Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial.

Area of Science:

• Child and Adolescent Psychiatry
• Clinical Psychology
• Pharmacotherapy

Background:

• School refusal is a significant issue in adolescents, often linked to anxiety and depression.
• Cognitive Behavior Therapy (CBT) is a common treatment, but its effectiveness in improving school attendance can be limited.

Purpose of the Study:

• To investigate if augmenting CBT with fluoxetine improves outcomes for adolescents with anxious school refusal.
• To compare the efficacy of CBT alone, CBT plus fluoxetine, and CBT plus placebo.

Main Methods:

• A randomized controlled trial involving 62 adolescents (11-16.5 years) with anxious school refusal.
• Participants were assigned to CBT alone, CBT + fluoxetine, or CBT + placebo.
• Outcomes measured included school attendance, anxiety, depression, self-efficacy, and global functioning, assessed at acute treatment, 6 months, and 1 year.

Main Results:

• All treatment groups showed significant improvements in school attendance and psychological measures.
• School attendance stabilized at approximately 54% across all groups during follow-up.
• The CBT + fluoxetine group reported significantly higher treatment satisfaction than the CBT alone group.

Conclusions:

• Augmenting CBT with fluoxetine did not lead to superior improvements in school attendance or anxiety/depression symptoms compared to CBT alone or placebo.
• School refusal is a chronic condition, and current treatments may not sufficiently improve school attendance rates.
• Further research is needed to identify more effective interventions for improving school attendance in this population.