Clinical characteristics of child and adolescent psychiatric patients with school refusal: Child versus adolescent onset.

Background: Clinical characteristics of children with school refusal may differ depending on whether school refusal onset occurs during childhood or adolescence. Objective: To determine variations in clinical characteristics of Japanese psychiatric outpatients with school refusal by age. Method: Participants were patients (aged <15 years) who consulted the Department of Child and Adolescent Psychiatry, Kohnodai Hospital, between January 1, 2016 and December 31, 2022. The proportion of diagnoses according to the ICD-10 classification grouped into "developmental and psychological domains" were calculated at each age of school refusal onset. Additionally, clinical characteristics of patients with school refusal onset during adolescence (11-15 years) were compared with child-onset (6-10 years). Results: Of 3,119 patients who had their initial consultation at Kohnodai Hospital, 36.7% (n=1,145) had school refusal. At age 7, 75.9% were classified as having a diagnosis in the "developmental domains," a proportion which subsequently declined with age. In contrast, 36.2% of 7-year-olds had a diagnosis in the "psychological domains," and the proportion subsequently increased with age. Based on a logistic regression model, students with psychological domain diagnoses and suicide-related behaviors had higher odds ratios of school refusal onset during adolescence, whereas those with developmental domain disorders had lower odds ratios, compared to child-onset. Conclusions: Gaining insight into the differences between child and adolescent school refusal may help develop targeted interventions and preventive strategies tailored to different developmental stages. Further research encompassing diverse populations and longitudinal studies could deepen our understanding and clarify causal relationships.