Co-designing a family and school intervention to address school refusal in families with neurodiversity

School refusal occurs when a student is unable to attend school due to emotional distress associated with school and despite the best efforts of their parents to facilitate attendance. School refusal, like all attendance problems, is thought to occur due to the result of child, family, school and societal factors and the dynamic interplay between these factors (Melvin et al., 2018). Recent research in both Australia (Adams, 2021) and the United Kingdom (Totsika et al., 2020) has demonstrated that autistic students are at much greater risk of experiencing school refusal than their typically developing counterparts. Unfortunately, few resources exist to support attendance of neurodiverse students. Further research is needed to understand and better address the systemic factors that predispose vulnerable young people, such as those with autism, to school refusal.

There is a dearth of literature pertaining to evidence-based treatments for school refusal. Of the few studies available, cognitive behavioural therapy (CBT) adapted for school refusal is commonly utilised. CBT has demonstrated benefits for young people with anxiety and mood disorders but neglects many of the systemic influences, such as family, school and society, around the young person. From a systems perspective, two studies advocate a ‘whole of family’ approach to intervention (Richardson, 2016; Roue et al., 2021), though neither examines the question of efficacy. Future research must consider systemic interventions that target the multitude of influences (individual, family and school) that maintain this concern.

Objectives

At present, no evidence-based interventions exist to support neurodiverse students back into school/an educational pathway following a period of absence due to refusal to attend. This project will aim to co-design a novel family-school intervention and conduct an initial evaluation of the intervention’s acceptability and feasibility.

Methodology

This project will likely utilise the Delphi method to gain expert consensus around intervention components plus co-design methods including interviewing parents, young people, school staff and mental health professionals. Interpretive phenomenological analysis will be used to interpret this interview data. The study may include a small clinical trial to determine feasibility/acceptability.