Antidepressant Medication: Is It a Viable and Valuable Adjunct to Cognitive-Behavioral Therapy for School Refusal?

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal.     

Differentiation Between School Attendance Problems: Why and How?

School attendance problems (SAPs) are heterogeneous with respect to etiology and presentation. The long history of conceptualizing SAPs has led to a vast array of terms and definitions as well as different perspectives on the most helpful approach to classification. For educators, practitioners, researchers, and policymakers, this presents a challenge in understanding, assessing, and intervening with SAPs. This paper outlines evolution in the conceptualization of SAPs, focusing on two contemporary approaches to differentiating between them. One approach draws on the longstanding differentiation between SAP types labeled school refusal, truancy, and school withdrawal. A fourth type of SAP, labeled school exclusion, is also considered. The other approach focuses on the function of absenteeism, measured via the School Refusal Assessment Scale (SRAS). Anecdotal and scientific support for the SAP typology is presented, along with the benefits and shortcomings of the SRAS approach to differentiation. The paper offers suggestions for how to differentiate between SAPs and introduces the SNACK, a brief screening measure that permits differentiation by SAP type.     

Assessing the Impact of a Paid Children,Youth, or Family Worker on Anglican Congregations in England

Drawing on the survey conducted by Christian Research and commissioned by the Youthscape Centre for Research and One Hope, this study examined the impact of a paid children, youth, or family worker on the weekly attendance of 5- to 18-year-old children within 786 Church of England churches with adult attendance ranging from 20 to 250 people. Nearly one-third of these churches had a paid children, youth, or family worker (N?=?259). The data demonstrated that on average the presence of a paid children, youth, or family worker added seven young people between the ages of 5 and 18 years to the total weekly Sunday attendance, after controlling for the weekly adult attendance figures.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

The effects of school anxiety on self-esteem and self-handicapping in pupils attending primary school

School anxiety appears to be related to self-esteem and self-handicapping strategies. This study aims at identifying children with atypical levels of anxiety and examining the relationship between their self-esteem at school and their use of self-handicapping strategies. The sample included 120 pupils (M = 8.6 years) attending third grade of primary school and was divided into three groups: pupils with low anxiety, average anxiety and high anxiety. Children were administered the Scale for Evaluation of Anxiety (SAFA A), the TMA - Multidimensional test of Self-esteem- and the Self-Handicapping Scale for Children. On the whole, results demonstrate a nearly normative distribution of school anxiety in a nonclinical sample. Pupils with an average level of school anxiety showed a higher level of Self-esteem and engaged more in self-handicapping strategies. The developmental perspective suggests the importance of preventive research in order to identify any risk factors of subsequent anxiety disorders at an early age.     

Dark and bright sides of thriving – school burnout and engagement in the Finnish context

School burnout is defined as exhaustion, cynicism and inadequacy as a student, and engagement can be conceptualized as study-related vigor, absorption and dedication. School burnout is increasing, particularly among students on an academic track, while at the end of elementary school almost half of the students no longer find school meaningful. School burnout and engagement were investigated by applying the demand-resource and stage-environment models. The results show that high school demands lead to burnout, while personal and school resources lead to school engagement. Burnout from school-context can also spillover to later depression, drop out and internet addiction, and engagement to overall satisfaction with life and success in educational pathways. In line with the stage-environment fit theory, educational transitions play a role in changes in school burnout trajectories. Adoption of a person-oriented approach revealed several different burnout-engagement profiles, including a profile in which students are at the same time both exhausted and engaged. The social context of peers, immigrant status, parents and teachers also play an important role in engagement and burnout.     

Adapting the Unique Minds Program: Exploring the Feasibility of a Multiple Family Intervention for Children with Learning Disabilities in the Context of Spain

The Unique Minds Program (Stern, Unique Minds Program, 1999) addresses the socio‐emotional needs of children with learning disabilities (LD) and their families. Children and their parents work together in a multiple family group to learn more about LD and themselves as people with the capacity to solve problems in a collaborative way, including problems in family school relationships. This article reports the cultural adaptation of the program for use in Spain and findings from a feasibility study involving three multiple family groups and a total of 15 children and 15 mothers, using a pre‐post design. This Spanish adaptation of the program is called “Mentes Únicas”. Standardized outcome measures indicated an overall statistically significant decrease in children's self‐rated maladjustment and relationship difficulties by the end of the program. Improvements were endorsed by most mothers, although they were not always recognized by the children's teachers. The program had a high level of acceptability: Mothers and children felt safe, understood, and helped throughout the sessions. The efficacy of the adapted intervention for the context of Spain remains to be tested in a more rigorous study.     

Peer rejection, negative peer treatment, and school adjustment: Self-concept and classroom engagement as mediating processes

Data gathered from a short term longitudinal study within fifth grade classrooms (n = 378) were used to evaluate two process-oriented models linking peer rejection and negative peer treatment to children's self-concept, school engagement and adjustment. Both structural models linked peer rejection, victimization, and exclusion to children's self-concept, classroom engagement, and change in achievement (fall of fifth grade to the spring). The model evaluations indicated that peer rejection predicted both exclusion and victimization and that these forms of peer treatment, in turn, predicted academic self-competence. Academic self-competence, however, only partially mediated linkages to achievement change. Parallel (i.e. direct) linkages from exclusion and victimization to both academic self-competence and engagement were required for adequate model fit, as were direct links from academic self-concept and engagement to achievement change. An alternative model representing the hypothesis that academic self-concept fully mediated the relationships between the forms of negative peer treatment and children's engagement and achievement did not fit the data well.     

Professional beliefs related to the practice of pediatric medicine and school psychology

This article proposes that pediatric medicine and school psychology are complementary fields. Five professional beliefs are reviewed: (a) the importance of classification, (b) a preference for evidence-based interventions, (c) an endorsement of advocacy in public policy, (d) the importance of working with the whole child including his/her parents, and (e) an assertion of team leadership. Each belief is discussed as a core value of pediatric medicine and considered for points of connection with school psychology. Some of these beliefs are widely shared by school psychologists, others are rejected because of historical and situational factors, and all warrant consideration in light of school psychology's continuing evolution.     

Processing speed, intelligence, creativity, and school performance: Testing of causal hypotheses using structural equation models

According to mental speed theory of intelligence, the speed of information processing constitutes an important basis for cognitive abilities. However, the question, how mental speed relates to real world criteria, like school, academic, or job performance, is still unanswered. The aim of the study is to test an indirect speed-factor model in comparison to rivaling models explaining the relationships between different mental abilities and performance. In this speed-factor model, basic cognitive processing is assumed to influence higher mental abilities (IQ and creativity). Intelligence and creativity themselves should be valid predictors of school performance. We computed bivariate correlations and structural equation models to test this hypothesis, using indicators of processing speed [Zahlen-Verbindungs-Test (ZVT) and Coding Test], psychometric intelligence [Kognitiver Fähigkeits-Test (KFT) and Raven's Advanced Progressive Matrices (APM)], creativity [Verbaler Kreativitäts-Test (VKT) and Verwendungs-Test (VWT)] and school performance (grades). In a sample of 271 students from German gymnasiums (Class Levels 9 to 11) the speed-factor model can reproduce at best the empirical relationships between processing speed, intelligence, creativity, and school performance: It assumes that processing speed influences higher mental abilities (intelligence and creativity), which, in the sequel, influence school performance. Therefore, processing speed seems to have no direct effect on school performance; the effect is indirect as it operates via mediation through higher cognitive abilities.