School refusal - Psychosocial distress or Psychiatric disorder?

Background: School refusal is not a diagnosis by itself but a behavior described when a child frequently refuses to go to school or remain in school. It is often associated with several psychiatric disorders. A prevalence rate of 5-10% is described in most studies. Several psychosocial factors, individual, familial, societal, school and medical are also known to play an important role. The study intends to explore the association of school refusal to either psychiatric disorder or to distress due to psychosocial factors. Aim: To explore the psychosocial factors and psychopathology in children presented with school refusal. Materials and Method: A descriptive study conducted on children attending Child and Adolescent Psychiatry OPD at ASHA Hospital with primary complaint of school refusal, from January 2018 to December 2018. Data pertaining to 33 new cases of school going children between 6 years and 18 years, with school refusal as main symptom were collected using a semi structured proforma. Various psychosocial factors which were broadly classified as individual, family, school, societal factors and other medical disorders were analyzed. Psychiatric diagnosis made using ICD 10 criteria was assessed. Data analyzed using SPSS software. Results: About 6.6% of total new child cases in the year of 2018 were with primary complaint of School Refusal. Out of these 33 subjects, 30 (91%) had a psychiatric diagnosis at baseline. Depressive disorder (36.4%) was commonest followed by anxiety disorder (18.2%), conduct disorders (15.1%) and remaining Hyperkinetic disorder, mental retardation and bipolar disorders. Psycho-social factors influenced school refusal contributing to the psychiatric disorder. Conclusion: The study highlights school refusal as a symptom of one or two psychiatric disorder rather than psychosocial distress alone, indicating high psychiatric morbidity. Further it emphasizes that the symptom need to be taken as an emergency and intervened. This would e