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School refusal in adolescence, a clinical study of 183 cases in a primary care
centre.
Abstract :
In modern societies, school difficulties that some adolescents encount, are a frequent reason for
consultation in psychiatry. We led a retrospective clinical study in order to determine the
frequency of consultation demand for school refusal, to measure the selection method
reliability, to describe the population of patients presenting a school refusal and to define some
clinical profiles. For this, between January 2009 and December 2012, we made up a 183
patients list, selected from a clinical situations table in a primary care centre. Then, the
patients’ symptomatology was submitted to a validation by some psychotherapists. Moreover,
we studied the clinical datas for school refusal to define the clinical profiles.
From 2009 to 2012, 10% of the consultation demands alluded to school refusal. After the
clinical validation by some psychotherapists, 83 school refusal cases have been indexed (4,5%
of consultations).
The selection method enabled us to identify 93% of school refusal cases but its positive
predictive value is only 38%. Despite its lack of specific feature, this selection method (clinical
situations table) is statistically very sensitive, so that it can be an interesting way of tracking
school refusal cases.
As part of patients presenting a school refusal, we can find as many boys as girls with an
average age of 15,3 years old. 90% of them were presenting some anxious disorders and for
85% there were some somatic symptoms associated to them. 83% of them had had some
anxious or sleep disorders during childhood and 75% of the mothers had some anxious or
depressive disorders. Girls are more concerned by the separation anxiety disorders than boys
(57% of girls versus 19,5% of boys). Finally, three clinical profiles for school refusal patients
could have been identified.
The clinical pictures’ heterogeneity and the lack of specific symptom make the school refusal
situations tracking more difficult.
Key words :
- school refusal
- school phobia
- adolescents