Browsing by Subject "School refusal"

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The adaptation and evaluation of a school refusal assessment for youth with medical conditions
(2023-08-13) Carberry, Caroline; Rodriguez, Erin M.; Klingbeil, David A.; Seung Choi; Shahidullah, Jeffrey
School refusal is a costly problem, linked to negative academic, social, and emotional outcomes (Kearney, 2006). However, despite the severity of this problem, youth with medical conditions are often overlooked in school refusal research. This oversight is concerning because youth with medical conditions are overrepresented in school refusal specialty clinics (McShane et al., 2001). Children with medical conditions may be excluded from research because there is no assessment that captures the unique topography of school refusal symptoms in this population. Currently, few methods for assessing school refusal exist and no measure considers the interaction of medical conditions with school refusal symptoms. The aim of this study was to develop a measure which can be used to inform decisions on the function of school refusal behavior in medical populations. I adapted the School Refusal Assessment-Revised (SRA-R), the most researched school refusal instrument, to better capture the experiences of individuals with medical conditions. More specifically, I evaluated the psychometric quality of the adapted SRA-R, referred to as the Pediatric School Refusal Assessment (PSRA), with a sample of 194 caregivers and 88 recently hospitalized patients at Dell Children’s Medical Center. I assessed the factor structure, test-retest reliability, internal consistency, and construct validity of scores on the PSRA caregiver version. Results suggest that the factor structure is acceptable. Additionally, scores on both versions of the PSRA had acceptable test-retest reliability and internal consistency for all factors except pursuit of tangible reinforcement. Due to difficulties recruiting children during the COVID-19 pandemic, for the PSRA child version I only evaluated the internal consistency of its scores and completed an exploratory test-retest reliability analysis. Correlations between the PSRA caregiver version and similar subscales on the Pediatric Quality of Life Inventory and Strengths and Difficulties Questionnaire provide preliminary evidence of scores’ construct validity. These findings provide initial support for the PSRA’s psychometric quality. Further research must address problems with the pursuit of tangible reinforcement factor. Once these issues are addressed, the PSRA may be used to improve the identification and treatment of school refusal in children with medical conditions, which could impact long-term academic, psychological, and social outcome.