Combined Treatment Best for Kids Who Skip School
March 1, 2000 (Minneapolis) -- Years ago, kids who skipped school were
considered bad seeds. Today, experts know there's more to it than that, and
these kids can be helped. Refusing to go to school is a relatively common
syndrome in children and adolescents. One of every 100 kids refuses to go to
school. But when kids are depressed or anxious, that number is much higher --
as high as one in four, and in some cases even greater, experts say.
However, following an eight-week study at the University of Minnesota,
researchers were "encouraged" by the results they achieved using a
combination of medication and counseling for adolescents who are depressed,
anxious, and skipping school. The findings were published in the March issue of
the Journal of the American Academy of Child & Adolescent
During the study, adolescents met with a therapist once a week for eight
weeks. Therapists used cognitive-behavioral therapy -- a type of therapy that
focuses on changing behavior through positive thinking -- to help eliminate
irrational beliefs and distorted thoughts.
At the same time, half of the children received a drug called Tofranil
(imipramine), an antidepressant to help reduce anxiety and depression. The
other half received a placebo, or sugar pill.
"Both groups showed a decrease in the level of depression during
treatment, with the imipramine plus cognitive-behavioral therapy group showing
a faster decrease in depression compared to the placebo plus
cognitive-behavioral therapy group," says Gail A. Bernstein, MD, associate
professor and director of the division of child and adolescent psychiatry,
University of Minnesota Medical School. Bernstein is the lead author of the
School attendance improved significantly for the Tofranil group during the
treatment, and the school attendance of kids receiving sugar pills did not
improve. However, many of the kids taking Tofranil continued to have symptoms
of depression at the end of the eight-week trial.
The reason, explains Glen R. Elliott, PhD, MD, University of California, San
Francisco, is that some antidepressants like Tofranil are more effective at
reducing anxiety than treating depression.
Kids [who are anxious about school] really need help to overcome what can be
a crippling illness," he tells WebMD. "We know that school phobias can
be extraordinarily debilitating and [render children] unable to function as a
direct [result] of being overwhelmed by anxiety and panic attacks." Elliott
is associate professor and director of child and adolescent psychiatry.
"Being able to refer to a nice study like this gives caregivers much
more to offer parents in terms of saying 'we have good reason to believe [your
child] will get better.' Clinicians [now] actually have real data [to help them
decide what] to offer children and their families," Elliott says.
But learning why kids are refusing to go to school is the first step,
Mae Sokol, MD, tells WebMD. "One kid may have a totally different reason
than the next [for skipping school]. Don't rush to your doctor and beg for
[Tofranil],"she says. "Go to your doctor and ask for help. Try therapy
first; medication is just a useful addition." Sokol is a child and
adolescent psychiatrist at the Menninger Clinic in Topeka, Kan.
Because of the potential for serious side effects, children on Tofranil must
be monitored closely, especially when used in combination with other