Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial

Glenn A. Melvin, Amanda L Dudley, Michael S. Gordon, Ester Klimkeit, Eleonora Gullone, John Taffe, Bruce J. Tonge

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16 Citations (Scopus)


This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11–16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.

Original languageEnglish
Pages (from-to)485-497
Number of pages13
JournalChild Psychiatry and Human Development
Issue number3
Publication statusPublished - 1 Jun 2017


  • Anxiety disorders
  • Cognitive behavior therapy
  • Fluoxetine
  • School refusal

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