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

Glenn A Melvin1, Amanda L Dudley2, Michael S Gordon2,3

  • 1Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. glenn.melvin@monash.edu.

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Summary

Adding fluoxetine to cognitive behavior therapy (CBT) for anxious school refusal did not significantly improve attendance. However, adolescents reported higher satisfaction with CBT plus fluoxetine compared to CBT alone.

Keywords:
Anxiety disordersCognitive behavior therapyFluoxetineSchool refusal

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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.