Institute of Psychology, Leiden University, The Netherlands.
Z Kinder Jugendpsychiatr Psychother. 2022 Nov;50(6):471-494. doi: 10.1024/1422-4917/a000881. Epub 2022 Jun 28.
It is important to consider developmental issues when addressing school refusal (SR) in adolescence. Referral rates appear to be higher among adolescents relative to children, and treatment appears to be less effective among adolescents. This paper provides an in-depth review of developmental issues associated with adolescent SR and treatment via cognitive-behavioral therapy (CBT). It begins by considering the reasons for the higher referral and poorer treatment outcomes, including the higher level of absenteeism in adolescence, higher rates of concurrent social anxiety disorder and depressive disorder, and the developmental challenges inherent to adolescence. Such challenges include increased academic and social demands in the secondary-school environment, and increasing autonomy which may contribute to family conflict. These developmental issues may potentiate and exacerbate an adolescent's difficulty attending school, make it difficult for families to cope, and complicate practitioners' efforts to provide effective treatment for SR. Further, the review describes CBT manuals for SR and the extent to which they are developmentally sensitive. There are five CBT manuals, which vary in their sensitivity to developmental issues. Various multimodal treatments employ interventions in addition to CBT, such as medication or inpatient treatment, to address the complexity of SR in adolescence. Nevertheless, nonresponse to treatment for adolescent SR ranges from one-third to two-thirds of youths. Attention thus needs to be given to ways of improving treatment outcomes.
在解决青少年学校拒绝（SR）问题时，考虑发展问题很重要。与儿童相比，青少年的转诊率似乎更高，而青少年的治疗效果似乎较差。本文通过认知行为疗法（CBT）深入探讨了与青少年 SR 及治疗相关的发展问题。它首先考虑了转诊率和治疗效果较差的原因，包括青少年的缺勤率较高、同时患有社交焦虑症和抑郁症的比率较高，以及青春期固有的发展挑战。这些挑战包括中学环境中日益增加的学业和社交要求，以及日益增加的自主权，这可能导致家庭冲突。这些发展问题可能会加剧青少年上学的困难，使家庭难以应对，并使从业者为 SR 提供有效治疗的努力复杂化。此外，该综述描述了针对 SR 的 CBT 手册及其对发展问题的敏感性程度。有五个 CBT 手册，它们对发展问题的敏感性各不相同。各种多模式治疗除了 CBT 之外还采用了干预措施，如药物治疗或住院治疗，以解决青少年 SR 的复杂性。然而，青少年 SR 的治疗无反应率从三分之一到三分之二不等。因此，需要关注改善治疗效果的方法。
