Predictores parentales de las dificultades de asistencia escolar en los niños Referido a una clínica de trastornos de ansiedad

  • Carla E. Marin Escuela de Medicina de la Universidad de Yale (USA)
  • Tess Anderson Escuela de Medicina de la Universidad de Yale (USA)
  • Eli R. Lebowitz Escuela de Medicina de la Universidad de Yale (USA)
  • Wendy K. Silverman Escuela de Medicina de la Universidad de Yale (USA)


Las dificultades para asistir a la escuela son comunes en niños referidos a clínicas sobre trastornos clínicos de ansiedad. Aunque los factores de los padres se han postulado como que juegan un importante papel predictivo, poco se sabe sobre qué factores de los padres están asociados con los problemas de asistencia escolar (PAE). Abordamos esta brecha al examinar la adaptación familiar, el control psicológico de los padres, la ansiedad de los padres y la depresión de los padres como posibles predictores de PAE en los niños (N=343; edades de 6 a 17 años, M=10,40 años, SD=2,93; 84% de madres; M=41.20 años, SD=5.49) que acudieron a una clínica de trastornos de ansiedad infantil. El cuarenta y ocho por ciento (N=166) tenía PAE que incluían no asistir a la escuela, llegar tarde a la escuela y / o irse temprano, no quedarse en el aula durante las horas escolares o problemas de comportamiento asociados con la asistencia a la escuela (por ejemplo, berrinches matutinos). Los análisis de regresión logística con calificaciones de niños y padres revelaron que las variables parentales examinadas, la acomodación familiar y la depresión parental fueron predictores significativos de PAE después de controlar los efectos del control psicológico parental, la ansiedad parental, la edad infantil, la ansiedad infantil y la depresión infantil. Los hallazgos del estudio sugieren que los altos niveles de acomodación familiar y los altos niveles de depresión de los padres aumentan las probabilidades de PAE en niños ansiosos.


Achenbach, T.M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised
Child Behavior Profile. Queen City, VT: Queen City Printers.

Bahali, K., Tahiroglu, A.Y., Avci, A., & Seydaoglu, G. (2011). Parental psychological symptoms
and familial risk factors of children and adolescents who exhibit school refusal. East Asian
Archives of Psychiatry, 21(4), 164-169.

Beck, A. T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical
anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6),
893-897. doi: 10.1037/0022-006X.56.6.893

Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4(6), 561-571.
doi: 10.1001/archpsyc.1961.01710120031004

Benito, K.G., Caporino, N.E., Frank, H.E., Ramanujam, K., Garcia, A., Freeman, J., ... Storch, E.
A. (2015). Development of the pediatric accommodation scale: Reliability and validity of
clinician- and parent-report measures. Journal of Anxiety Disorders, 29, 14-24.
doi: 10.1016/j.janxdis.2014.10.004

Berg, I. (1997). School refusal and truancy. Archives of Disease in Childhood, 76(2), 90-91.

Bools, C., Foster, J., Brown, I., & Berg, I. (1990). The identification of psychiatric disorders in
children who fail to attend school: A cluster analysis of a non-clinical population.
Psychological Medicine, 20(1), 171-181. doi:10.1017/S0033291700013350

Broadwin, I.T. (1932). A contribution to the study of truancy. American Journal of
Orthopsychiatry, 2(3), 253-259. doi:10.1111/j.1939-0025.1932.tb05183.x

Carless, B., Melvin, G.A., Tonge, B.J., & Newman, L.K. (2015). The role of parental self-efficacy
in adolescent school-refusal. Journal of Family Psychology, 29(2), 162-170.

Clark, J.P., & Alvarez, M. (Eds.). (2010). Response to intervention: A guide for school social
workers. USA: Oxford University Press.

Colletti, C.J.M., Forehand, R., Garai, E., Rakow, A., McKee, L., Fear, J.M., & Compas, B.E.
(2009). Parent depression and child anxiety: An overview of the literature with clinical
implications. Child & Youth Care Forum, 38(3), 151-160. doi:10.1007/s10566-009-9074

De Los Reyes, A. (2011). Introduction to the special section: More than measurement error:
Discovering meaning behind informant discrepancies in clinical assessments of children
and adolescents. Journal of Clinical Child & Adolescent Psychology, 40(1), 1-9.
doi: 10.1080/15374416.2011.533405

Egger, H.L., Costello, J.E., & Angold, A. (2003). School refusal and psychiatric disorders: A
community study. Journal of the American Academy of Child & Adolescent Psychiatry,
42(7), 797-807. doi: 10.1097/01.CHI.0000046865.56865.79

Enders, C.K. (2010). Applied missing data analysis. New York, NY: The Guilford Press.
Hansen, C., Sanders, S.L., Massaro, S., & Last, C.G. (1998). Predictors of severity of absenteeism
in children with anxiety-based school refusal. Journal of Clinical Child Psychology, 27(3),
246-254. doi: 10.1207/s15374424jccp2703_2

Heyne, D. (2006). School refusal. In J.E., Fisher & W.T. O’Donohue (Eds), Practitioner’s guide to
evidence-based psychotherapy (pp. 600-619). Boston, MA: Springer.

