Parental Predictors of School Attendance Difficulties in Children Referred to an Anxiety Disorders Clinic
Parental Predictors of School Attendance Difficulties in Children Referred to an Anxiety Disorders Clinic
Main Article Content
Abstract
Difficulties with attending school are common in children referred to anxiety disorders clinics. Although parental factors have been posited as playing an important predictive role, little is known about which parental factors are associated with school attendance difficulties (SADs). We address this gap by examining family accommodation, parental psychological control, parental anxiety, and parental depression as possible predictors of SADs in children (N=343; ages 6 to 17 years, M=10.40 years, SD=2.93; 84% mothers; M=41.20 years, SD=5.49) who presented to a childhood anxiety disorders clinic. Forty-eight percent (n= 166) had SADs including not attending school, arriving to school late and/or leaving early, not staying in the classroom during school hours, or behavior problems associated with attending school (e.g. morning tantrums). Logistic regression analyses using child and parent ratings revealed that of the parental variables examined, family accommodation and parental depression were significant predictors of SADs after controlling for the effects of parental psychological control, parental anxiety, child age, child anxiety and child depression. The study’s findings suggest that high levels of family accommodation and high levels of parental depression increase the odds of SADs in anxious children.
References
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implications. Child & Youth Care Forum, 38(3), 151-160. doi:10.1007/s10566-009-9074
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Discovering meaning behind informant discrepancies in clinical assessments of children
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International Journal of Behavioral Consultation and Therapy, 1(3), 216-222.
doi: 10.1037/h0100746
Kearney, C.A., & Graczyk, P. (2014). A response to intervention model to promote school
attendance and decrease school absenteeism. Child & Youth Care Forum, 43(1), 1-25.
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Kearney, C.A., LaSota, M.T., Lemos-Miller, A., & Vecchio, J. (2007). Parent training in the
treatment of school refusal behavior. In J.M. Briesmeister & C.E. Schaefer (Eds.),
Handbook of parent training: Helping parents prevent and solve behavior problems,
(pp. 164-193). Hoboken, NJ: John Wiley & Sons.
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School Refusal Assessment Scale. Journal of Clinical Child Psychology, 22(1), 85-96.
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Journal of Family Therapy, 23(1), 59-72. doi: 10.1080/01926189508251336
Kovacs, M. (1981). Rating scales to assess depression in school-aged children. Acta
Paedopsychiatricia, 46(5-6), 305-315.
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Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 31-35.doi:
10.1097/00004583-199001000-00006
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198712000-00004
Lebowitz, E.R., Leckman, J.F., Feldman, R., Zagoory-Sharon, O., McDonald, N., & Silverman,
W.K. (2016). Salivary oxytocin in clinically anxious youth: Associations with separation
anxiety and family accommodation. Psychoneuroendocrinology, 65, 35-43.
doi: 10.1016/j.psyneuen.2015.12.007
Lebowitz, E.R., Marin, C. E., Martino, A., Shimshoni, Y., Silverman, W.K. (in press).
Parent-based treatment as efficacious as CBT for childhood anxiety: A randomized
noninferiority study of SPACE. Journal of the American Academy of Child and Adolescent
Psychiatry.
Lebowitz, E.R., Omer, H., Hermes, H., & Scahill, L. (2014). Parent training for childhood anxiety
disorders: the SPACE program. Cognitive and Behavioral Practice, 21(4), 456-469.
doi: 10.1016/j.cbpra.2013.10.004
Lebowitz, E.R., Scharfstein, L., & Jones, J. (2015). Child-report of family accommodation in
pediatric anxiety disorders: Comparison and integration with mother-report. Child
Psychiatry and Human Development, 46(4), 501-511. doi: 10.1007/s10578-014-0491-1
Lebowitz, E.R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., ...
Leckman, J. F. (2013). Family accommodation in pediatric anxiety disorders. Depression
and Anxiety, 30(1), 47-54. doi: 10.1002/da.21998
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Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of
the American Academy of Child & Adolescent Psychiatry, 36(4), 554-565.
