COGNITIVE-BEHAVIORAL TREATMENT OF SCHOOL-REFUSING CHILDREN - A CONTROLLED EVALUATION

Objective: To evaluate the efficacy of a 4-week cognitive-behavioral t reatment program for children who refuse to go to school. Method: Thir ty-four school-refusing children (aged 5 to 15 years) were randomly as signed to a cognitive-behavioral treatment condition or a waiting-list control condition. Treatment consisted of individual child cognitive- behavioral therapy plus parent/teacher training in child behavior mana gement skills. Measures taken before and after treatment included scho ol attendance, child self-report of emotional distress and coping, car egiver reports on emotional and behavioral problems, and clinician rat ings of global functioning. Results: Relative to waiting-list controls , children who received cognitive-behavioral therapy exhibited a signi ficant improvement in school attendance. These children also improved on self-reports of fear, anxiety, depression, and coping. Significant improvements also occurred in relation to caregiver reports and clinic ian ratings. Maintenance of therapeutic gains was demonstrated at a 3- month follow-up assessment. Conclusions: Cognitive-behavioral treatmen t of school refusal was efficacious and acceptable. The relative contr ibutions of child therapy and parent/teacher training require further study.