School Refusal in Adolescence: Personality Traits and Their Influence on Treatment Outcome

There has been little attention to personality in research on school refusal (SR). This study examined personality traits among 41 adolescents receiving cognitive–behavioral therapy (CBT) during participation in a School Refusal Program. Traits were examined via clinical scales and 2-point code types derived from the Minnesota Multiphasic Personality Inventory—Adolescent. The influence of personality traits on treatment outcome was examined at post-treatment and 1-year follow-up. At pretreatment, eight of the 10 clinical scales were disproportionately skewed toward the “high to very high” range relative to a norm group. Social introversion and depressive symptomatology were significantly increased relative to the norm group, and nearly one-half of the adolescents were characterized by code type 2-3/3-2 (depression/hysteria) or 2-0/0-2 (depression/social introversion). Adolescents characterized by a 2-0/0-2 code type were almost twice as likely (odds ratio = 1.78) to be treatment responders at post-treatment. There was no relation between personality traits and treatment outcome at follow-up. The small sample size limits generalization of the study’s findings. If the results are replicated, personality traits may provide useful indications for personalizing treatment when employing interventions recommended in CBT manuals for SR.

[1]  D. Heyne.  Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals. , 2022, Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie.

[2]  D. Heyne,et al.  Signposts for School Refusal Interventions, Based on the Views of Stakeholders , 2022, Continuity in education.

[3]  María Vicent,et al.  School Refusal Behavior Profiles, Optimism/Pessimism, and Personality Traits in Spanish Children , 2021, Education Sciences.

[4]  M. Moro,et al.  Multifamily Therapy for Adolescents With School Refusal: Perspectives of the Adolescents and Their Parents , 2021, Frontiers in Psychiatry.

[5]  K. Alanko,et al.  A Scoping Review of Constructs Measured Following Intervention for School Refusal: Are We Measuring Up? , 2020, Frontiers in Psychology.

[6]  C. E. van der Put,et al.  Risk Factors for School Absenteeism and Dropout: A Meta-Analytic Review , 2019, Journal of Youth and Adolescence.

[7]  B. Tonge,et al.  The Kids and Teens at School (KiTeS) Framework: An Inclusive Bioecological Systems Approach to Understanding School Absenteeism and School Attendance Problems , 2019, Front. Educ..

[8]  D. Heyne,et al.  Early identification of school attendance problems: How helpful are Dutch laws, policies, and protocols? , 2019, European Journal of Education and Psychology.

[9]  Lorraine Graham,et al.  Reengagement With Education: A Multidisciplinary Home-School-Clinic Approach Developed in Australia for School-Refusing Youth , 2019, Cognitive and Behavioral Practice.

[10]  D. Heyne,et al.  Differentiation Between School Attendance Problems: Why and How? , 2019, Cognitive and Behavioral Practice.

[11]  Brandy R. Maynard,et al.  Treatment for School Refusal Among Children and Adolescents , 2018 .

[12]  H. Xueqing,et al.  A psychological and medical analysis of temperament, character and behavior in children and adolescents of school refusal , 2018 .

[13]  B. Tonge,et al.  Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial , 2017, Child psychiatry and human development.

[14]  R. Archer.  Assessing Adolescent Psychopathology: MMPI-A / MMPI-A-RF, Fourth Edition , 2016 .

[15]  Thomas H. Ollendick,et al.  Moderators and mediators of youth treatment outcomes , 2015 .

[16]  E. Bru,et al.  School factors associated with school refusal- and truancy-related reasons for school non-attendance , 2015 .

[17]  E. Bru,et al.  Assessing Reasons for School Non-attendance , 2015 .

[18]  B. Grant,et al.  PERSONALITY DISORDERS AND THE PERSISTENCE OF ANXIETY DISORDERS IN A NATIONALLY REPRESENTATIVE SAMPLE , 2014, Depression and anxiety.

[19]  Esteban M. Aucejo,et al.  Assessing the Effect of School Days and Absences on Test Score Performance. CEP Discussion Paper No. 1302. , 2014 .

[20]  Michael A. Gottfried.  Chronic Absenteeism and Its Effects on Students’ Academic and Socioemotional Outcomes , 2014 .

[21]  C. Kearney,et al.  A Response to Intervention Model to Promote School Attendance and Decrease School Absenteeism , 2014 .

[22]  T. Ollendick,et al.  Developmentally Sensitive Cognitive Behavioral Therapy for Adolescent School Refusal: Rationale and Case Illustration , 2013, Clinical child and family psychology review.

[23]  Xin Wu,et al.  Cognitive Behaviour Therapy Combined Fluoxetine Treatment Superior to Cognitive Behaviour Therapy Alone for School Refusal , 2013 .

