School Refusal

As a working defi nition, school refusal can be either (a) refusal to attend or (b) diffi culty remaining in school for an entire day (Kearney & Silverman, 1990). School refusal is a complicated behavior inasmuch as children may refuse to go to school for many diff erent reasons. Most important, school refusal must be diff erentiated from truancy, a distinction initially discussed during the 1930s and 1940s (see Kearney, Eisen, & Silverman, 1995) when school absenteeism was defi ned as a “clinical behavior” and distinguished from truancy. Truancy, a disruptive behavior, was considered to be an aspect of juvenile delinquency, whereas school refusal described children who desired to go to school but nevertheless were uncomfortable about attendance. In the 1940s, the term “school phobia” (Johnson, Falstein, Szurek, & Svendsen, 1941) was fi rst used (Kearney et al., 1995) to describe the following constellation of behaviors: the presence of child anxiety, maternal anxiety, and an enmeshed mother-child relationship. Specifi cally, psychoanalytic theory implied that a close symbiotic

relationship between mother and child led to an over dependent relationship that resulted in the child’s reluctance to attend school. Later, behavioral theory postulated school refusal as a learned reaction to a specifi c event or situation associated with the school environment (see section on etiology for an extended description of these theories).