MRCPsych CASC: Assessment of School Refusal

This MRCPsych CASC Sample Case assesses a child's refusal to attend school. It is important to consider several key factors when evaluating the situation.

First, it is crucial to determine the age of the child and whether they desired to attend the scheduled appointment. It is also important to determine who is currently responsible for their care and if they have any connections to CAMHS (Child and Adolescent Mental Health Services) or social services.

The duration of the child's refusal to attend school should also be considered, as well as the different perspectives on the cause of the refusal from the child, their parents, and the school. It is important to determine if the child is refusing other situations.

If the child is exhibiting signs of separation anxiety, it is important to note that they may have worries about the safety of their caregiver and follow them closely in all situations. It is also important to assess the potential risks to the child, to others, from others, and for neglect.

It is important to consider any history of drug and alcohol use and the impact of the school refusal on the child's life at home, at school (academically), and with their friends. A mental state examination should be performed, evaluating the child's mood (such as low mood) and any potential symptoms of psychosis. The child's level of anxiety should also be assessed, including any possible experiences of bullying, checking and washing behaviours, and any specific concerns they may have about the school or a teacher.

A comprehensive developmental and psychiatric history should be obtained, as well as any history of medication use. The child's past medical history and family history should also be considered.

The management of the child's refusal to attend school may involve a gradual return to school, liaison with the school to address any potential bullying, and involving an educational social worker and psychologist as necessary. Incentives for attending school may also be implemented, and group tutorials should be considered if the child falls academically behind.

Virtual Scenario

Psychiatrist: Good afternoon, thank you for coming in today. Can you tell me a little bit about your child and their recent refusal to attend school?

Parent: Yes, my son has been refusing to go to school for the past few weeks. He used to love going to school, but now he just refuses to leave the house in the morning.

Psychiatrist: I see. How old is your son?

Parent: He is 11 years old.

Psychiatrist: Is he refusing to attend any other activities or events besides school?

Parent: No, just school. He seems to have a lot of anxiety about it.

Psychiatrist: I understand. Have you or the school noticed any changes in his behavior, mood, or overall functioning?

Parent: He has become increasingly withdrawn and has been complaining of low mood. He used to have a lot of friends, but now he just wants to be alone all the time.

Psychiatrist: That's concerning. Has there been any history of bullying or other adverse events at school?

Parent: Not that we're aware of. The school hasn't mentioned anything, and my son hasn't talked about it.

Psychiatrist: I see. Can you tell me about his developmental and psychiatric history?

Parent: He has never had any major developmental or psychiatric issues. He's always been a happy and healthy child.

Psychiatrist: Okay, thank you. Can you tell me about any medications he is currently taking and his past medical history?

Parent: He is not currently taking any medications, and he has no significant past medical history.

Psychiatrist: Alright. And what about his family history, is there any history of mental illness or substance abuse in the family?

Parent: No, there is no history of mental illness or substance abuse in our family.

Psychiatrist: Okay, thank you. Based on what you've told me, it seems like there may be some anxiety or mood-related issues contributing to his school refusal. I would like to perform a mental state examination to get a better understanding of his current state.

Parent: Yes, of course.

Psychiatrist: After the examination, we can discuss potential management options, such as graded exposure to school, liaising with the school to address any potential bullying, and involving an educational social worker and psychologist as necessary. We may also consider using incentives for attending school and providing group tutorials if necessary.

Parent: That sounds like a good plan. Thank you for your help.

Psychiatrist: You're welcome. We'll work together to help your son get back to school and feel more comfortable.