Heyne, D., King, N.J., Tonge, B.J., Rollings, S., Young, D., Pritchard, M., & Ollendick, T.H.
(2002). Evaluation of child therapy and caregiver training in the treatment of school
refusal. Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 687-
695. doi: 10.1097/00004583-200206000-00008

Heyne, D., Gren-Landell, M., Melvin, G., & Gentle-Genitty, C. (2018). Differentiation between
school attendance problems: Why and how? Cognitive and Behavioral Practice. Advanced
online publication. doi: 10.1016/j.cbpra.2018.03.006

Ingul, J. M., Havik, T., & Heyne, D. (2018). Emerging school refusal: A school-based framework
for identifying early signs and risk factors. Cognitive and Behavioral Practice. Advanced
online publication. doi: 10.1016/j.cbpra.2018.03.005

Johnson, A.M., Falstein, E. I., Szurek, S.A., & Svendsen, M. (1941). School phobia. American
Journal of Orthopsychiatry, 11(4), 702-711. doi:10.1111/j.1939-0025.1941.tc05860.x

Kearney, C.A. (2008). School absenteeism and school refusal behavior in youth: A contemporary
review. Clinical Psychology Review, 28(3), 451-471. doi: 10.1016/j.cpr.2007.07.012

Kearney, C.A., Chapman, G., & Cook, L.C. (2005). School refusal behavior in young children.
International Journal of Behavioral Consultation and Therapy, 1(3), 216-222.
doi: 10.1037/h0100746

Kearney, C.A., & Graczyk, P. (2014). A response to intervention model to promote school
attendance and decrease school absenteeism. Child & Youth Care Forum, 43(1), 1-25.
doi: 10.1007/s10566-013-9222-1

Kearney, C.A., LaSota, M.T., Lemos-Miller, A., & Vecchio, J. (2007). Parent training in the
treatment of school refusal behavior. In J.M. Briesmeister & C.E. Schaefer (Eds.),
Handbook of parent training: Helping parents prevent and solve behavior problems,
(pp. 164-193). Hoboken, NJ: John Wiley & Sons.

Kearney, C.A., & Silverman, W.K. (1993). Measuring the function of school refusal behavior: The

School Refusal Assessment Scale. Journal of Clinical Child Psychology, 22(1), 85-96.
doi: 10.1207/s15374424jccp2201_9

Kearney, C.A., & Silverman, W.K. (1995). Family environment of youngsters with school refusal

behavior: A synopsis with implications for assessment and treatment. The American
Journal of Family Therapy, 23(1), 59-72. doi: 10.1080/01926189508251336

Kovacs, M. (1981). Rating scales to assess depression in school-aged children. Acta

Paedopsychiatricia, 46(5-6), 305-315.

Last, C.G., & Strauss, C.C. (1990). School refusal in anxiety-disordered children and adolescents.

Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 31-35.doi:

Last, C.G., Strauss, C.C., & Francis, G. (1987). Comorbidity among childhood anxiety disorders.

The Journal of Nervous and Mental Disease, 175(12), 726-730. doi: 10.1097/00005053-

Lebowitz, E.R., Leckman, J.F., Feldman, R., Zagoory-Sharon, O., McDonald, N., & Silverman,

W.K. (2016). Salivary oxytocin in clinically anxious youth: Associations with separation
anxiety and family accommodation. Psychoneuroendocrinology, 65, 35-43.
doi: 10.1016/j.psyneuen.2015.12.007

Lebowitz, E.R., Marin, C. E., Martino, A., Shimshoni, Y., Silverman, W.K. (in press).

Parent-based treatment as efficacious as CBT for childhood anxiety: A randomized
noninferiority study of SPACE. Journal of the American Academy of Child and Adolescent

Lebowitz, E.R., Omer, H., Hermes, H., & Scahill, L. (2014). Parent training for childhood anxiety

disorders: the SPACE program. Cognitive and Behavioral Practice, 21(4), 456-469.
doi: 10.1016/j.cbpra.2013.10.004

Lebowitz, E.R., Scharfstein, L., & Jones, J. (2015). Child-report of family accommodation in

pediatric anxiety disorders: Comparison and integration with mother-report. Child
Psychiatry and Human Development, 46(4), 501-511. doi: 10.1007/s10578-014-0491-1

Lebowitz, E.R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., ...
Leckman, J. F. (2013). Family accommodation in pediatric anxiety disorders. Depression
and Anxiety, 30(1), 47-54. doi: 10.1002/da.21998