[24]  J. Rosenvinge,et al.  Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. , 2013, Journal of affective disorders.

[25]  P. Westenberg,et al.  School refusal and anxiety in adolescence: non-randomized trial of a developmentally sensitive cognitive behavioral therapy. , 2011, Journal of anxiety disorders.

[26]  Elizabeth K. Hughes,et al.  A Case-Control Study of Emotion Regulation and School Refusal in Children and Adolescents , 2010 .

[27]  G. Lehmkuhl,et al.  Short term effects of inpatient cognitive behavioral treatment of adolescents with anxious-depressed school absenteeism: an observational study , 2010, European Child & Adolescent Psychiatry.

[28]  D. Tolin,et al.  Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series , 2009 .

[29]  C. Suveg,et al.  Changes in Emotion Regulation Following Cognitive-Behavioral Therapy for Anxious Youth , 2009, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[30]  H. Steinhausen,et al.  Frequency, stability and differentiation of self-reported school fear and truancy in a community sample , 2008, Child and adolescent psychiatry and mental health.

[31]  S. Girimaji,et al.  Outcome of children with school refusal , 2007, Indian journal of pediatrics.

[32]  C. Suveg,et al.  They’re Not Just “Little Adults”: Developmental Considerations for Implementing Cognitive-Behavioral Therapy With Anxious Youth , 2006, Journal of Cognitive Psychotherapy.

[33]  R. Archer.  Implications of MMPI/MMPI–A Findings for Understanding Adolescent Development and Psychopathology , 2005, Journal of personality assessment.

[34]  D. Westen,et al.  Assessing adolescent personality pathology , 2005, British Journal of Psychiatry.

[35]  J. Rey,et al.  Functional Outcome of Adolescents with ‘School Refusal’ , 2004 .

[36]  J. Reich.  The effect of Axis II disorders on the outcome of treatment of anxiety and unipolar depressive disorders: a review. , 2003, Journal of personality disorders.

[37]  H. Kaneko,et al.  Study on feelings of school avoidance, depression, and character tendencies among general junior high and high school students , 2003, Psychiatry and clinical neurosciences.

[38]  M. Kushner,et al.  Predictors of treatment response in anxious-depressed adolescents with school refusal. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[39]  J. Rey,et al.  Characteristics of Adolescents with School Refusal , 2001, The Australian and New Zealand journal of psychiatry.

[40]  S. Niwa,et al.  School refusal and depression with school inattendance in children and adolescents: Comparative assessment between the Children’s Depression Inventory and somatic complaints , 2001, Psychiatry and clinical neurosciences.

[41]  J. Hektner,et al.  Treatment of school refusal: one-year follow-up. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  M. Okada,et al.  Factors responsible for the prolongation of school refusal , 1999, Psychiatry and clinical neurosciences.

[43]  C. R. Cloninger,et al.  The Junior Temperament and Character Inventory: Preliminary Validation of a Child Self-Report Measure , 1999, Psychological reports.

[44]  P. Links,et al.  The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview. , 1999, Journal of personality disorders.

[45]  C. G. Last,et al.  Cognitive-behavioral treatment of school phobia. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[46]  C. G. Last,et al.  School refusal in anxiety-disordered children and adolescents. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  H. Eysenck,et al.  A revised version of the Psychoticism scale. , 1985 .

[48]  M. Oddy,et al.  The influence of a return to school on the long-term adjustment of school refusers. , 1984, Journal of adolescence.

[49]  W. Yule,et al.  The behavioural treatment of school refusal--a comparative study. , 1984, Behaviour research and therapy.

[50]  HazelB. Baker,et al.  School Phobia: Classification and Treatment , 1978, British Journal of Psychiatry.

[51]  I. Berg,et al.  The Outcome of Adolescent School Phobia , 1976, British Journal of Psychiatry.

[52]  I. Berg.  A follow-up study of school phobic adolescents admitted to an in-patient unit. , 1970, Journal of child psychology and psychiatry, and allied disciplines.

[53]  R. Brodie,et al.  A TEN-YEAR FOLLOW-UP STUDY OF SIXTY-SIX SCHOOL-PHOBIC CHILDREN. , 1964, The American journal of orthopsychiatry.

[54]  J. Kahn,et al.  School refusal: a comprehensive view of school phobia and other failures of school attendance. , 1962, The American journal of orthopsychiatry.

[55]  L. Hersov.  PERSISTENT NON‐ATTENDANCE AT SCHOOL* , 1960 .

[56]  L. Eisenberg,et al.  THE OUTCOME OF SCHOOL PHOBIA: A FOLLOW-UP STUDY BASED ON 41 CASES , 1959 .