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Muthén.
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childhood anxiety: The mediating role of perceived lack of control. Journal of Child and
Family Studies, 21(4), 637-645. doi: 10.1007/s10826-011-9516-6
Norman, K.R., Silverman, W.K., & Lebowitz, E.R. (2015). Family accommodation of child and
adolescent anxiety: Mechanisms, assessment, and treatment. Journal of Child and
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school refusal. Journal of Research in Special Educational Needs, 2(2), 1-10.
doi: 10.1111/j.1471-3802-2002.00167.x
Schwarz, J.C., Barton-Henry, M.L., & Pruzinsky, T. (1985). Assessing child-rearing behaviors: A
comparison of ratings made by mother, father, child, and sibling on the CRPBI. Child
Development, 56(2), 462-479. doi: 10.2307/1129734
Schludermann, E., & Schludermann, S. (1970). Replicability of factors in children’s report of
parent behavior (CRPBI). The Journal of Psychology, 76(2), 239-249.
doi: 10.1080/00223980.1970.9916845
Settipani, C.A., O’Neil, K.A., Podell, J.L., Beidas, R.S., & Kendall, P.C. (2013). Youth anxiety
and parent factors over time: Directionality of change among youth treated for anxiety.
Journal of Clinical Child & Adolescent Psychology, 42(1), 9-21.
doi: 10.1080/15374416.2012.719459
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(Child and Parent Versions). New York: Oxford University Press.
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of parents with anxiety disorders. Journal of the American Academy of Child and
Adolescent Psychiatry, 27(6), 779-784. doi: 10.1097/00004583-198811000-00020
Silverman, W.K., & Eisen, A.R. (1992). Age differences in the reliability of parent and child
reports of child anxious symptomatology using a structured interview. Journal of the
American Academy of Child & Adolescent Psychiatry, 31(1), 117-124.
doi: 10.1097/00004583-199201000-00018
Silverman, W.K, Marin, C. E., Rey, Y., Kurtines, W.M., Jaccard, J., & Pettit, J.W. (in press).
Group-versus parent-involvement CBT for childhood anxiety disorders: Treatment
specificity and long-term recovery mediation. Clinical Psychological Science.
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and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent
versions. Journal of American Academy of Child & Adolescent Psychiatry, 40(8), 937-944.
doi: 10.1097/00004583-200108000-00016
Thompson-Hollands, J., Kerns, C. E., Pincus, D.B., & Comer, J.S. (2014). Parental
accommodation of child anxiety and related symptoms: Range, impact, and correlates.
Journal of Anxiety Disorders, 28(8), 765-773.
Tonge, B.J., & Silverman, W.K. (2019). Reflections on the field of school attendance problems:
For the times they are a-changing? Cognitive and Behavioral Practice. Advance online
publication. doi: 10.1016/j.cbpra.2018.12.004
Wilcox, R.R., & Keselman, H.J. (2003). Modern robust data analysis methods: Measures of central
tendency. Psychological Methods, 8(3), 254-274. doi: 10.1037/1082-989X.8.3.254
Wood, J.J., Piacentini, J.C., Bergman, L.R., McCracken, J., & Barrios, V. (2002). Concurrent
validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for
the DSM-IV: Child and parent versions. Journal of Clinical Child & Adolescent
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Bahali, K., Tahiroglu, A.Y., Avci, A., & Seydaoglu, G. (2011). Parental psychological symptoms
and familial risk factors of children and adolescents who exhibit school refusal. East Asian
Archives of Psychiatry, 21(4), 164-169.
Beck, A. T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical
anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6),
893-897. doi: 10.1037/0022-006X.56.6.893
Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4(6), 561-571.
doi: 10.1001/archpsyc.1961.01710120031004
Benito, K.G., Caporino, N.E., Frank, H.E., Ramanujam, K., Garcia, A., Freeman, J., ... Storch, E.
