The Indian Journal of Pediatrics

, Volume 85, Issue 12, pp 1073–1078 | Cite as

School Refusal Behavior in Indian Children: Analysis of Clinical Profile, Psychopathology and Development of a Best-Fit Risk Assessment Model

  • Ajita Nayak
  • Bijal Sangoi
  • Hrishikesh NachaneEmail author
Original Article



School refusal is seen as an emergency in child psychiatry and various risk factors have been analyzed. Children who present with school refusal have been shown to have several associated psychiatric comorbidities. However, risk assessment of psychiatric comorbidities is lacking, particularly in the Indian context. The authors aimed to study the sociodemographic profile and associated psychopathology in children with school refusal. They compared the prevalence rates of psychiatric illnesses to that of the community. A best-fit model for risk assessment of psychopathology was formulated.


Past records of children aged 5–16 y, who presented with school refusal in the period from June 2013 through June 2015 to authors’ Child Guidance Clinic were studied and their sociodemographic details, symptoms and diagnoses were obtained. Chi square test of proportion was used to compare the prevalence rates between the study population and community. Multinomial analysis was used to elucidate a best-fit model of risk assessment.


School refusal was seen in 3.6% of children. 77.8% of the children had a psychiatric diagnosis, most common being depression (26.7%), followed by anxiety (17.7%). Prevalence of psychiatric disorders was significantly higher in the study population than community (p < 0.05). A best-fit model of 4 factors: academic difficulties, adjustment problems at school, behavioral problems and parental conflicts is suggested (p < 0.05).


School refusal is associated with significant psychopathology, most commonly depression, followed by anxiety. The best-fit model for risk assessment can predict the likelihood of psychopathology and help in early diagnosis.


School refusal Psychopathology Best-fit model 



All the three authors formulated the protocol, prepared the results and discussion, and approved the final draft. BS and HN did the sampling and analysis. AN will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest



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Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  1. 1.Department of PsychiatryKEM Hospital and Seth GS Medical CollegeMumbaiIndia

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