School refusal: graduated and rapid behavioural treatment strategies.

School refusal is a complex phenomenon that has been subject to definitional and diagnostic confusion. The aetiology of school refusal remains incompletely understood; heterogeneity rather than homogeneity prevails. In the behaviour management of school refusal, the clinician may plan either a gradual or rapid school return. Although a graduated return to school may be necessary in certain cases, secondary complications are minimized by an immediate return to school. Both graduated and rapid treatment require a flexible and integrative approach drawing on classical, operant and vicarious conditioning principles. Little research has been conducted on the effectiveness of the behavioural management of school refusal, as well as psychological adjustment to school.