Traditionally, mental health professionals and school authorities have found school refusal to be a perplexing and challenging problem. Relevant to an understanding of school refusal, we initially review some important developmental-normative considerations. The clinical features, epidemiology, and etiology of school refusal are also briefly discussed. We then describe a number of behavioural strategies that have been used in the management of school refusal. Finally, we review the research support for the efficacy and acceptability of behavioural strategies in the treatment of school refusal.

School refusal is a complex and heterogeneously determined and experienced behaviour problem. Due to its complexity and heterogeneity, a multimethod and multisource approach to assessment is required. The approach is described as a hypothesis-testing approach which uses developmentally sensitive and empirically validated procedures. Clinical-behavioural interviews, structured diagnostic interviews, self-reports, reports of significant others, self-monitoring, and behavioural observations are recommended. Issues associated with these procedures are reviewed.

Following Bandura's theory, a Self-efficacy Questionnaire for School Situations (SEQ-SS) was developed to assess the cognitions of school refusers. The instrument contains twelve school-related situations which are rated by children according to their belief about their ability to cope with each situation. Factor analysis yielded two reliable factors labelled Academic/Social Stress and Separation/Discipline Stress. Psychometric evaluation also revealed good internal consistency and test-retest reliability. Total self-efficacy scores for 135 school refusers ranged from very low to very high. Self-efficacy was highest with regard to doing school work and lowest with regard to answering peers' questions about absences. The clinical utility of the SEQ-SS is discussed, with implications for the selection of cognitive and behavioural treatment procedures. The application of the instrument in future research is also considered.

One aim of this study was to describe attitudes, beliefs, and behaviours concerned with testicular and breast self-examination (TSE, BSE); the second was to test the efficacy of the Ajzen and Fishbein theory of reasoned action in predicting self-examination behaviour. Participants comprised 116 male adults with a mean age of 27.9, and 141 female adults with a mean age of 30.0 years. The sample was relatively well-educated, with over half having engaged in some tertiary studies. They completed a questionnaire assessing self-examination behaviours, intentions, beliefs, attitudes, and perceived norms. Results indicated low rates of self-examination for both TSE and BSE. Barriers to self-examination included embarrassment, perceived unpleasantness and difficulty, concern about reliability, and worries about what the tests might reveal. Respondents perceived only moderate levels of support from salient others for engaging in the self-examinations. The theory of reasoned action was strongly supported by the study, with intentions to perform self-examination being predicted by attitudes and subjective norms, and intentions in turn predicting self-examination behaviours.

A preschool girl who displayed severe noncompliant and disruptive behaviour was taught to successfully complete a card-matching task, to verbalise the task requirements, and to report successful task completion by means of a time-out procedure in combination with correspondence training. In order to bring about this success, time out was successively introduced for three preparatory behaviours (sitting still, keeping hands down, and looking at the task materials), for completion of simple tasks interspersed between trials of card-matching, and for stating the card-matching task requirement. The conditions for implementing time-out were gradually changed from allowing two chances to comply (implemented only after a second request was not complied with) to allowing only one chance (implemented after the first request was not complied with). This changing criterion time-out procedure was used in place of the more commonly used, but possibly more lengthy procedure whereby tasks not performed adequately are broken down into smaller steps and successive approximations are contingently shaped. The success of the time-out procedure is discussed as a potential means of conducting powerful early interventions with young children at risk for diagnoses of attention-deficit/hyperactivity disorder or similar disorders where a failure to correct severe behaviour problems observed at an early age is predictive of the need for more intrusive and expensive interventions later.