This document discusses truancy, which is when a school-aged child frequently misses school without an excuse. Truancy can be caused by factors related to the child, parents, or school and can lead to conduct problems, low academic achievement, and involvement in criminal behavior. The document outlines approaches for assessing and managing truancy through cognitive behavioral therapy, educational support, pharmacotherapy, and collaborating with parents and teachers. Prevention emphasizes addressing underlying issues through a multifaceted approach involving the school, parents, and child.

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