Kearney C A, Silverman W K
Department of Psychology, University at Albany, State University of New York 12222.
Behav Modif. 1990 Jul;14(3):340-66. doi: 10.1177/01454455900143007.
We assessed whether treatment of children and adolescents with school refusal behavior is effective when based upon an individualized, functional analysis. Seven children and adolescents, who were currently experiencing difficulties attending school, were evaluated with the School Refusal Assessment Scale (SRAS), an instrument designed to identify maintaining variables surrounding school refusal behavior. These included specific fearfulness/general overanxiousness, escape from aversive social situations, attention-getting or separation anxious behavior, and tangible reinforcement. Prescriptive treatment was given in accordance with the assessed motivating condition and included systematic desensitization/relaxation training, modeling and cognitive restructuring, shaping and differential reinforcement of other behavior, and contingency contracting for each condition, respectively. Daily measures of anxiety, depression, distress, and school attendance were taken, as well as pretreatment, posttreatment, and 6-month follow-up child and/or parent questionnaires. Results indicated that 6 of the subjects maintained full-time school attendance by posttreatment and at the 6-month follow-up. All reported moderate improvements in daily levels of anxiety, depression, and/or distress. The implications of a prescriptive treatment approach for school refusal behavior are discussed.
我们评估了基于个体化功能分析对有拒学行为的儿童和青少年进行治疗是否有效。七名目前在上学方面存在困难的儿童和青少年，使用拒学评估量表（SRAS）进行了评估，该量表旨在识别围绕拒学行为的维持变量。这些变量包括特定的恐惧/一般性过度焦虑、逃避厌恶的社交情境、引人注意或分离焦虑行为以及物质强化。根据评估出的激发条件给予针对性治疗，分别包括系统脱敏/放松训练、示范和认知重构、塑造和对其他行为的差别强化，以及针对每种情况的应急契约。每天测量焦虑、抑郁、痛苦程度和上学出勤率，同时还进行治疗前、治疗后以及6个月随访时的儿童和/或家长问卷调查。结果表明，6名受试者在治疗后以及6个月随访时维持了全日制上学。所有人都报告说在日常焦虑、抑郁和/或痛苦程度方面有适度改善。文中讨论了针对拒学行为的针对性治疗方法的意义。
