• Volker Reissner, Diana Jost, Ulrike Krahn, Martin Knollmann, Ann-Kathrin Weschenfelder, Anja Neumann, Jürgen Wasem, and Johannes Hebebrand.
• Department of Child and Adolescent Psychiatry, LVR-Klinikum Essen, University of Duisburg-Essen, IMIBE, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Institute of Health Care Management and Research, Department of Health Economics, University of Duisburg-Essen.
• Dtsch Arztebl Int. 2015 Sep 25; 112 (39): 655662655-62.

Background5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders.Methods112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life.ResultsIn both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, p< 0.001; OR for MT versus TAU 1.05, 95% CI 0.58-1.90, p = 0.875). The improvement persisted 12 months after inclusion.ConclusionIn accordance with earlier studies, we found that manual-based multimodal treatment did not improve school avoidance to any greater extent than treatment as usual. Future studies should focus on the conditions for successful reintegration in school and on the differential indicators for outpatient versus inpatient treatment.

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