Functional analysis of school refusal: An exploratory study in the Indian context.

Background: School refusal behaviour is an umbrella term that often subsumes constructs such as truancy, school refusal, and school phobia. It is influenced by various psychological and psychosocial factors and can lead to significant distress to the child and the family. Aim: To assess the clinical and functional profile of school refusal behavior in children and adolescents presenting to a tertiary care child and adolescent psychiatry center in the Indian context. Materials and Methods: Thirty-six subjects (6-17 years) presenting to a tertiary Child and Adolescent Psychiatry service with school refusal behavior (SRB) were evaluated using the MINI-KID 6.0 and School Refusal Assessment Scale-Revised (SRAS-R). The sociodemographic and clinical characteristics of the sample were studied using frequency analysis and central tendencies. The association between school refusal and these variables was examined using Cramer's Results: Anxiety in social/evaluative situations associated with tangible rewards at home was the predominant primary reason for school refusal in this sample. There was a significant statistical association between functions of school refusal and scholastic performance, psychiatric diagnosis, and family stressors. The Children's Global Assessment Scale (CGAS) scores varied widely from 30 to 80 indicating an inability to function in almost all areas to no more than a slight impairment in functioning. Conclusions: School refusal is a complex multifactorial phenomenon with both individual and psychosocial contributing factors. Understanding the phenomenon from a functional perspective helps in devising an individualized treatment plan that may lead to better outcomes.