Stephanie Rollings

Treating Sexually Abused Children With Posttraumatic Stress Symptoms: A Randomized Clinical Trial

OBJECTIVE To evaluate the efficacy of child and caregiver participation in the cognitive-behavioral treatment of sexually abused children with posttraumatic stress symptoms. METHOD Thirty-six sexually abused children (aged 5-17 years) were randomly assigned to a child-alone cognitive-behavioral treatment condition, a family cognitive-behavioral treatment condition, or a waiting-list control condition. RESULTS Compared with controls, children who received treatment exhibited significant improvements in posttraumatic stress disorder symptoms and self-reports of fear and anxiety. Significant improvements also occurred in relation to parent-completed measures and clinician ratings of global functioning. In general, parental involvement did not improve the efficacy of cognitive-behavioral therapy. Maintenance of improvement was evident at a 12-week follow-up assessment. CONCLUSIONS Cognitive-behavioral treatment was useful, but further research is required on caregiver involvement.

Cognitive-behavioral treatment of school-refusing children: a controlled evaluation.

OBJECTIVE To evaluate the efficacy of a 4-week cognitive-behavioral treatment program for children who refuse to go to school. METHOD Thirty-four school-refusing children (aged 5 to 15 years) were randomly assigned 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 management skills. Measures taken before and after treatment included school attendance, child self-report of emotional distress and coping, caregiver reports on emotional and behavioral problems, and clinician ratings of global functioning. RESULTS Relative to waiting-list controls, children who received cognitive-behavioral therapy exhibited a significant 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 clinician ratings. Maintenance of therapeutic gains was demonstrated at a 3-month follow-up assessment. CONCLUSIONS Cognitive-behavioral treatment of school refusal was efficacious and acceptable. The relative contributions of child therapy and parent/teacher training require further study.

Evaluation of Child Therapy and Caregiver Training in the Treatment of School Refusal

OBJECTIVE To evaluate the relative efficacy of (1) child therapy, (2) parent/teacher training, and (3) the combination of child therapy and parent/teacher training in the treatment of anxiety-based school refusal. METHOD Sixty-one school-refusing children (aged 7-14 years) from throughout Melbourne, Australia, were randomized to a child therapy program, a parent and teacher training program, or a combination of the two. Children were assessed before and after treatment, and at 4.5-month follow-up, by means of attendance records, self-report of emotional distress and self-efficacy, parent and teacher reports of emotional distress, and clinician ratings of overall functioning. RESULTS Statistically and clinically significant pretreatment-posttreatment change occurred for each group. Immediately posttreatment, child therapy appeared to be the least effective in increasing attendance. By follow-up, the attendance and adjustment of those in the child therapy group equalled that of children whose parents and teachers were involved in treatment, whether on their own (parent/teacher training) or together with their children (combined child therapy and parent/teacher training). CONCLUSION Contrary to expectations, combined child therapy and parent/teacher training did not produce better outcomes at posttreatment or follow-up.

Cognitive-Behavioural Treatment of School-Refusing Children: Maintenance of improvement at 3- to 5-year follow-up

Although evidence is accumulating on the immediate or short-term efficacy of cognitive-behavioural strategies in the treatment of school refusal, no studies have been reported on the long-term efficacy of this treatment approach. An earlier randomized clinical trial conducted by the authors demonstrated the efficacy of a manual-based cognitive-behavioural treatment program for school refusal relative to waiting list controls. We now report findings of a 3- to 5-year follow-up investigation of the treatment group. In general, results support the long-term efficacy of the treatment program, with children showing maintenance of improvements in school attendance and school adjustment. Methodological limitations of the follow-up investigation are emphasized.

School Refusal: An Overview

Traditionally, mental health professionals and school authorities have found school refusal to be a perplexing and challenging problem. Relevant to an understanding of school refusal, we initially review some important developmental-normative considerations. The clinical features, epidemiology, and etiology of school refusal are also briefly discussed. We then describe a number of behavioural strategies that have been used in the management of school refusal. Finally, we review the research support for the efficacy and acceptability of behavioural strategies in the treatment of school refusal.

Cognitive-behavioural Intervention with a Depressed Adolescent Experiencing School Attendance Difficulties

This article describes a cognitive-behavioural intervention implemented over 10 sessions with an adolescent girl experiencing school refusal and depression. Treatment focused on the learning of various coping skills to deal with stressful situations at home and school. Following a decision to change schools, a rapid school return was employed. A multimethod, multisource evaluation was used at pretreatment, posttreatment, and follow-up assessments. The data indicated positive treatment outcomes: the adolescent returned to full-time attendance at school and exhibited decreased levels of emotional distress. The treatment gains were maintained at a 3-month follow-up.