Cognitive behavioural therapy with or without fluoxetine for school refusal: A randomised controlled trial.

Cognitive behavioural therapy is currently the treatment of choice for anxious school-refusing students; however, response rates in adolescents are lower than in children. Antidepressant medications have been shown to be efficacious in the treatment of the anxiety and depressive disorders that may underlie school refusal. This study investigated whether a combination of cognitive behavioural therapy (CBT) and fluoxetine (FLX) would be superior to CBT alone in adolescents exhibiting school refusal. Sixty-two adolescents with school refusal and an anxiety disorder were randomly allocated to CBT, CBT+FLX or CBT and placebo (PLA). The primary outcome measure was proportion of school attendance over the last month. Mean attendance at baseline was 15%. Average school attendance after 12 weeks of treatment was 55% for CBT, 53% for CBT+FLX and 42% for CBT+PLA. These findings suggest that fluoxetine did not augment CBT in the treatment of school refusal in the short term. Side effects of treatment were not significantly different between treatment groups and overlapped substantially with anxiety symptoms. This presentation will present a range of outcomes from this trial from post-treatment and 6- and 12-month follow-up assessments and discuss their implications for the management of school refusal.