Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity

Background: School refusal behavior is a particularly nettlesome problem for mental health and education professionals because of its symptom severity and heterogeneity as well as lack of consensus regarding inclusive classification strategies. Alternatively, a functional model of school refusal behavior may provide a particularly useful way of organizing, assessing, and treating this population. Method: The present study included 222 youths aged 5–17 years (134 males, 88 females) with school refusal behavior and their parents. Participants were assessed at a specialized university‐based clinic for youths with school refusal behavior. Child self‐report and parent‐based measures of forms of behavior related to school refusal as well as functions of school refusal behavior were employed. Results: Hierarchical regression analysis and structural equation modeling revealed that function was a better determinant of degree of school absenteeism than behavior form. Conclusions: Assessing the function of school refusal behavior is likely a key factor in the evaluation of this population and may be linked to informed decisions about choice of treatment.