Niveau d’anxiété et refus scolaire dans les troubles anxieux chez l’adolescent

Objectives

The primary objective was to compare the level of anxiety on the Multidimensional Anxiety Scale for Children in two groups of anxious secondary school children, one group out of school meeting the criteria of School Refusal and the other in school. The secondary objective was to compare these groups on other clinical, sociodemographic and therapeutic parameters.

Patient and method

Retrospective observational study of 34 school-going anxious teenagers recruited at the University Hospital of Montpellier, compared with 55 out of school anxious teenagers meeting the criteria of Anxious School Refusal recruited in a multicentre study.

Results

There was no significant intergroup difference in median scores on the Multidimensional Anxiety Scale for Children (P = 0.49), but a significant intergroup difference in median scores was found on the Behavioural Anxiety and Phobia Scale with higher total scores in the School Refusal group (151.5 [130.5; 169.0] vs. 125.0 [94.0; 139.0], P < 0.01). The School Refusal group was more likely to have a panel of anxiety disorders including agoraphobia, separation anxiety, depressive disorders, more impaired global functioning and more likely to receive psychotropic medication (P < 0.01). There were no significant intergroup differences in sociodemographic characteristics except age.

Discussion

The absence of significant intergroup differences in the level of anxiety measured with the Multidimensional Anxiety Scale for Children could be related to a lower level of anxiety in the school refusal group due to school refusal. The higher anxiety score with the Behavioural Anxiety and Phobia Scale in the refusal group could be related to their better sensitivity. The clinical picture in the refusal group, both more severe and with co-morbidities, is comparable to what is described in the literature.

Conclusion

A higher level of anxiety was not associated with school refusal according to main endpoints in teenagers with anxiety disorders. However, this group had other criteria of greater clinical severity that justify early identification.