A. (2015). Development of the pediatric accommodation scale: Reliability and validity of
clinician- and parent-report measures. Journal of Anxiety Disorders, 29, 14-24.
doi: 10.1016/j.janxdis.2014.10.004
Berg, I. (1997). School refusal and truancy. Archives of Disease in Childhood, 76(2), 90-91.
doi:10.1136/adc.76.2.90
Bools, C., Foster, J., Brown, I., & Berg, I. (1990). The identification of psychiatric disorders in
children who fail to attend school: A cluster analysis of a non-clinical population.
Psychological Medicine, 20(1), 171-181. doi:10.1017/S0033291700013350
Broadwin, I.T. (1932). A contribution to the study of truancy. American Journal of
Orthopsychiatry, 2(3), 253-259. doi:10.1111/j.1939-0025.1932.tb05183.x
Carless, B., Melvin, G.A., Tonge, B.J., & Newman, L.K. (2015). The role of parental self-efficacy
in adolescent school-refusal. Journal of Family Psychology, 29(2), 162-170.
doi:10.1037/fam0000050
Clark, J.P., & Alvarez, M. (Eds.). (2010). Response to intervention: A guide for school social
workers. USA: Oxford University Press.
Colletti, C.J.M., Forehand, R., Garai, E., Rakow, A., McKee, L., Fear, J.M., & Compas, B.E.
(2009). Parent depression and child anxiety: An overview of the literature with clinical
implications. Child & Youth Care Forum, 38(3), 151-160. doi:10.1007/s10566-009-9074
De Los Reyes, A. (2011). Introduction to the special section: More than measurement error:
Discovering meaning behind informant discrepancies in clinical assessments of children
and adolescents. Journal of Clinical Child & Adolescent Psychology, 40(1), 1-9.
doi: 10.1080/15374416.2011.533405
Egger, H.L., Costello, J.E., & Angold, A. (2003). School refusal and psychiatric disorders: A
community study. Journal of the American Academy of Child & Adolescent Psychiatry,
42(7), 797-807. doi: 10.1097/01.CHI.0000046865.56865.79
Enders, C.K. (2010). Applied missing data analysis. New York, NY: The Guilford Press.
Hansen, C., Sanders, S.L., Massaro, S., & Last, C.G. (1998). Predictors of severity of absenteeism
in children with anxiety-based school refusal. Journal of Clinical Child Psychology, 27(3),
246-254. doi: 10.1207/s15374424jccp2703_2
Heyne, D. (2006). School refusal. In J.E., Fisher & W.T. O’Donohue (Eds), Practitioner’s guide to
evidence-based psychotherapy (pp. 600-619). Boston, MA: Springer.
Heyne, D., King, N.J., Tonge, B.J., Rollings, S., Young, D., Pritchard, M., & Ollendick, T.H.
(2002). Evaluation of child therapy and caregiver training in the treatment of school
refusal. Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 687-
695. doi: 10.1097/00004583-200206000-00008
Heyne, D., Gren-Landell, M., Melvin, G., & Gentle-Genitty, C. (2018). Differentiation between
school attendance problems: Why and how? Cognitive and Behavioral Practice. Advanced
online publication. doi: 10.1016/j.cbpra.2018.03.006
Ingul, J. M., Havik, T., & Heyne, D. (2018). Emerging school refusal: A school-based framework
for identifying early signs and risk factors. Cognitive and Behavioral Practice. Advanced
online publication. doi: 10.1016/j.cbpra.2018.03.005
Johnson, A.M., Falstein, E. I., Szurek, S.A., & Svendsen, M. (1941). School phobia. American
Journal of Orthopsychiatry, 11(4), 702-711. doi:10.1111/j.1939-0025.1941.tc05860.x
Kearney, C.A. (2008). School absenteeism and school refusal behavior in youth: A contemporary
review. Clinical Psychology Review, 28(3), 451-471. doi: 10.1016/j.cpr.2007.07.012
Kearney, C.A., Chapman, G., & Cook, L.C. (2005). School refusal behavior in young children.
