Truancy jo.pptx

1. TRUANCY
Dr Jo Martin Kuncheria
JR, Pediatrics

2. INTRODUCTION
• School aged child or adolescent frequently misses
school without an adequate excuse which is associated
with conduct and psychosocial problems.
• Truancy can be a precursor to delinquent behaviors and
low level crimes.
• It can also indicate family problems
• Significant short and long term effect on childrens
social, emotional and educational development
• Causes are multifactorial

3. TRUANCY
• Excessive anxiety about
attending school not commonly
seen
• Parents are usually unaware of
absence from school
• Antisocial behavior such as
delinquent act
• Not frequently stay home
during school hours
SCHOOL REFUSAL
• Severe emotional distress about
attending school manifests as
anxiety , temper tantrums ,
depression or somatic
symptoms
• Parents are aware of absence
and often tries to persuade
parents to allow him/her to stay
home
• Anti social behaviors such as
delinquent are not notably seen
• Children usually stay home
during school hours

4. TRUANCY - ETIOLOGY
• A school is responsible for creating a safe
environment, tracking student attendance,
communicating with parents and ensuring that
all policies are clear , consistent and
communicated
Didaskaleinophobia Fear of Going to School

5. SCHOOL CAUSE TRUANCY
• Unmet needs
• Undiagnosed learning difficulties
• Unaddressed mental health issues
• Poor relationship with teachers, boring class and
lack of interest in school

6. PARENTAL CAUSES
• Poor parenting skills
• Improper housing , food insecurity, separation and divorce
• Inability to supervise children
• Placing little value on education
• Parents with intellectual disability/substance abuse
• Abuse and neglect
• Pressure to stay home to take care of parents who are diseased
/work to help family

7. YOUTH RELATED CAUSES
• Peer pressure to skip school
• Bullying
• Mental health issues
• Boredom
• Lack of ambition
• Poor grades
• Being behind on school work
• Low self esteem
• Drugs and alcohol use
• Having no friends at school

8. EPIDEMOLOGY
• 2-5% of all school aged children have school refusal
including truancy
• More common in older children
• The longer a child is out of school the harder it is to
return.
• No socioeconomic difference have been noted

9. EFFECTS OF TRUANCY
• Falling behind in school, Not graduating, Unemployment
• Socially isolated, running away out of frustration
• Engaging in delinquent behaviors, Mental health issues
• Substance abuse
• Unstable relationship
• Dropping out of school
• Violating law, Criminal behaviors

10. ASSESSMENT
• Complete physical and medical history
• Clinical interview with child and parents
• History of onset and development of symptoms
• Associated stressors
• School history
• Family psychiatric history
• Mental status examination for psychiatric problems
and substance abuse
• Collaboration with school staff
• Review of school records
• Psychological assessment tools

11. MANAGEMENT
• To facilitate the childs returning to normal functioning
• To make the child tolerate normal separation from caregivers
without distress or impairment of functioning
• To make the child attend school consistently without subjective
experience of distress
• Address comorbid psychiatric problems,family dysfunction and
other contributing problems
• Collaborative team approach include physician, child ,parents
,school staff and mental health professional

12. MANAGEMENT cont…..
• Cognitive behavior therapy
• Educational support therapy
• Pharmacotherapy
• Parent- teacher interventions

13. COGNITIVE BEHAVIOR THERAPY
• Therapist offers specific instructions for children to enable and
gradually increase their exposure to the school environment
• Children are encouraged to confront their fears and taught how
to modify negative thoughts
• Provides solution to current problems and provides tools to
change unhelpful thoughts and behaviors
• Desensitization , operant behavioral techniques (reinforcement
& punishment) are useful
• Modelling(observes the behavior of others and imitates), role
playing (visualize and practice different ways of handling a
situation), relaxation techniques and reward system are
frequently used

14. EDUCATIONAL SUPPORT THERAPY
• Children are encouraged to talk about their fears and
identify difference between fear, anxiety and phobias
• Children are given information to help them overcome
their fears about attending school
• They are given written assignments that are discussed
at follow up sessions
• Children keep a daily diary to describe their fears ,
thoughts, coping strategies and feelings
• Will not receive specific instructions on how to
confront fears /positive reinforcement as CBT

15. PHARMACOTHERAPHY
• SSRI – 1st line pharmacologic treatment for anxiety
disorders
• Fluvoxamine and sertaline are used frequently
• Sertaline started at initial dose 12.5 to 25 mg per day for
a minimum of 7 days and titrated upto 50mg per day in
increments of 12.5 mg (Child) or 25 mg (adolescent)
• If adequate clinical response not seen after 6 to 8 wks of
treatment increase dose of 12.5mg per day (Child) and
25mg per day(adolescent) to a maximum of 200 mg per
day.

16. PHARMACOTHERAPHY cont…
• Benzodiazepines used as short term basis with
severe school refusal
• Benzodiazepines added with SSRI to target acute
symptoms of anxiety. Discontinued once SSRI
produce beneficial effects . Benzodiazepines has risk
of addiction, sedation, Behavior disinhibition and
cognitive impairment

17. PARENT – TEACHER INTERVENTION
• Parent involvement and caregiver training are critical factors in
enhancing the effectiveness of behavior treatment
• It includes clinical sessions with parents and consultation with school
personnel
• Parents are given behavior management strategies
– Escorting the child to school
– Providing positive reinforcement for school attendance
– Decreasing positive reinforcement for staying home
• Helps parents to reduce their own anxiety and understand their role
in helping their children make effective changes
• School consultation for school staff to give positive reinforcement/
academic, social & emotional accommodations

18. PREVENTION
• Multifaceted approach that considers school, parents and
youth
• Best practice is to address the underlying psychological
symptoms and empowering parents, children and school
staff.
• Mentoring
• Law enforcement involvement
• Communication training
• Community involvement

19. ROLE OF SCHOOL
• Keep proper records
• Communicate problems to parents
• Change poor conditions in school
• Students should be matched with right teachers
• Students should get special attention when necessary

20. ROLE OF HOME
• Preventing truancy begins at home
• Open communication and problem solving
• Communication with school authority to solve the
problem
• Transferring classrooms / new school may help
• Rather than punishing ,find actionable solutions
• Youth should be referred for a mental health
evaluation

21. Thank you