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Practitioner review : school refusal : developments in conceptualisation and treatment since 2000.

Elliott, J.G. and Place, M. (2019) 'Practitioner review : school refusal : developments in conceptualisation and treatment since 2000.', Journal of child psychology and psychiatry., 60 (1). pp. 4-15.


Background A generation has passed since the literature on the conceptualisation, assessment and treatment of school refusal was reviewed in this journal (Elliott, 1999). In the light of considerable gaps in the literature, identified at that time, and growing international interest, the current paper sought to identify progress subsequently made this century. Methods We open with discussion of continuing conceptual uncertainty as to whether school refusal should incorporate both truancy and absenteeism marked by anxiety and distress. We then consider progress in treatment, and conclude by examining prognosis and subsequent adult functioning. In selecting intervention studies for review, our primary focus has been upon RCTS, systematic reviews and meta-analyses. Results The literature review indicates that, since the turn of the century, there has been little substantial advance in knowledge that can guide practitioners. Many of the issues raised in the 1999 paper, in particular, conceptual confusion over this heterogeneous condition, a dearth of rigorous RCT designs, limited knowledge of underlying mechanisms and uncertainty as to the long-term effects of specific forms of intervention, are little clearer than before. Conclusions While several sound publications are available to guide intervention for school refusal, there is a continuing need for rigorous studies that can provide evidence to support individualised and tailored responses to an incapacitating problem with many causes and manifestations. While a multisystemic response to intervention approach is considered attractive, the practicalities of operating this across disparate professional borders are likely to present a long-term challenge.

Item Type:Article
Full text:(AM) Accepted Manuscript
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Publisher statement:This is the accepted version of the following article: Elliott, J. G. and Place, M. (2019), Practitioner Review: School refusal: developments in conceptualisation and treatment since 2000. Journal of Child Psychology and Psychiatry 60(1): 4-15, which has been published in final form at This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Date accepted:24 October 2017
Date deposited:16 January 2018
Date of first online publication:02 December 2017
Date first made open access:02 December 2018

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