School Refusal in Children of Parents with and without Alcohol Dependence – A Cross-Sectional Comparative Study

Background: Having a parent with alcohol dependence syndrome (ADS) is a recognized risk factor for negative outcomes in child’s development both due to parental psychopathology and the wider environmental disadvantages associated. This hampers adjustment in school and may be associated with school refusal (SR) which has further negative effects both in the short-term and long-term well-being. This outcome has not been adequately explored among young children. The objectives of the study were to compare the proportion of SR between children of ADS parent(s) and of non-ADS parents and the profile of related psychosocial factors. Methodology: Two groups of children (aged 4–10 years)-firstly of ADS parent(s) from a hospital sample and secondly of non-ADS parents from a primary school were identified. Thirty-seven consenting parents in each group were interviewed about sociodemographic and clinical data pertaining to the children. They also answered self-report tools, namely, School Refusal Assessment Scale and Strength and Difficulties Questionnaire, to understand SR behavior and the positive and negative attributes, respectively, in the two groups of children. Statistical analysis was done using SPSS software. Results: The proportion of SR behavior was 18.9% ( n = 14) in children of ADS parent(s) and 5.4% ( n = 4) in children of non-ADS parents. The primary reason for SR was a positive reinforcer in 57% and a negative reinforcer in 43% among children with ADS parent(s) with SR. Children of ADS parent(s) had higher emotional problems ( P = 0.03), externalizing symptoms ( P = 0.001), and lower prosocial behavior ( P = 0.006). The children of non-ADS parents had SR mostly due to positive reinforcers (75%) and had higher conduct ( P = 0.05) and lower prosocial scores ( P = 0.016). Conclusion: Children of ADS parent(s) had higher SR behavior than those of non-ADS parents. They had higher internalizing and externalizing symptoms and SR was motivated almost equally by both positive and negative reinforcers unlike in the comparator group. Future studies looking at the phenomenon are needed to better understand the problem.