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Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial

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Abstract

This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11–16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.

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Acknowledgments

The authors acknowledge the National Health and Medical Research Council (545968), beyondblue The National Depression Initiative and Financial Markets Foundation for Children. The authors thank A/Prof Neville King (retired) who made a substantial contribution to establishment of this study, the team of clinicians, Slade Pharmacy for preparation of the fluoxetine and placebo and all the participating adolescents and their families.

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Authors and Affiliations

  1. Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia

    Glenn A. Melvin, Amanda L. Dudley, Michael S. Gordon, Ester Klimkeit, Eleonora Gullone, John Taffe & Bruce J. Tonge

  2. Early in Life Mental Health Service, Monash Health, Clayton, VIC, 3168, Australia

    Michael S. Gordon

Authors
  1. Glenn A. Melvin
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  2. Amanda L. Dudley
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  3. Michael S. Gordon
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  4. Ester Klimkeit
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  5. Eleonora Gullone
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  6. John Taffe
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  7. Bruce J. Tonge
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Corresponding author

Correspondence to Glenn A. Melvin.

Additional information

This trial is registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au; Trial Number: ACTRN12606000103561; Trial Name: Treatment of School Refusal).

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Melvin, G.A., Dudley, A.L., Gordon, M.S. et al. Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial. Child Psychiatry Hum Dev 48, 485–497 (2017). https://doi.org/10.1007/s10578-016-0675-y

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