Jun 04, 2013


Cognitive-behavioral therapy was given to school-refusing children. The six therapy sessions explored ways in which children could recognize and cope with their anxiety, and gradually exposed children to anxiety-provoking situations. Results indicated that children who received treatment improved their school attendance as well as their emotional distress and coping mechanisms. No differences were found between the treatment group and control group in internalizing and externalizing behaviors reported by teachers or externalizing behaviors reported by parents.


Target population: School-refusing children

Children who meet the criteria for school-refusal are given four weeks of cognitive-behavioral therapy. The treatment consists of six 50-minute sessions evenly distributed across four weeks. Themes explored in the sessions include identifying anxiety-provoking situations, training on coping skills, recognizing and assessing self-talk, and gradual exposure to anxiety-provoking situations. Parents also receive training in the form of five 50-minute sessions focusing on child behavior management skills. In addition, teachers meet once with the research team to discuss the treatment plan and the teacher’s role in treatment.


King, N. J., Tonge, B. J., Heyne, D., Pritchard, M., Rollings, S., Young, D., …, & Ollendick, T. H. (1998). Cognitive-behavioral treatment of school-refusing children: A controlled evaluation. Journal of American Academy of Child and Adolescent Psychiatry, 37, 395-403.

Evaluated population: A total of 34 children between the ages of 5 and 15 years participated. About half (18) were males. In order to participate, children had to meet the criteria for school-refusal: (1) persistent difficulties in attending school, (2) severe emotional upset when faced with the prospect of going to school, (3) at home with parent’s knowledge when the youngster should be at school, and (4) absence of antisocial characteristics such as stealing, lying, and destructiveness. The majority of children were diagnosed with at least one mental disorder, such as separation anxiety (24 percent), adjustment disorder (21 percent), overanxious disorder (15 percent), simple phobia (9 percent), and social phobia (6 percent). Some children (15 percent) did not meet the criteria for any diagnoses, but did fulfill criteria for school-refusal.

Approach: Children were randomly assigned to the intervention group or the wait list control group. Children in the wait list control group received no treatment and were not contacted during the four weeks that treatment lasted (these children were offered treatment once the four weeks were over).

Pre and post intervention assessments were given two weeks before and two weeks after the intervention, respectively. Measures collected with children included the Fear Thermometer, in which the child rates their emotional distress associated with school attendance on a 0-to-100 scale, the Fear Survey Schedule for Children II, which identifies the fears of children and adolescents, the Revised-Children’s Manifest Anxiety Scale, which measures chronic anxiety, the Children’s Depression Inventory, which measures depressive symptoms, and the Self-Efficacy Questionnaire for School Situations, which assesses changes in children’s perceived ability to manage specific anxiety-provoking situations at school. Parents completed the Child Behavior Checklist, and teachers completed the Child Behavior Checklist-Teacher’s Report Form and recorded school attendance. Clinicians completed the Global Assessment of Functioning Scale, which assesses children’s overall psychological, social, and school functioning.

A follow-up assessment was conducted an average of 12 weeks after the intervention ended.

Results: Analyses of post-treatment assessments revealed that children who received the intervention exhibited a higher level of school attendance, a lower level of emotional distress associated with school attendance, fewer fears, less anxiety, fewer depressive symptoms, and better perceived ability to manage anxiety-provoking situations at school than children in the control group. All of these gains were maintained at follow-up. In addition, the treatment group had lower scores of internalizing behavior as reported by parents. No differences between the treatment group and control group were found at post-treatment on externalizing behaviors as reported by parents or on internalizing or externalizing behaviors as reported by teachers. The treatment group received higher clinician’s ratings of global functioning than the control group at post-treatment. These gains remained at follow-up.



King, N. J., Tonge, B. J., Heyne, D., Pritchard, M., Rollings, S., Young, D., …, & Ollendick, T. H. (1998). Cognitive-behavioral treatment of school-refusing children: A controlled evaluation. Journal of American Academy of Child and Adolescent Psychiatry, 37, 395-403.

KEYWORDS:  Children (3-11), Adolescents (12-17), Males and Females (co-ed), Clinic/Provider-based, Counseling/Therapy, Parent or Family Component, Anxiety Disorders/Symptoms, Other Mental Health, Attendance, Depression/Mood Disorders

Program information last updated 6/25/12