title: The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness.
abstract: BACKGROUND
  5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders.
  
  
  METHODS
  112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life.
  
  
  RESULTS
  In both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, p< 0.001; OR for MT versus TAU 1.05, 95% CI 0.58-1.90, p = 0.875). The improvement persisted 12 months after inclusion.
  
  
  CONCLUSIONS
  In accordance with earlier studies, we found that manual-based multimodal treatment did not improve school avoidance to any greater extent than treatment as usual. Future studies should focus on the conditions for successful reintegration in school and on the differential indicators for outpatient versus inpatient treatment.
authors.affiliation: Department of Child and Adolescent Psychiatry, LVR-Klinikum Essen, University of Duisburg-Essen, IMIBE, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Institute of Health Care Management and Research, Department of Health Economics, University of Duisburg-Essen.
authors.forename: Volker
authors.initials: V
authors.lastname: Reissner
authors.forename: Diana
authors.initials: D
authors.lastname: Jost
authors.forename: Ulrike
authors.initials: U
authors.lastname: Krahn
authors.forename: Martin
authors.initials: M
authors.lastname: Knollmann
authors.forename: Ann-Kathrin
authors.initials: AK
authors.lastname: Weschenfelder
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.forename: Johannes
authors.initials: J
authors.lastname: Hebebrand
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001362:Avoidance Learning; D002648:Child; D002652:Child Behavior / Q000523:psychology; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome