Developmental and Environmental Aspects In Inpatients With School Refusal: A Dimensional Model

School attendance problems is a broader symptomatology that includes “School Refusal” due to internalizing problems and “Truancy” linked to externalizing problems. These different profiles of young patients might highlight specific developmental trajectories and specific risk factor profiles. The aims of this study is to present retrospective data to compare school refusal to three different populations (Truancy, behavior disorder and Anorexia Nevrosa) of inpatients thought dimensional approach on development and environmental aspects. In this study, we highlight risk factors profile for school refusal and truancy. School refusal inpatients are characterized by associated specific risk factors usually found in internalizing problems: medical complications during pregnancy, learning disorder, isolation/reject and bullying in peer relationships. It is frequently associated with a diagnosis of anxiety and depression and suggest difficulties in emotional dysregulation and problems of socializing with peers. In behavior disorder and truancy groups, associated to externalizing problems, the following associated specific factors were found: unwanted pregnancy, substance abuse during pregnancy, baby sleeping disturbances, delayed language development, attachment disorder, learning disorder, physical abuse, violent and conflictual family relationships, breaking contact with parents and a concomitant diagnosis of conduct disorder or oppositional defiant disorder. The highlight of these two profiles should enable the identification of specific axes of intervention according to the type of problem, whether internalized or externalized.