Background: School refusal is a multicausal disorder with an estimated prevalence of about 5%. Patients are at risk for developing educational, social, and behavioral problems. Studies evaluating therapeutic interventions are, however, rare. Objectives: We prospectively investigated adolescents with prolonged school refusal who took part in a standardized group treatment program to find out if the program was suited for this group and if comorbid problems influenced the therapeutic progress. Patients and Methods: We investigated 18 adolescents admitted for prolonged school refusal. They were 10-14 years old and met ICD-10 criteria for social phobia (F40.1). All attended 16 sessions of manual-based, cognitive behavioral group therapy (CBT) [Joormann und Unnewehr, 2002] and were psychologically tested before, during and at the end of CBT. Results: 14 patients completed the study and the pre- and posttherapeutic assessment. Social phobia, clinical, and depression scores improved but not significantly. Temperamental factors 'persistence', 'self-directedness', and 'cooperativeness' were associated with better therapeutic success, 'harm avoidance' with higher social phobia scores and a less substantial clinical improvement. All patients had at least one comorbid axis-1 diagnosis, most frequently separation anxiety. Nearly all patients had impaired executive functions, and nearly all parents had psychiatric problems. Conclusions: The Joormann and Unnewehr CBT program was somewhat effective. Considering the high number of comorbidities, longer duration of treatment, additional treatment components and parental psychotherapy are recommended.
