Cognitive and Behavioral Therapy in School Refusal (RSA-Coll)

Anxious School Refusal in Adolescents: Efficiency of a Cognitive and Behavioral Therapy (CBT) Day Hospital Program

Anxious school refusal (ASR) is a common disorder which concerns more and more adolescents who are at worse completely absent from school. A specific ambulatory cognitive and behavioral therapy (CBT) program has been established to gradually reintegrate the child back into the school environment with a multidisciplinary team. Alongside school reintegration assessment, the child's overall ability to function and anxiety levels will be measured before and after the program with additional assessments made after a further 6 and 12 months have elapsed.

Study Overview

• Status: Completed
• Conditions: Adolescent; Cognitive Behavioral Therapy; Child Psychiatry; Anxious School Refusal
• Intervention / Treatment: Other: cognitive and behavioral therapy (CBT)

Detailed Description

ASR concerns children and adolescents who feel anxiety about going to school. Some are totally absent, some just have difficulty remaining in school for the entire day, or go to school following behavioral problems such as morning tantrums or psychosomatic complaints. Anxiety disorders are the main diagnostic underlying this behavioral problem, with one or many anxiety disorders associated (i.e. separation anxiety disorder, panic disorder, social anxiety disorder, generalized anxiety disorder or specific phobia). ASR causes much distress to the child, the parents, and the school personnel and interferes with social and educational development. Children with severe or chronic school refusal appear to have a long-term risk of adult mental health issues (e.g. anxiety, depression). Studies about ASR are few, and nonexistent in France. ASR occurs in approximately 1% of all school-aged children, and 5% of all clinic-referred children, is equally common in both boys and girls but more frequent in adolescents. Recommendations for anxiety disorder treatment in youth is psychotherapy. CBT, especially exposure-based, is the intervention that is supported by numerous, randomized, controlled trials in this area. But concerning ASR, there are few studies.

A specific ambulatory therapeutic CBT program for totally absent from school adolescents is established within the children and adolescent psychiatric unit in the University Hospital of Montpellier, France. The unit has implemented CBT techniques to gradually reintegrate the child back into the school environment. This program will be implemented in 3 other child and adolescent psychiatry centers (Marseille, Béziers and Nîmes).

The main objective of this study is to evaluate the efficiency of a CBT program on the return back to school.

Secondary objectives are:

1. To evaluate the feasibility in implantation of this program
2. To describe the characteristics of adolescents
3. To assess the initial severity of mental disorders and the evolution of these disorders
4. To describe the evolution of patient anxiety
5. To describe the evolution of the overall functioning
6. To evaluate the efficiency on the return back to school at 6 and 12 month after intervention.

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Montpellier, France, 34295
    • Montpellier University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 12 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion criteria:

• Adolescents between 10 and 16 years old registered in French college (6è to 3è),
• Anxious school refusal based on Berg's criteria,
• Completely dropped out from school (>5 consecutive days of school nonattendance, absenteeism < 12 months),
• Anxiety disorder as a principal diagnosis (DSM 5)(MINI -S KID),
• Adolescents want to return to school,
• Signed consent by parents and adolescents

Exclusion criteria:

• Intellectual disabilities
• Autism spectrum disorder
• Learning disabilities that causes emotional trouble and being the primary cause of teenagers dropping out of school.
• Conduct disorder (DSM 5)
• Ongoing psychotherapeutic care that the parents or the adolescent would not wish to suspend
• Participation in other ongoing research
• Pregnancy
• Patient not benefiting from a social security scheme

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Anxious school refusal; Adolescents with anxious shool refusal will beneficiate of cognitive and behavioral therapy (CBT) in order to help them to return back to school

Other: cognitive and behavioral therapy (CBT); The CBT program is delivered by a multidisciplinary team with 4 half day hospitalization that includes individual, group CBT and education time (2 hours per day delivered by the teacher). Participants have homework to do in their own time at home. CBT is a manualized program with anxiety psychoeducation, stress management, cognitive restructuration, problem solving techniques, progressive exposure, assertiveness exercises and self-esteem work.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
School continue reintegration	The return back to school next year : school continue reintegration (number of hours the adolescent attended school > 80% of the number of hours expected for each patient	46 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Types of anxiety disorders according to the DSM 5	The questionnaire Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-S KID) is completed with parents and the adolescent	46 months
Presence of comorbidities	Presence of comorbidities is evaluated by the questionnaire Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-S KID) completed with parents and the adolescent	46 months
Initial severity of mental disorders and the evolution of these disorders	Mesure thanks to the Clinical Global Impression (CGI) scale.	46 months
Anxiety assessment	Mesure thanks to the Anxiety and Phobia Behavioural (ECAP) Scale	46 months
Anxiety assessment	Mesure thanks to the scales Revisited Children's Manifest Anxiety scale (RCMAS)	46 months
Anxiety assessment	Mesure thanks to the scales Multidimensional Anxiety Scale for Children (MASC)	46 months
Global functioning	Mesure thanks to the scale Children's global Assessment (C GAS) Scale	46 months
School attendance time month by month		46 months

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier
• Investigators: Principal Investigator: Hélène DENIS, Montpellier University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): September 22, 2020
• Primary Completion (Actual): May 22, 2023
• Study Completion (Actual): July 8, 2024

Study Registration Dates

• First Submitted: August 18, 2020
• First Submitted That Met QC Criteria: September 16, 2020
• First Posted (Actual): September 23, 2020

Study Record Updates

• Last Update Posted (Actual): July 18, 2024
• Last Update Submitted That Met QC Criteria: July 17, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: adolescents; treatment outcome; CBT; anxiety disorders; Anxious school refusal
• Other Study ID Numbers: RECHMPL20_0048

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No