International Journal of Behavioral Consultation and Therapy, 1(3), 216-222.
doi: 10.1037/h0100746
Kearney, C.A., & Graczyk, P. (2014). A response to intervention model to promote school
attendance and decrease school absenteeism. Child & Youth Care Forum, 43(1), 1-25.
doi: 10.1007/s10566-013-9222-1
Kearney, C.A., LaSota, M.T., Lemos-Miller, A., & Vecchio, J. (2007). Parent training in the
treatment of school refusal behavior. In J.M. Briesmeister & C.E. Schaefer (Eds.),
Handbook of parent training: Helping parents prevent and solve behavior problems,
(pp. 164-193). Hoboken, NJ: John Wiley & Sons.
Kearney, C.A., & Silverman, W.K. (1993). Measuring the function of school refusal behavior: The
School Refusal Assessment Scale. Journal of Clinical Child Psychology, 22(1), 85-96.
doi: 10.1207/s15374424jccp2201_9
Kearney, C.A., & Silverman, W.K. (1995). Family environment of youngsters with school refusal
behavior: A synopsis with implications for assessment and treatment. The American
Journal of Family Therapy, 23(1), 59-72. doi: 10.1080/01926189508251336
Kovacs, M. (1981). Rating scales to assess depression in school-aged children. Acta
Paedopsychiatricia, 46(5-6), 305-315.
Last, C.G., & Strauss, C.C. (1990). School refusal in anxiety-disordered children and adolescents.
Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 31-35.doi:
10.1097/00004583-199001000-00006
Last, C.G., Strauss, C.C., & Francis, G. (1987). Comorbidity among childhood anxiety disorders.
The Journal of Nervous and Mental Disease, 175(12), 726-730. doi: 10.1097/00005053-
198712000-00004
Lebowitz, E.R., Leckman, J.F., Feldman, R., Zagoory-Sharon, O., McDonald, N., & Silverman,
W.K. (2016). Salivary oxytocin in clinically anxious youth: Associations with separation
anxiety and family accommodation. Psychoneuroendocrinology, 65, 35-43.
doi: 10.1016/j.psyneuen.2015.12.007
Lebowitz, E.R., Marin, C. E., Martino, A., Shimshoni, Y., Silverman, W.K. (in press).
Parent-based treatment as efficacious as CBT for childhood anxiety: A randomized
noninferiority study of SPACE. Journal of the American Academy of Child and Adolescent
Psychiatry.
Lebowitz, E.R., Omer, H., Hermes, H., & Scahill, L. (2014). Parent training for childhood anxiety
disorders: the SPACE program. Cognitive and Behavioral Practice, 21(4), 456-469.
doi: 10.1016/j.cbpra.2013.10.004
Lebowitz, E.R., Scharfstein, L., & Jones, J. (2015). Child-report of family accommodation in
pediatric anxiety disorders: Comparison and integration with mother-report. Child
Psychiatry and Human Development, 46(4), 501-511. doi: 10.1007/s10578-014-0491-1
Lebowitz, E.R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., ...
Leckman, J. F. (2013). Family accommodation in pediatric anxiety disorders. Depression
and Anxiety, 30(1), 47-54. doi: 10.1002/da.21998
March, J.S., Parker, J.D., Sullivan, K., Stallings, P., Conners, C.K. (1997). The Multidimensional
Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of
the American Academy of Child & Adolescent Psychiatry, 36(4), 554-565.
doi: 10.1097/00004583-199704000-00019
Muthén, L.K., & Muthén, B.O. (2012). Mplus Version 7 user’s guide. Los Angeles, CA: Muthén &
Muthén.
