Our integrated approach to treatment comprises work with the young person and their parents, and consultation to school staff. Specific attention is given to older school-refusing children and adolescents (10 to 17 years) because previous treatments were not always effective with this group. A developmentally-sensitive treatment has been developed, with implications for: how cognitive-behavioural treatment is conducted with the young person; the role parents are encouraged to play in supporting and steering their child; and the process of engaging the young person and their parents in communication and family problem-solving. In addition to the question of how well the treatment works, we’re interested in questions such as ‘how’ treatment works and ‘for whom’ it works. In particular, because social anxiety disorder has been found to be common among older school refusers, it warrants special attention in the conceptualization, assessment, and treatment of school refusal.

The @school team also develops and evaluates instruments useful in understanding more about school refusal and its treatment. School refusal is often described as ‘heterogeneous’ - it may present in different ways (e.g., together with separation anxiety, or with depression) and the factors associated with the onset and continuation of school refusal vary considerably from one case to the next (e.g., avoiding social-evaluative situations at school; enjoying activities and privileges when at home during the school day). This heterogeneity can present a challenge to education and mental health professionals who are often confronted with the task of quickly understanding the problem and making appropriate recommendations. The need to develop a sound system for determining treatment-relevant differences among school refusers fuelled the development of the School Refusal Assessment Scale (SRAS; Kearney & Silverman, 1993) and its revision (SRAS-R; Kearney, 2002). Youth and parent versions of the questionnaire help professionals identify the factors maintaining a young person’s difficulty attending school. This information is used to identify interventions which are most likely to address the maintenance factors. The @school research team has developed a Dutch translation of the SRAS-R. Administration of the questionnaire with referred and non-referred school refusers and their parents is helping shed light on the utility of the Dutch translation.

The measurement of cognitive factors is also important in research on the outcome of cognitive-behavioural treatment for school refusal. The team is investigating the reliability and validity of the Self-Efficacy Questionnaire for School Situations, a self-report instrument which was designed to assess children’s and adolescents’ perceived ability to handle anxiety-provoking situations associated with school attendance and non-attendance (e.g., “How sure are you that you could handle questions from others about why you’ve been away from school?”). The instrument is used in clinical settings to determine targets of cognitive intervention and it is used in treatment-outcome research to determine whether and how treatment for school refusal works. A parallel questionnaire, the Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP) has been developed for use with the parents of school refusers, to assess their self-efficacy in relation to helping their child attend school regularly and without difficulty (e.g., “If my child has difficulty attending school, I know what can be done to address this”).

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