Preliminary Findings on School Refusal Outcomes in Children and Adolescents Following 1‐Year Psychiatric Outpatient Treatment

TL;DR

This study examines factors influencing school refusal in children and adolescents after one year of psychiatric treatment.

Contribution

The study identifies predictors of new-onset school refusal and successful return to school during treatment.

Findings

Older children and those from divorced/separated families are more likely to develop school refusal.

Shorter refusal duration predicts a higher chance of returning to school.

37% of initially refusing students resumed school attendance after treatment.

Abstract

School refusal affects many children and adolescents receiving psychiatric care; however, predictors of new‐onset refusal and successful return during treatment remain unclear. This retrospective cohort study identified factors associated with (1) developing school refusal among initially attending patients and (2) returning to school among those initially refusing.

We reviewed 235 psychiatric outpatients younger than 15 years who continued treatment for 1 year after a first visit between April 2022 and March 2023. Patients were categorised into maintained attendance (n = 131), developed school refusal (n = 12), resumed attendance (n = 34) and persistent refusal (n = 58). Demographic variables, diagnoses, prior absence duration and psychiatrist experience were analysed using chi‐squared tests, Fisher's exact tests, Mann–Whitney U tests and multivariate logistic regression.

Among 143 patients attending school at baseline, 12 (8.4%) developed school refusal during treatment; these patients were older (11.8 ± 2.0 vs. 9.2 ± 3.0 years, p < 0.01) and more likely to have divorced/separated parents (33.3% vs. 6.9%, p < 0.05) than were those who maintained attendance. Among 92 patients already refusing school, 34 (37.0%) resumed attendance. In multivariate analysis, a refusal duration < 1 year independently predicted return to school (odds ratio: 3.28, 95% confidence interval: 1.32–8.15, p < 0.05).

Shorter refusal duration was associated with a higher likelihood of successful return to school, underscoring the importance of early intervention. Older children and those from separated families were more vulnerable to developing school refusal, supporting the need for targeted preventive strategies.

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