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Combined Treatment Best for Kids Who Skip School

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WebMD Health News

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 Psychiatry.

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 study.

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 antidepressants.

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