Child rehabilitation refusal: why it happens and possible strategies to avoid it.
OBJECTIVE
Despite an obvious need for rehabilitative treatment, some parents deny consent and some others withdraw their children from a previously accepted program. There is limited literature concerning how to prevent this, serving the child's best interest, and the existing is mainly focused on legal implications.


METHODS
This was a naturalistic study, carried out using data obtained during the diagnostic evaluation of 166 children (all those seen in the Child Neuropsychiatry Unit). For 25 children (15.1%), parents refused or interrupted suggested treatment.


RESULTS
Statistical analysis showed that there is a significant difference in terms of impairment in children of parents accepting or refusing the rehabilitative treatment. Treatment discontinuation is related to the diagnosis (higher percentage in severe language disorders or complex developmental disorders), higher reduction in global functioning, higher disability burden, need for integrated treatment, lower age.


CONCLUSIONS
Findings of this study could be useful in order to better plan rehabilitative options and goals. It is possible that an attempt to increase parental involvement in the rehabilitative program could lead to a decrease in treatment discontinuation. Anyway, more research is needed because we are still far from having a good predictive model to anticipate and, if possible, avoid treatment discontinuation.
Chiappedi
M
M
Department of Rehabilitation, Santa Maria alle Fonti Medical Center, Don Carlo Gnocchi ONLUS Foundation, Salice Terme, Pavia, Italy. mchiappedi@dongnocchi.it
Maltagliati
S
S
Amoruso
A
A
Dolci
R
R
Carniglia
C
C
Bejor
M
M
D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D033282:Parental Consent / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D012046:Rehabilitation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000523:psychology*