Nanda, M.M., Kotchick, B.A., & Grover, R.L. (2012). Parental psychological control and
childhood anxiety: The mediating role of perceived lack of control. Journal of Child and
Family Studies, 21(4), 637-645. doi: 10.1007/s10826-011-9516-6
Norman, K.R., Silverman, W.K., & Lebowitz, E.R. (2015). Family accommodation of child and
adolescent anxiety: Mechanisms, assessment, and treatment. Journal of Child and
Adolescent Psychiatric Nursing, 28(3), 131-140. doi: 10.1111/jcap.12116
Partridge, J.M. (1939). Truancy. Journal of Mental Science, 85(354), 45-81.
doi: 10.1192/bjp.85.354.45
Place, M., Hulsmeier, J., Davis, S., & Taylor, E. (2002). The coping mechanisms of children with
school refusal. Journal of Research in Special Educational Needs, 2(2), 1-10.
doi: 10.1111/j.1471-3802-2002.00167.x
Schwarz, J.C., Barton-Henry, M.L., & Pruzinsky, T. (1985). Assessing child-rearing behaviors: A
comparison of ratings made by mother, father, child, and sibling on the CRPBI. Child
Development, 56(2), 462-479. doi: 10.2307/1129734
Schludermann, E., & Schludermann, S. (1970). Replicability of factors in children’s report of
parent behavior (CRPBI). The Journal of Psychology, 76(2), 239-249.
doi: 10.1080/00223980.1970.9916845
Settipani, C.A., O’Neil, K.A., Podell, J.L., Beidas, R.S., & Kendall, P.C. (2013). Youth anxiety
and parent factors over time: Directionality of change among youth treated for anxiety.
Journal of Clinical Child & Adolescent Psychology, 42(1), 9-21.
doi: 10.1080/15374416.2012.719459
Silverman, W.K. & Albano, A.M. (1996). The Anxiety Disorders Interview Schedule for DSM-IV
(Child and Parent Versions). New York: Oxford University Press.
Silverman, W.K., Cerny, J.A., Nelles, W.B., & Burke, A.E. (1988). Behavior problems in children
of parents with anxiety disorders. Journal of the American Academy of Child and
Adolescent Psychiatry, 27(6), 779-784. doi: 10.1097/00004583-198811000-00020
Silverman, W.K., & Eisen, A.R. (1992). Age differences in the reliability of parent and child
reports of child anxious symptomatology using a structured interview. Journal of the
American Academy of Child & Adolescent Psychiatry, 31(1), 117-124.
doi: 10.1097/00004583-199201000-00018
Silverman, W.K, Marin, C. E., Rey, Y., Kurtines, W.M., Jaccard, J., & Pettit, J.W. (in press).
Group-versus parent-involvement CBT for childhood anxiety disorders: Treatment
specificity and long-term recovery mediation. Clinical Psychological Science.
Silverman, W.K., Saavedra, L.M., & Pina, A.A. (2001). Test-retest reliability of anxiety symptoms
and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent
versions. Journal of American Academy of Child & Adolescent Psychiatry, 40(8), 937-944.
doi: 10.1097/00004583-200108000-00016
Thompson-Hollands, J., Kerns, C. E., Pincus, D.B., & Comer, J.S. (2014). Parental
accommodation of child anxiety and related symptoms: Range, impact, and correlates.
Journal of Anxiety Disorders, 28(8), 765-773.
Tonge, B.J., & Silverman, W.K. (2019). Reflections on the field of school attendance problems:
For the times they are a-changing? Cognitive and Behavioral Practice. Advance online
publication. doi: 10.1016/j.cbpra.2018.12.004
Wilcox, R.R., & Keselman, H.J. (2003). Modern robust data analysis methods: Measures of central
tendency. Psychological Methods, 8(3), 254-274. doi: 10.1037/1082-989X.8.3.254
Wood, J.J., Piacentini, J.C., Bergman, L.R., McCracken, J., & Barrios, V. (2002). Concurrent
validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for
the DSM-IV: Child and parent versions. Journal of Clinical Child & Adolescent
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