title: School refusal and psychiatric disorders: a community study.
abstract: OBJECTIVE
  To examine the association between anxious school refusal and truancy and psychiatric disorders in a community sample of children and adolescents using a descriptive rather than etiological definition of school refusal.
  
  
  METHODS
  Data from eight annual waves of structured psychiatric interviews with 9- to 16-year-olds and their parents from the Great Smoky Mountains Study were analyzed.
  
  
  RESULTS
  Pure anxious school refusal was associated with depression (odds ratio [OR] = 13, 95% confidence interval [CI] 3.4, 42) and separation anxiety disorder (OR = 8.7, 95% CI 4.1, 19). Pure truancy was associated with oppositional defiant disorder (OR = 2.2, 95% CI 1.2, 4.2), conduct disorder (OR = 7.4, 95% CI 3.9, 14), and depression (OR = 2.6, 95% CI 1.2, 56). Of mixed school refusers (children with both anxious school refusal and truancy), 88.2% had a psychiatric disorder. They had increased rates of both emotional and behavior disorders. Specific fears, sleep difficulties, somatic complaints, difficulties in peer relationships, and adverse psychosocial variables had different associations with the three types of school refusal.
  
  
  CONCLUSIONS
  Anxious school refusal and truancy are distinct but not mutually exclusive and are significantly associated with psychopathology, as well as adverse experiences at home and school. Implications of these findings for assessment, identification, and intervention for school refusal are discussed.
authors.affiliation: Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. hegger@psych.mc.duke.edu
authors.forename: Helen Link
authors.initials: HL
authors.lastname: Egger
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Costello
authors.forename: Adrian
authors.initials: A
authors.lastname: Angold
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D015995:Prevalence; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012111:Residence Characteristics; D013332:Student Dropouts / Q000523:psychology* / Q000706:statistics & numerical data*