Two hundred and one school refusers (less than or equal to 18 years old), e
xcluding schizophrenia, were treated at the Department of Neuropsychiatry,
Hirosaki University Hospital between April 1975 and March 1995. Of 56 cases
of school refusal, 31 did not improve for more than 2 years (group P), and
25 cases had improved in the degree of school refusal and social impairmen
t (group B). The remaining cases were excluded from the analysis for severa
l reasons. There was no significant difference between groups B and P in ag
e at the first psychiatric evaluation as well as the age of onset of school
refusal. The duration from school absence to the first evaluation of group
P was significantly longer than that of group B. The duration of school re
fusal significantly and positively correlated with the duration from school
absence to the first evaluation. Introversion and nervousness prolonged th
e duration of school refusal. The non-presence of volition for school atten
dance, and a low frequency of school attendance during the 1 month prior to
the first evaluation influenced the prolongation of school refusal. The 'd
uration from school absence to the first evaluation', the 'patient's charac
ter', the 'non-presence of volition for school attendance' and the 'frequen
cy of school attendance' influenced the prolongation of school refusal. The
introduction of treatment within 10 months of the onset of school refusal
is an important factor in preventing the prolongation of the school refusal
.