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

儿童精神病学的研究方法我们调查了处于不同社会地位的人的拒学观念。被报道的拒绝上学的概念相当不同，然而，不同社会地位的受访者群体之间的反应差异很小。然后，我们采用DSM-III-R诊断标准和多元分析(即因子分析和聚类分析)对拒绝上学的案例进行了调查。结果表明，小学生和被视为拒学者的学生包括神经症、精神分裂症和多动症等不同的亚群，包括几乎逃学的学生。约70%的就诊学生存在睡眠节律紊乱。睡眠节律紊乱的严重程度与缺勤时间长短有关。睡眠节律紊乱发生在较早的拒绝阶段。我们认为，睡眠节律紊乱可能会导致拒学者的缺课时间进一步延长。来自临床心理学的报道我们管理了一家为拒学者设立的日托机构，名为“Gonta-Juku”。我们还利用短期治疗的技巧，对家庭咨询情况下和学校环境中的拒学者进行了治疗。我们展示了学校拒绝学生周围的人类系统的治疗意义。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.