Day school treatment in Sweden: A 4-year follow-up study of maladjusted pupils

Day schools have developed as an important psychoeducational resource in the Swedish school system since the middle of the 1960's. Day schools provide a combination of special education and training in small groups, as well as supervised free time activities for pupils exhibiting very pronounced adjustment problems. In an earlier national study, 108 pupils in the first three grades were examined. The majority of the day school pupils exhibited symptoms and behavioural disturbances associated with poor prognosis. Their families exhibited a pattern usually associated with "at risk families", which affects the development of children and their adjustment to society. In the follow-up study, four years later, 104 pupils (95 boys/9 girls) and their families were re-examined with semi-structured interviews. The study also included interviews with day school staff and teachers from the ordinary school. At the time of the follow-up, 88% of the pupils had been discharged to a regular school after spending an average of two years at the day school. The symptom interview showed that mental health had improved significantly, especially with regard to social and emotional out acting behaviour. Sixty percent were now symptom-free or had only mild symptoms. On the other hand, two thirds were still slow performers and in need of special education and the children were still more disturbed compared to normal children. The most common diagnoses, according to DSM-III-R, were oppositional defiant disorders (53%) and conduct disorders (21%). All diagnostic groups did improve, but the children with conduct disorders were the most disturbed on both occasions. The majority of the parents had a positive attitude towards the day school and wanted to recommend day school placement to other parents. The ability of the day schools to intervene early and treat (secondary prevention) children with adjustment disorders was found to be an important resource.