higher than that of cigarette smoking (p<0.001) for both boys and girls. WP initiation was documented in 39% of boys and 28% of girls. Cigarette initiation was documented in 37% of boys and 24% of girls. Determinants of WP initiation included ever-cigarette smoking, low WP refusal self-efficacy, intention to smoke, and having teachers and friends who smoke WP. Determinants of cigarette smoking initiation included ever-WP smoking, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends and family who smoke.^ These studies reveal intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of WP smoking. WP may be a vehicle for tobacco dependence and subsequent cigarette uptake. The sizeable incidence of WP and cigarette initiation among students of both sexes points to a need for culturally relevant smoking prevention interventions. Gender-specific factors, refusal skills, and smoking cessation of both WP and cigarettes for youth and their parents/teachers would be important components of such initiatives. ^

Determinants of Waterpipe and Cigarette Smoking Progression among a School Based Sample of Adolescents in Irbid, Jordan: A Three-Year Longitudinal Study (2008-2011)

The prevalence of waterpipe smoking exceeds that of cigarettes among adolescents in the Middle East where waterpipe is believed as less harmful, less addictive and can be a safer alternative to cigarettes. This dissertation tested the gateway hypothesis that waterpipe can provide a bridge to initiate cigarette smoking, identified the predictors of cigarette smoking progression, and identified predictors of waterpipe smoking progression among a school-based sample of Jordanian adolescents (mean age ± SD) (12.7 ±0.61) years at baseline. Data for this research have been drawn from Irbid Longitudinal Study of smoking behavior, Jordan (2008-2011). The grouped-time survival analysis showed that waterpipe smoking was associated with a higher risk of cigarette smoking initiation compared to never smokers (P < 0.001) and this association was dose dependent (P < 0.001). Predictors of cigarette smoking progression were peer smoking and attending public schools for boys, siblings’ smoking for girls, and the urge to smoke for both genders. Predictors of waterpipe smoking progression were enrollment in public schools, frequent physical activity, and low refusal self-efficacy for boys, ever smoking cigarettes, friends’ and siblings’ waterpipe smoking for girls. Awareness of harms of waterpipe among boys and seeing warning labels on the tobacco packs by girls were protective against waterpipe smoking progression. In Conclusion, waterpipe can serve as a gateway to cigarette smoking initiation among adolescents. Waterpipe and cigarette smoking progressions among initiators were solely family-related among girls, and mainly peer-related among boys. The unique gender differences for both cigarette and waterpipe smoking among Jordanian adolescents in Irbid call for cultural and gender-specific smoking prevention interventions to prevent the progression of smoking among initiators.