March, J.S., Parker, J.D., Sullivan, K., Stallings, P., Conners, C.K. (1997). The Multidimensional
Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of
the American Academy of Child & Adolescent Psychiatry, 36(4), 554-565.
doi: 10.1097/00004583-199704000-00019

Muthén, L.K., & Muthén, B.O. (2012). Mplus Version 7 user’s guide. Los Angeles, CA: Muthén &

Nanda, M.M., Kotchick, B.A., & Grover, R.L. (2012). Parental psychological control and
childhood anxiety: The mediating role of perceived lack of control. Journal of Child and
Family Studies, 21(4), 637-645. doi: 10.1007/s10826-011-9516-6

Norman, K.R., Silverman, W.K., & Lebowitz, E.R. (2015). Family accommodation of child and
adolescent anxiety: Mechanisms, assessment, and treatment. Journal of Child and
Adolescent Psychiatric Nursing, 28(3), 131-140. doi: 10.1111/jcap.12116
Partridge, J.M. (1939). Truancy. Journal of Mental Science, 85(354), 45-81.
doi: 10.1192/bjp.85.354.45

Place, M., Hulsmeier, J., Davis, S., & Taylor, E. (2002). The coping mechanisms of children with
school refusal. Journal of Research in Special Educational Needs, 2(2), 1-10.
doi: 10.1111/j.1471-3802-2002.00167.x

Schwarz, J.C., Barton-Henry, M.L., & Pruzinsky, T. (1985). Assessing child-rearing behaviors: A
comparison of ratings made by mother, father, child, and sibling on the CRPBI. Child
Development, 56(2), 462-479. doi: 10.2307/1129734

Schludermann, E., & Schludermann, S. (1970). Replicability of factors in children’s report of
parent behavior (CRPBI). The Journal of Psychology, 76(2), 239-249.
doi: 10.1080/00223980.1970.9916845

Settipani, C.A., O’Neil, K.A., Podell, J.L., Beidas, R.S., & Kendall, P.C. (2013). Youth anxiety
and parent factors over time: Directionality of change among youth treated for anxiety.
Journal of Clinical Child & Adolescent Psychology, 42(1), 9-21.
doi: 10.1080/15374416.2012.719459

Silverman, W.K. & Albano, A.M. (1996). The Anxiety Disorders Interview Schedule for DSM-IV
(Child and Parent Versions). New York: Oxford University Press.

Silverman, W.K., Cerny, J.A., Nelles, W.B., & Burke, A.E. (1988). Behavior problems in children
of parents with anxiety disorders. Journal of the American Academy of Child and
Adolescent Psychiatry, 27(6), 779-784. doi: 10.1097/00004583-198811000-00020

Silverman, W.K., & Eisen, A.R. (1992). Age differences in the reliability of parent and child
reports of child anxious symptomatology using a structured interview. Journal of the
American Academy of Child & Adolescent Psychiatry, 31(1), 117-124.
doi: 10.1097/00004583-199201000-00018

Silverman, W.K, Marin, C. E., Rey, Y., Kurtines, W.M., Jaccard, J., & Pettit, J.W. (in press).
Group-versus parent-involvement CBT for childhood anxiety disorders: Treatment
specificity and long-term recovery mediation. Clinical Psychological Science.

Silverman, W.K., Saavedra, L.M., & Pina, A.A. (2001). Test-retest reliability of anxiety symptoms
and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent
versions. Journal of American Academy of Child & Adolescent Psychiatry, 40(8), 937-944.
doi: 10.1097/00004583-200108000-00016

Thompson-Hollands, J., Kerns, C. E., Pincus, D.B., & Comer, J.S. (2014). Parental
accommodation of child anxiety and related symptoms: Range, impact, and correlates.
Journal of Anxiety Disorders, 28(8), 765-773.

Tonge, B.J., & Silverman, W.K. (2019). Reflections on the field of school attendance problems:
For the times they are a-changing? Cognitive and Behavioral Practice. Advance online
publication. doi: 10.1016/j.cbpra.2018.12.004

Wilcox, R.R., & Keselman, H.J. (2003). Modern robust data analysis methods: Measures of central
tendency. Psychological Methods, 8(3), 254-274. doi: 10.1037/1082-989X.8.3.254

Wood, J.J., Piacentini, J.C., Bergman, L.R., McCracken, J., & Barrios, V. (2002). Concurrent
validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for
the DSM-IV: Child and parent versions. Journal of Clinical Child & Adolescent
Psychology, 31(3), 335-342. doi: 10.1207/S15374424JCCP3103_05

Woodruff-Borden, J., Morrow, C., Bourland, S., & Cambron, S. (2002). The behavior of anxious
parents: Examining mechanisms of transmission of anxiety from parent to child. Journal of
Clinical Child and Adolescent Psychology, 31(3), 364-374. doi: