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Clinical Atlas Prestige · Evidence-first

Psych VivasChild and adolescent psychiatry — school refusal and school anxiety

Psych Vivas · Child and adolescent psychiatry — school refusal and school anxiety

School refusal and school anxiety — structured clinical viva

Fellowship viva covering functional analysis, multi-agency return-to-school, CBT and pharmacotherapy evidence for school refusal and school anxiety.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CAP registrar. Discuss school refusal as behaviour versus diagnosis, Kearney’s four functions, Egger’s anxious refusal versus truancy distinction, how you build a graded return-to-school plan with caregivers, landmark CBT evidence (King, Heyne), Melvin fluoxetine augmentation findings, when CAMS-level SSRI evidence applies to the underlying anxiety disorder, and iatrogenic pitfalls of open-ended medical certificates.

Interpretation

Reveal interpretation

Nosology. School refusal is a behaviour needing functional analysis, not a freestanding DSM diagnosis. Map DSM drivers (separation, social anxiety, GAD, depression) separately from the attendance problem.[1][2]

Kearney functions. Avoid negative affectivity; escape aversive social/evaluative situations; attention-seeking; tangible reinforcement outside school. Mixed functions are common.[1]

Egger. Anxious refusal and truancy have different community psychiatric associations — tailor intervention.[2]

CBT core. Exposure hierarchies + caregiver contingency training (King; Heyne). Graded school return is treatment, not aftercare.[3][4]

Drugs. Melvin: fluoxetine did not clearly outperform CBT alone for anxious school-refusing adolescents. CAMS anchors combo CBT + sertraline superiority for underlying youth anxiety disorders. Bernstein imipramine+CBT is a historical school-refusal pharmacotherapy anchor; modern first-line meds are generally SSRIs with monitoring, not routine TCAs.[5][6][7][8]

Pitfalls. Open-ended certificates; waiting for zero anxiety before any school contact; missing risk/safeguarding.[1][8]

Key points

Behaviour not diagnosis

Formulate Kearney functions; code the DSM driver separately.

Melvin caution

Do not overclaim SSRI superiority for SR attendance versus CBT alone.

Monitoring

If SSRI started, counsel activation and suicidality signals with early review.
[1] [5] [8]

References

  1. [1]Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects Behav Modif, 2004.PMID 14710711
  2. [2]Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study J Am Acad Child Adolesc Psychiatry, 2003.PMID 12819439
  3. [3]King NJ, Tonge BJ, Heyne D, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation J Am Acad Child Adolesc Psychiatry, 1998.PMID 9549960
  4. [4]Heyne D, King NJ, Tonge BJ, et al. Evaluation of child therapy and caregiver training in the treatment of school refusal J Am Acad Child Adolesc Psychiatry, 2002.PMID 12049443
  5. [5]Melvin GA, Dudley AL, Gordon MS, et al. Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial Child Psychiatry Hum Dev, 2017.PMID 27485100
  6. [6]Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety N Engl J Med, 2008.PMID 18974308
  7. [7]Bernstein GA, Borchardt CM, Perwien AR, et al. Imipramine plus cognitive-behavioral therapy in the treatment of school refusal J Am Acad Child Adolesc Psychiatry, 2000.PMID 10714046
  8. [8]Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials JAMA, 2007.PMID 17440145