Nosological Constellation of School Refusal Syndrome

Summary

The nomenclature “school refusal syndrome” is no longer used in the international classification of mental disorders, although it is still used frequently in the psychiatric field of Japan because of clinical convenience. This study was carried out with the idea of clarifying the essential pathological state of so-called school refusal, a disorder of childhood and adolescence. The patients diagnosed as having school refusal syndrome according to Japanese criteria were then characterized using international diagnostic criteria. The study included 34 patients, ranging in age from 10 to 17 years, who had been diagnosed as having school refusal syndrome at the psychiatric ward of our hospital. They were followed for 8 to 15 years, and an attempt was made to determine their lifetime diagnoses according to the criteria of ICD-10. Some misdiagnoses were noted, including schizophrenia in two cases, affective disorder in one case, eating disorder in one case, and mental retardation in one case. Others diagnosed as having the school refusal syndrome in Japan were then classified into three groups: (1) those meeting the diagnostic criteria for adult neurotic disorders (F4); (2) those who had behavioral and emotional disorders with onset usually during childhood or adolescence; and (3) those determined to have personality disorders.