Therapeutic and educational program for school refuser in a day-care institute. -Approaches from clinical psychology, chronobiology, and child psychiatry

来自儿童精神病学的方法我们调查了不同社会地位的人的拒学观念。拒学的概念各不相同，但不同社会地位的被调查者的反应差异不大。然后，我们使用DSM-III-R诊断标准和多变量分析(i)来调查拒学病例。即因子分析和聚类分析)。结果表明，被认为是拒学的小学生和学生由不同的亚群组成，如神经症、精神分裂症和多动症，包括近逃学的学生。我们调查了经常伴有拒学的睡眠节律障碍。在被转介到医疗机构的拒绝上学的学生中，约有70%存在睡眠节律障碍。睡眠节律紊乱的严重程度与缺席的时间长短有关。睡眠节律紊乱发生在拒绝的较早阶段。我们认为，睡眠节律紊乱可能会进一步延长拒学学生缺勤的时间。来自临床心理学的方法我们管理着一个专为拒绝上学的学生开设的日托机构，叫做“Gonta-Juku”。在家庭咨询情况下和学校环境下，我们也采用简短治疗的方法对学校拒绝者进行治疗。我们展示了人体系统对拒学学生的治疗意义。他们之间的交流给患者本身和患者周围的人带来了更好的变化。

APPROACH FROM CHILD PSYCHIATRY We surveyed concepts of school refusal among persons in various social positions. Reported concepts of school refusal were quite various, however, there were very little differences in the responses among the groups of respondents in different social positions. Then, we investigated cases of school refusal by means of DSM-III-R diagnostic criteria and multi-variational analysis(i. e., Factor analysis and Cluster analysis). The results suggested that pupils and students regarded as school refusers were consisted from various subgroups, e. g., neurotic, schizophrenic, and hyperactive, including nearly truant students.APPROACH FROM CHRONOBIOLOGY We investigated sleep rhythm disturbances frequently accompanied by school refusers. Sleep rhythm disturbance was observed among about 70% of the school refusers who were referred to the medical institutions. Severity of sleep rhythm disturbances were associated with period length of the absence. Sleep rhythm disturbances were occurred in rather earlier stage of refusal. We suggested the possibility that sleep rhythm disturbances might cause a further prolongation of the absence of school refusers.APPROACH FROM CLINICAL PSYCHOLOGY We managed a day-care institute for school refusers, called 'Gonta-Juku'. We also conducted therapeutic approach for school refusers in family counseling situation and in school environment using techniques from brief therapy. We showed the therapeutic significance of human system around school refusing students. Communications among them bring the better changes in patients themselves and also in the people around patients.