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.     

Clarity and creativity as womanist ethics for teaching and evaluating theological writing

This article uses womanist ethics and theories of writing instruction to illuminate the experiences of black women seminarians with theological writing at a predominantly white institution. The three cases presented here highlight two ethics for teaching and evaluating theological writing: clarity and creativity. Already triply marginalized by race, sex, and class, black women are often greeted with unwritten norms around academic theological writing that threaten their self‐concept and their development as producers of theological knowledge. This work centers reflections of student‐learning on the voices of black women who found their own ways of negotiating these demands. Their responses to the problems of writing for and in white, male‐dominated theological discourses provide moral strategies that all writers can employ and that all theology professors can make a regular part of their ethical pedagogical practice.     

Comorbidity of Attention Deficit Hyperactive Disorder (ADHD) and major depression in primary school children

The study investigated comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and depression in a sample of rural primary school children in Limpopo Province, South Africa. A total of 320 learners participated in this study of whom 160 learners had teacher and parent identified ADHD symptoms (females?=?50%; age range 6–14 years). All the learners took the Beck Depression Youth Inventory, second edition. Data were analysed applying ANOVA to investigate the possible differences between and within age, gender, and ADHD subtype group differences in depression symptomatology. Results indicated no statistically significant differences in the scores on the depression scale between the children with ADHD as identified by parents and teachers and the comparison group peers.     

Psychological,social and physical environmental mediators of the SCORES intervention on physical activity among children living in low-income communities

ObjectivesThis study examined mediation effects of socio-ecological variables on accelerometer-determined physical activity among children in the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention.DesignRandomized control trial mediation analysis.MethodsPrimary school children were randomly assigned the SCORES multi-component intervention or control group for the 12-month study. The outcome was accelerometer derived total moderate-to-vigorous physical activity (MVPA). Hypothesized mediators measured in children were physical activity enjoyment and perceived sport competence and social support. Hypothesized mediators measured in parents were family social support, access to physical activity facilities and equipment at home, and perceived access to physical activity opportunities in the local community. Mediation analyses were conducted using multi-level linear analysis in MPlus.ResultsThere were significant intervention effects for social support from teachers (A = 1.73, SE = 0.88, p = 0.048) and parental perceived access to physical opportunities in the local community (A = 2.69, SE = 1.12, p = 0.016). There were significant associations between changes in perceived sport competence (B = 0.48, SE = 0.36, p = 0.027), parental perceived access to physical activity opportunities in the local community (B = 0.60, SE = 0.26, p = 0.021), and changes in total MVPA. Parental perceived access to physical activity opportunities in the local community was found to have a significant mediating effect on total MVPA (AB = 1.61, 95% CI = 0.06 to 3.95, proportion 13%).ConclusionsParental perceived access to physical activity opportunities in the local community is a potential mechanism of behavior change for children and mediated the effect of the SCORES intervention on objectively measured physical activity.     

A Theological Cartography of Cultural Evolution

This article maps key points of contact between Christian doctrine and recent advances in cultural evolution. Beginning with theological anthropology, the article shows that cultural evolution problematizes purely substantive accounts of the image of God. Moving to the doctrine of sin, we explain how cultural evolutionary findings enrich and challenge distinct aspects of hamartiology. The article turns to moral topics, since cultural evolution sheds light on altruistic and hyper-social behavior; additionally, we show how belief in moral deities and observation of religious rituals provide an evolutionary advantage. Finally, the authors analyze whether cultural evolution amounts to an explanation of religion.     

The Effect of Physical Activity on Children With ADHD: A Quantitative Review of the Literature

Research on the effects of physical activity on children with attention deficit hyperactivity disorder is promising, yet no attempt has been made to integrate current findings using meta-analytic techniques. Using a meta-regression, the present study examined the effectives of physical activity for children with attention deficit hyperactivity disorder on a number of cognitive, behavioral, and emotional outcomes. From 20 empirical studies, 164 effect sizes quantifying the effectiveness of physical activity for children with attention deficit hyperactivity disorder were extracted from 22 independent samples. Results indicated an overall moderate-to-large effect for physical activity on children with attention deficit hyperactivity disorder, with a significant effect for emotion/mood. Limitations of the study, future directions, and implications for school professionals are discussed.     

Enhancing the Behavioral and Mental Health Services Within School-Based Contexts

ABSTRACT

Recent health care reform provides many new opportunities to expand mental health and behavioral support to students in schools and school–community partnerships. Through newly available funding sources, as well as expanded legislative initiatives, school psychologists can advocate for and become leaders in delivering universal programming, tiered mental health supports, and formalized collaborative efforts with community agencies. The authors highlight the application of tiered levels of services, with current practice samples, designed to address students' mental and behavioral health. Implications for practice are discussed.