Attached
INTRODUCTION AND OBJECTIVES: School refusal oc
curs in 1 -5% of all school children and has major social,
emotional and educational implications for the child . It
can cause serious disruption of the child's wellbeing and
associated with significant short- and long-term sequelae. Children with school refusal may suffer from significant emotional distress, especially anxiety and depression. The objectives were to study the clinical features,
social, familial, and environmental and temperamental
factors associated with children presenting with school
refusal and the outcome of school refusal
METHOD: All children between 5 to 12 years of age, seen
at child mental health clinic during January 2009 to July
2010 were included in the study. An interviewer administered semi-structured questionnaire used for collection of
bio-data and features associated with school refusal.
RESULTS: 71 children aged 5 to 12 years(mean age
9.08 years) participated in the study. 59.2%(42) were
male. Commonest associated features were Somatic
complaints 98.6%(70), fearfulness 46.5%(33), anxiety
29.6°/0(21), difficulty in separation 28.2%(20).Commonest precipitants were difficulty with peers 25.4%(18),
difficulty with teacher 18.3%(13), change of school
14.1 %(10). 50.7%(36) had an 'easily upset" temperament. 32.4%(23) of these children were temperamentally
timid. Majority of the children 45.1%(32) did not carry
a specific diagnosis while others had phobic anxiety
disorder 16.9%(12), asperger syndrome 14.1 %(10) and
depression 11.3%(8).Learning disability was represented
only in 1,4%(1). 84.5%(60) children were managed as out
patients.36.6%(26) required medication. 57.7 %(41) returned to school consistently and 22.5%(16)returned to
school inconsistently.
CONCLUSIONS: Children with school refusal may suffer
from significant emotional distress, especially anxiety
and depression.
1 Lecturer, Department of Family Medicine, University of
Sri Jayewardenepura 2 Professor, Department of Psychological Medicine, University of Colombo
