Factors associated with school refusal and outcome in Sri Lankan children

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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