Social Anxiety and School Refusal in Adolescence

School Refusal (@school)

The @school research program focuses on the evaluation of treatment for young people refusing to attend school, often because of anxiety and/or depression. Our integrated approach to treatment comprises work with the young person and their parents, and consultation to school staff. The focus is upon older school-refusing children and adolescents (10 to 17 years) because previous treatments were not always effective with this group. The @school team also develops and evaluates instruments useful in understanding more about school refusal and its treatment.

Principal Investigator: David Heyne, PhD

Current Projects

Evaluation of developmentally-sensitive CBT for school refusal 

Researcher: David Heyne, PhD, Floor Sauter and Anne-Jaan den Besten

Our focus on the evaluation of treatment for anxiety-related school refusal extends beyond the question of its efficacy.  We are also very interested in questions such as ‘for whom’ treatment works and ‘how’ it works. Clinicians and researchers postulate that specific developmental capacities are prerequisite to engagement in CBT, and developmental factors (e.g., cognitive developmental level; psychosocial development) are of specific interest in our investigation of predictors of outcome as well as the process of therapy. Cognitive factors (e.g., self-efficacy; cognitive errors) and factors not specific to CBT (e.g., the therapeutic alliance) are also studied. More recently, attention is being given to the potential utility of interventions from the ‘third-wave of behaviour therapy’ when working with young people at risk for the development of anxiety disorders. 

Self-efficacy among school refusers and their parents: How reliable and valid are the SEQ-SS and the SEQ-RSAP?

Researcher: David Heyne, PhD

The measurement of cognitive-related factors such as self-efficacy beliefs is held to be important in treatment outcome research with young people, including treatment outcome research with school refusers. This research project investigates the reliability and validity of the SEQ‑SS-NL and the SEQ-RSAP The Self-Efficacy Questionnaire for School Situations (SEQ-SS; Heyne et al., 1998) is a self-report instrument which was designed to assess children’s and adolescents’ perceived ability to handle anxiety provoking situations associated with school attendance and non-attendance (e.g., “How sure are you that you could handle questions from others about why you’ve been away from school?”). It has been used in clinical settings to determine targets of intervention during cognitive and behaviour therapy. It is also a promising tool in treatment-outcome research, to evaluate mid-treatment and post-treatment changes in self-efficacy. Thus, the SEQ-SS has been extended and translated for use in the @school project, yielding the SEQ‑SS‑NL. A parallel questionnaire, the Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP) has been developed for use with the parents of school refusers, to assess their self-efficacy in relation to helping their child attend school regularly and without difficulty (e.g., “If my child has difficulty attending school, I know what can be done to address this”)..

Functional analysis of school refusal: How reliable and valid are the Dutch versions of the SRAS-R?

Researcher: David Heyne, PhD

School refusal is often described as ‘heterogeneous’. It may present in different ways (e.g., together with separation anxiety, or with depression), and the factors associated with the onset and continuation of school refusal vary considerably from one case to the next (e.g., avoiding social-evaluative situations at school; enjoying activities and privileges when at home during the school day). This ‘heterogeneity’ may present a challenge to education and mental health professionals who are often confronted with the task of quickly understanding the problem and making appropriate recommendations for intervention. 

The need to develop a sound system for determining intervention-relevant differences among school refusers fuelled the development of the School Refusal Assessment Scale (SRAS; Kearney & Silverman, 1993) and its revision (SRAS-R; Kearney , 2002). This questionnaire was developed to provide a standardized functional analysis of the behaviours of school refusers. That is, it helps professionals to identify the factors maintaining a young person’s difficulty attending school. This information is then used to support the identification of interventions which are most likely to address these maintenance factors.

In this project we have developed and are evaluating the Dutch translation of the SRAS-R. School attendance problems are not uncommon in The Netherlands, and the availability of a psychometrically sound translation of this important tool is likely to be of benefit to education and mental health professionals alike. Administration of the questionnaire with referred and non-referred school refusers and their parents will shed light on the reliability and validity of the SRAS-R-NL (School Refusal Assessment Scale – Dutch Version).