School refusal and anxiety in adolescence: Non-randomized trial of a developmentally sensitive cognitive behavioral therapy

Social Anxiety and the School Environment of Adolescents

“…Further, one of the most common diagnoses at initial contact was avoidant disorder of childhood or adolescence (AD), which overlaps extensively with SAD (APA 1994). In another study of school-refusing adolescents (11-17 years; M = 14.6 years), SAD was a primary or secondary diagnosis among approximately two-thirds of the sample (65 %; Heyne et al 2011 ).…”

“…Heyne et al ( 2011 ) reported that school attendance 2 months following treatment was lower for schoolrefusing adolescents who still met criteria for SAD (18 % of school-time attended) relative to those who had no disorder or a disorder other than SAD following treatment (68 % of school-time attended). Interestingly, adolescent school refusers who still met criteria for SAD at 2-month follow-up less commonly had friends in the same class at pretreatment, relative to adolescents who did not meet criteria for SAD at follow-up (50 % versus 80 %, respectively).…”

“…Studies suggest that SAD among school-refusing adolescents is often treatment resistant and that SAD is associated with poor outcomes well after the end of treatment for school refusal. Suggestions to improve outcomes for school refusers with SAD have included the following: adjunctive interventions such as social skills training and pharmacotherapy (Layne et al 2003 ); starting with individual treatment and progressing to group-based treatment (Albano 1995 ); greater fl exibility at school, such as reduced academic demands for adolescents already burdened with the challenge of social anxiety (Heyne et al 2011 ); longer and more intensive treatment (Heyne et al 2011 ;McShane et al 2004 ); and targeting social isolation and promoting participation in prosocial activities (Ingul and Nordahl 2013 ). According to Place et al ( 2000 ); there is little likelihood of school refusers ever returning to mainstream schooling if peer functioning cannot be improved.…”

Flying Under the Radar: School Reluctance in Anxious Youth

“…In addition to demographic variables, differences in comorbidity were examined between the two groups through independent-samples t tests, and no significant group differences were found. Prior research has not found a clear pattern of primary diagnoses in school-refusing youth, with some identifying separation anxiety disorder and others social phobia (Beidas et al, 2010;Heyne et al, 2011;Kearney & Albano, 2004). In this sample, SR youth had higher rates of primary separation anxiety disorder diagnoses (31.7 %) compared to NSR youth (12 %), and NSR youth had higher rates of primary generalized anxiety disorder (66 %) compared to SR youth (39 %).…”

The Implementation of an Evidence-Based Treatment for a Complex Case of School Refusal

“…Nevertheless, there is an abundance of literature that supports the use of cognitive-behavioral therapy (CBT) for children who present with school-refusing behaviors (Heyne, Sauter, Van Widenfelt, Vermeiren, & Westenberg, 2011;Kearney & Graczyk, 2014;Maric, Heyne, MacKinnon, Van Widenfelt, & Westenberg, 2013). In addition, a recent meta-analysis (Maynard et al, 2015) that included six randomized control trials, reported that CBT for school refusal behaviors had positive and significant effects on attendance.…”