School refusal as a sign of underlying developmental disorders: patient characteristics and prognostic factors

Abstract

  Objective: We examined the characteristics of school refusal in children and the prognostic factors that may influence their outcomes. Methods: We retrospectively investigated 80 cases of school refusal in children who visited our hospital from 2007 to 2009, mainly focusing on the underlying diseases such as developmental and psychiatric disorders, educational support, and their outcomes. Results: Children with school refusal often had the underlying diseases including neurodevelopmental disorders such as pervasive developmental disorder and attention-deficit/hyperactivity disorder (57% of the patients) and psychiatric disorders (24% of the patients). In addition to the school refusal, unexplained physical complaints such as sleep disturbances or headache were observed in 91% of the patients. The reasons for school refusal were mixed, and the most frequent reason was difficulty in human relations. Regarding the prognosis one year later, 48% and 26% of the patients attended school completely or partially, respectively. Sixty percent of schoolchildren and 41% of junior high school and high school children led to complete school attendance. Forty two percent of normal development patients and 17% of patients who have developmental disorders kept school refusal. All patients who received special needs education attended school completely. Conclusions: Children with school refusal often have underlying diseases. Therefore, appropriate educational support depending on their developmental characteristics and mental status may help such children to overcome school refusal and to enjoy their school life.