Risk Factor Profile in Inpatients with School Refusal: a Dimensional Model

Area of Science:

• Child and Adolescent Psychiatry
• Developmental Psychology
• Clinical Psychology

Background:

• School attendance problems, including school refusal and truancy, significantly impact youth development.
• Understanding the developmental trajectory of school refusal is crucial for early detection and improved management.
• A dimensional model suggests school refusal is an internalizing problem, while truancy is an externalizing problem, implying distinct risk factors.

Purpose of the Study:

• To investigate the developmental trajectory and risk factor profiles of school refusal in child and adolescent inpatients.
• To compare school refusal patients with those exhibiting truancy, behavior disorders, and eating disorders.

Main Methods:

• A retrospective study was conducted on four groups of child and adolescent inpatients: school refusal (SR), truancy (TR), behavior disorder without deschooling (BD), and eating disorder (ED).
• Group allocation was based on checklist criteria and inpatient diagnoses.
• Descriptive statistics, including Chi-squared and Fisher's exact tests, were used for group comparisons.

Main Results:

• Delayed language development, attachment disorder, ADHD, physical abuse, and substance abuse were more common in BD and TR groups.
• Learning disorders were prevalent across BD, TR, and SR groups.
• SR patients experienced more isolation and rejection, with higher rates of anxiety and mood disorders, while BD and TR groups showed more externalizing behaviors and violent family/peer interactions.

Conclusions:

• Severe school refusal in inpatients is associated with internalizing problems, emotional dysregulation, and social difficulties with peers.
• Behavioral disorders and truancy in inpatients are linked to externalizing problems and challenges in behavioral regulation.