Christopher A. Kearney

A preliminary analysis of a functional model of assessment and treatment for school refusal behavior.

We assessed whether treatment of children and adolescents with school refusal behavior is effective when based upon an individualized, functional analysis. Seven children and adoles-cents, who were currently experiencing difficulties attending school, were evaluated with the School Refusal Assessment Scale (SRAS), an instrument designed to identify maintaining variables surrounding school refusal behavior. These included specific fearfulness/general overanxiousness, escape from aversive social situations, attention-getting or separation anxious behavior, and tangible reinforcement. Prescriptive treatment was given in accordance with the assessed motivating condition and included systematic desensitization/relaxation training, modeling and cognitive restructuring, shaping and differential reinforcement of other behavior, and contingency contracting for each condition, respectively. Daily measures of anxiety, depression, distress, and school attendance were taken, as well as pretreatment, posttreatment, and 6-month follow-up child and/or parent questionnaires. Results indicated that 6 of the subjects maintained full-time school attendance by posttreatment and at the 6-month follow-up. All reported moderate improvements in daily levels of anxiety, depression, and/or distress. The implications of a prescriptive treatment approach for school refusal behavior are discussed.

The Functional Profiles of School Refusal Behavior: Diagnostic Aspects.

School refusal behavior is a common problem seen by mental health professionals and by educators but little consensus is available as to its classification, assessment, and treatment. This study assessed 143 youth with primary school refusal behavior and their parents to examine diagnoses that are most commonly associated with proposed functions of school refusal behavior. As expected, results indicated that great heterogeneity in diagnoses marks this population. In general, anxiety-related diagnoses were associated more with negatively reinforced school refusal behavior; separation anxiety disorder was associated more with attention-seeking behavior; and oppositional defiant disorder and conduct disorder were associated more with pursuit of tangible reinforcement outside of school. These results are discussed within the context of classification, assessment, and treatment of this population.

The phenomenology of panic disorder in youngsters: An empirical study of a clinical sample

Questions about the existence of panic disorder in youngsters are now evolving into questions about the phenomenology of panic disorder in children and adolescents. The current study thus examined the primary clinical features of panic disorder in an outpatient sample of older children and adolescents with panic disorder. Youngsters with panic disorder were compared to a matched-gender group of youngsters with non-panic anxiety disorders. Dependent variables included diagnoses and self-ratings of fear, depression, general anxiety, and anxiety sensitivity. The panic group was found to display more frequent diagnoses of depression and greater levels of self-reported anxiety sensitivity than the non-panic group. These results are discussed in the context of one potential cognitive developmental pathway of panic disorder, and preliminary assessment and treatment recommendations are offered.

Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought.

Youths who have been maltreated often experience symptoms of posttraumatic stress disorder (PTSD), and this special population has received increased attention from researchers. Pathways toward maladaptive effects of maltreatment and PTSD are remarkably similar and reflect specific biological diatheses and psychological vulnerabilities that produce wide-ranging self-regulation deficits. Developmental models of effects of maltreatment and of PTSD are thus increasingly intertwined and have begun to inform specialized assessment and treatment strategies for this population. This review covers key aspects of posttraumatic stress disorder in maltreated youth, including epidemiology, symptomatology, outcome, and risk factors as well as assessment and treatment strategies and challenges for these youths.

School refusal behavior in youth : a functional approach to assessment and treatment

A discussion of the historical context and common strategies for treating the problem of school refusal in youth. It offers an empirically-based approach, designed to help clinicians to weigh multiple symptoms and generate a focus on the factors that are maintaining the behaviour.

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a childs school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.

Family environment of youngsters with school refusal behavior: A synopsis with implications for assessment and treatment

Abstract Several predominant themes for conceptualizing school refusal behavior in children and adolescents have endured across decades of study, including the idea that problematic family relationships are integral to etiology. We review evidence that several familial subtypes are characteristic of this population. These include enmeshed, conflictive, detached, isolated, and healthy parent-child dyads, as well as mixed familial profiles. Recommendations for educators and health professionals who interact with this population are made subsequently. These include guidelines for integrating familial profiles into contemporary classification and assessment strategies, and for modifying treatment protocols based on differential family dynamics.

Functionally based prescriptive and nonprescriptive treatment for children and adolescents with school refusal behavior

The management of school refusal behavior in children and adolescents has long been a nettlesome process for clinicians. However, a functional analytic model of school refusal behavior has been proposed to assist clinicians in organizing, assessing, and treating this heterogeneous population. The present study examined, on a preliminary controlled basis, the treatment utility of this functional model and the School Refusal Assessment Scale (SRAS). Specifically, participants with acute school refusal behavior were initially assigned prescriptive (n = 4) or nonprescriptive (n = 4) treatment from child and parent SRAS ratings. Those receiving nonprescriptive treatment did so in a lagged design prior to prescriptive treatment. Results indicated that nonprescriptive treatment led to worsened percentage of time out of school and daily ratings of anxiety and depression. However, prescriptive treatment substantially ameliorated these problems. In addition, improvements were seen across child self-report measures and parent and/or teacher ratings of internalizing and externalizing behavior. Using a functional model, treatment may thus be assigned efficiently and effectively for this population.

The trials of childhood: The development, reliability, and validity of the daily life stressors scale

The assessment of daily life stress in youngsters is receiving extensive research attention due to its pertinence to psychological and medical problems. This investigation addressed concerns from previous studies of daily life stress in children and adolescents. These included an integration with ratings of negative affectivity, exploration of developmental changes, and presentation of psychometric data. The Daily Life Stressors Scale (DLSS) is a 30-item measure designed to assess the severity of aversive feelings and everday events for youngsters. Three groups of children and adolescents were evaluated to assess the scales test-retest reliability and construct and concurrent validity. Developmental changes in a normative group were also examined. Results indicated the DLSS to be moderately reliable and valid for children. Also, male children reported more stress than female children, whereas female adolescents reported more stress than male adolescents. Results were discussed with respect to resilience, gender role stress, therapy implications, and usefulness for determining precursors to physiological problems.

Post-Traumatic Stress Disorder in Maltreated Youth A Study of Diagnostic Comorbidity and Child Factors

The study of post-traumatic stress disorder (PTSD) in maltreated youth has received increased attention, though extensive comparisons to maltreated youth without PTSD and administrations of anxiety-based structured diagnostic interviews remain needed. We examined maltreated youth with or without PTSD using structured diagnostic interviews and standardized child self-report measures. We hypothesized that maltreated youth with PTSD, compared to their peers without PTSD, would experience significantly greater duration of abuse, diagnostic comorbidity, PTSD symptomatology, dysfunctional family environment, and avoidant coping styles. Results indicated that the group with PTSD did indeed experience significantly greater duration of abuse, diagnostic comorbidity, and PTSD symptomatology, though less so dysfunctional family environment or avoidant coping styles. The presence of a mood or anxiety disorder was highly predictive of PTSD in this sample. Results are discussed within the context of evolving etiological and maintenance models of PTSD in maltreated youth.