Modular Treatment for Children and Adolescents With Problematic School Absenteeism: Development and Description of a Program in Germany

School Refusal in Youth: A Systematic Review of Ecological Factors

To guide school practitioners in the identification and intervention of youth with anxious school refusal, this systematic review used an ecological lens to examine the factors that differentiated children and adolescents with school refusal from those without. Based on the rigorous protocol from the Center for Reviews and Dissemination's (CRD) internationally recognized guidelines, 15 studies examining 67 different factors were identified. Results reveal 44 individual, social and contextual factors that differentiate youth with school refusal from peers without school refusal. Findings highlight the centrality of anxiety, or anxiety-related symptoms, and diverse learning needs as main points of contrast between youth with school refusal and those without. Implications of an ecological understanding of the factors associated with school refusal for selective and indicative prevention by school and mental health practitioners are discussed.

Depressive, Anxiety, and Stress Symptoms Among Schoolgirls With Disordered Eating Behaviors

Objectives This study aimed to assess the relationship between depression, anxiety, stress, and disordered eating behaviors among schoolgirls in Riyadh, Saudi Arabia. The current study could provide insights into potential intervention strategies for addressing both aspects simultaneously, contributing to a more holistic approach in the field. Method Via simple sampling technique, the current quantitative, descriptive, and cross-sectional study included 347 female adolescents aged between 13 and 18 years in public schools in Riyadh, Saudi Arabia. A self-administered questionnaire comprised demographic information, items on body image satisfaction and perception, the Eating Attitude Test-26 (EAT-26), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results Among the participants, 32.6% scored at or above the cutoff point on the EAT-26, indicating a negative eating attitude. Additionally, multiple factors such as age, obesity, body image dissatisfaction, and peer pressure were correlated with disordered eating behaviors, with excessive exercise being the most reported weight control behaviors. The prevalence of depression, anxiety, and stress were 58.5%, 73.2%, and 40.9%, respectively. Notably, anxiety was significantly associated with disordered eating behaviors. Conclusion In conclusion, disordered eating behaviors were reported by 32.6% of the participants, and symptoms of anxiety were significantly associated with these behaviors. Media consumption appeared to influence more than half of the participants in their weight loss attempts.

Factors Associated with Anxiety, Depression, and Stress Levels in High School Students

This study aims to investigate the relationship between anxiety, depression, and stress levels with physical activity level and academic performance in high school students; secondly, this study aims to relate and compare anxiety, depression, and stress levels with physical activity level and academic performance. This is a quantitative, descriptive, and comparative cross-sectional study, which evaluated 443 high school students (48% female; 15.13 ± 1.59 years) belonging to the Maule region, Chile. The Depression, Anxiety, and Stress Questionnaire (DASS-21) and the International Physical Activity Questionnaire (IPAQ) were applied. Academic performance was consulted on language, mathematics, and overall grade point average. The results indicate that vigorous physical activity (OR = 0.504; p = 0.017) and high academic performance in mathematics (OR = 0.597; p = 0.027) are associated with a reduced risk of depression. In turn, there is a significant inverse correlation between physical activity with anxiety (r = -0.224; p = 0.000), depression (r = -0.224; p = 0.000) and stress (r = -0.108; p = 0.032), while the performance of mathematics is inversely correlated with depression (r = -0.176; p = 0.000). On the other hand, significant differences (p < 0.05) between anxiety, depression, stress levels, and grade point average were found, with females exhibiting higher scores than males. In conclusion, greater vigorous physical activity and scoring above average in mathematics performance are protective factors against depression.

Practitioner Review: Signposts for Enhancing Cognitive-Behavioral Therapy for School Refusal in Adolescence

Factors associated with adolescent development influence the occurrence and presentation of school refusal (SR). Cognitive-behavioral therapy (CBT) manuals for the treatment of SR account for these developmental issues to varying degrees. Some multimodal treatments aim to address the complexity of adolescent SR by incorporating interventions alongside CBT, such as medication, inpatient treatment, and educational support in a special setting. However, CBT manuals and multimodal treatments appear to fail to help approximately one-third to two-thirds of adolescents, with respect to achieving regular school attendance. This paper provides an overview of suggestions in the literature for improving treatment for SR, with a focus on adolescent SR. Seven signposts emerge from the literature, namely, increased number or frequency of sessions, greater attention to social anxiety disorder and social functioning, greater attention to depression, greater attention to emotion regulation, careful consideration of the role of parents, greater attention to parent-adolescent communication and problem-solving, and the use of alternative educational settings. Professionals may find these signposts helpful when planning and delivering treatment for SR in adolescents. Research is needed to determine the benefit of including one or more of these adaptations alongside an existing SR treatment.

Signposts for School Refusal Interventions, Based on the Views of Stakeholders

School refusal (SR) signals a young person's difficulty attending school. It jeopardizes their development, often contributes to distress for parents, and places an extra burden on school personnel. Reviews of empirical studies indicate that intervention for SR helps to increase school attendance, but not for all youths. This practice-based manuscript aims to support practitioners and organisations addressing the needs of youths and families affected by SR. Specifically, we present 14 signposts for the development and delivery of intervention for SR. The signposts represent important conditions for effective intervention based on key findings from the Knowing What Works project in the Netherlands. During that project, 76 professionals shared their views about the important elements in SR interventions they delivered, and 39 youths and 86 parents shared their views about the helpful elements in SR interventions in which they participated. These 201 stakeholders were variously associated with 21 SR interventions across 9 of the 12 Dutch provinces, most situated in mainstream or special education settings. Their responses informed the development of the 14 signposts presented here, supported by the extant literature on SR intervention. We describe the essence of each signpost and conclude with suggestions for using the signposts and evaluating their utility.

Students' Psychological Adjustment in Normative School Transitions From Kindergarten to High School: Investigating the Role of Teacher-Student Relationship Quality

School transitions require students to adapt to new challenges and situations and can increase the risk of externalizing and internalizing psychological symptoms. The teacher-student relationship seems to be a protective factor for the risk of developing psychological symptoms during school transitions. The aim of the present study is to investigate whether the quality of the teacher-student relationship predicts the decrease of internalizing and externalizing symptoms during three school transitions, namely: from kindergarten to primary school (T1), from primary to middle school (T2), and from middle to high school (T3). We recruited 127 kindergarten students (mean age = 5.40, SD = 0.49), 113 fifth grade primary school students (mean age = 10.64, SD = 0.54), and 240 eighth grade students (mean age = 13.88, SD = 0.37) and their teachers (response rate = 95%). Data were collected from 2016 to 2018. Teachers filled out an anonymous survey, acting as informants for the students, reporting demographic details (age, gender), psychological symptoms, and quality of the teacher-student relationship. The data show that a positive teacher-student relationship quality tends to be associated with a reduction of psychological symptoms. A stable, low-conflict teacher-student relationship was confirmed as a protective factor from increased internalizing and externalizing symptoms during all normative school transitions. Furthermore, we see that an increase in teacher-student conflict during the transitions from primary to middle school, and from middle to high school is linked to an exacerbation in students’ externalizing symptoms during the first year of attendance of the new school. Our study confirms the importance of the teacher-student relationship in reducing psychological symptoms associated with school transitions, in every type of transition, favoring an improved psychological adjustment to the new environment. A positive teacher-student relationship represents a protective factor for the development of students. Study limitations are discussed.