Treatment of school refusal: One-year follow-up

Gail A. Bernstein, Joel M. Hektner, Carrie M. Borchardt, Maren H. Mcmillan

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Objective: To conduct a 1-year follow-up of anxious-depressed school-refusing adolescents who participated in an 8-week study of imipramine versus placebo, each in combination with cognitive-behavioral therapy. Method: Sixty-five percent (41 of 63) of the randomly assigned subjects returned for follow-up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questionnaire regarding interim treatments and school programs. Results: From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety disorder and 33.3% met criteria for a depressive disorder. Remission rates and acquisition rates for specific anxiety and depressive dis-orders were determined. In the follow-up period, 67.5% received at least one psychotropic medication trial and 77.5% had outpatient therapy. Higher level of somatic complaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p = .029). Conclusions: In this naturalistic follow-up study, there was high utilization of mental health interventions. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. Investigation of duration of acute treatments and evaluation of maintenance treatments for school refusal is needed.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
StatePublished - 2001


  • Anxiety
  • Depression
  • Follow-up
  • School refusal


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