The importance of family factors in adolescent school refusal

School refusal, defined primarily upon the absence from school on the basis of emotional distress, is understood to be a multifaceted phenomenon operating under the influence of youth, parent and family characteristics. While a growing body of literature supports a multitude of factors being implicated in school refusal, this research has primarily investigated affective and behavioural domains, such as psychopathology and family behaviours and processes. More recent research has begun to incorporate cognitive elements involved in school refusal; however, these have primarily addressed child cognitions with little attention toward the role of parental cognitions in school refusal. Furthermore, despite the problematic parenting practices and family processes that frequently characterise school refusing families, relational dynamics within this population has been largely overlooked within the literature. The overarching aim of this thesis was to broaden the conceptualisation of adolescent school refusal by examining individual, parent, and family characteristics from complementary paradigms; that is, the consideration of cognitive-behavioural and attachment-theory frameworks in conceptualising the phenomenon of school refusal. This aim was examined over three studies whereby school refusing adolescents where compared to school attending adolescents. A sample of 65 school refusing adolescents and 46 school attending adolescents, along with their parent participated across the three studies. Participants completed measures of demographics, psychopathology, family functioning and a measure of the parental cognitive construct, parental self-efficacy. A sub-sample additionally completed an interview assessing attachment-related constructs. The first study examined whether school refusing adolescents could be distinguished from school attending adolescents on the basis of individual, parent and family characteristics. As expected, families of school refusing adolescents were characterised by higher levels of adolescent and parent psychopathology as well as more problematic family functioning than families of school attending adolescents. Logistic regression analysis identified adolescent depression and family dysfunction as predictors of school refusal. The second study investigated the role of parenting self-efficacy in school refusal. As expected, parents of school refusing adolescents were found to have lower levels of parental self-efficacy than parents of school attending adolescents. Logistic regression analyses determined parenting self-efficacy to be a predictor of school refusal. However, upon controlling for related constructs including family dysfunction and familiar psychopathology, the predictive capacity of parental self-efficacy was reduced or eliminated. The third study adopted an attachment-theory framework towards the examination of school refusal to examine whether families of school refusing adolescents, anxious school attending adolescents, and regular attending adolescents differed with respect to attachment-related constructs. The results provided a model of school refusal as reflecting parental difficulties in encouraging the individuation of their school refusing adolescent in the context of interacting deficits in the capacity for reflective functioning, emotion regulation, and depressive characteristics. Taken together, the findings from these three interrelated studies suggest that while individual characteristics – such as adolescent depression – are important considerations in school refusal, greater emphasis ought to be placed upon relational dynamics transpiring within the family system. The findings also suggest that adopting an attachment-theory framework towards the conceptualisation of school refusal may provide a complementary perspective in the conceptualisation, assessment, and treatment of school refusal.