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Medical Author:

Bettina E Bernstein, DO

Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Treatment of school refusal includes cognitive behavior therapy along with systematic desensitization, exposure therapy, and operant behavioral techniques.

• Cognitive behavior therapy: Derived from behavior therapy, the goals include the correction of maladaptive and inappropriate behaviors.
• Systematic desensitization: A technique by which the child is gradually helped to modify his or her emotionally distressing reaction to school so that eventually the child can return to school without experiencing distress.
• Exposure therapy: A technique by which the child is exposed in a stepwise fashion to increasing intensity and duration of the emotionally distressing event coupled with encouragement to modify maladaptive and inappropriate cognitions gradually enough that the child becomes able to tolerate the previously distressing experience (that is, school attendance) without distress.
• Operant behavioral techniques: These involve reward for desired behaviors in order to increase their frequency.

The goal of therapy is to help the student to restructure his or her thoughts and actions into a more assertive and adaptive framework to allow a rapid return to school. Therapeutic techniques include modeling, role playing, and reward systems for positive behavior change. Play therapy for younger, less verbally oriented children helps to reenact anxiety-provoking situations and master them. Interpersonally oriented individual therapy as well as group therapy can be extremely helpful for adolescents to counteract feelings of low self-esteem, isolation, and inadequacy. Interpersonally oriented individual therapy centers on the person's maladaptive responses to interpersonal interaction (usually involves difficulty in interactions with other people).

Obviously offering a welcoming and safe environment is the first and most important step. In addition, teachers and school staff should help the student identify and recognize the triggers for school refusal. Zero tolerance for bullying, available guidance staff, and opportunities to practice relaxation techniques can significantly reduce anxiety.

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