Therapy improved anxiety more reliably than it improved attendance
A systematic review and meta-analysis of treatments for school refusal
Reviewed by Sian Trombley, CCCFounder, Thrive Family Company
Moderate confidence
Source citation
Maynard B. R., Heyne D., Brendel K. E., Bulanda J. J., Thompson A. M., Pigott T. D. (2015). Treatment for School Refusal Among Children and Adolescents: A Systematic Review and Meta-Analysis. Research on Social Work Practice. https://doi.org/10.1177/1049731515598619
Published 1 January 2015 · Added to Thrive 26 July 2026 · Reviewed 26 July 2026
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Attendance and anxiety are treated as the same problem. This meta-analysis shows they respond differently.
Published research findings
The study
Maynard and colleagues pooled controlled trials of psychosocial treatment for school refusal, mostly cognitive behavioural.
What researchers examined
Effects on school attendance and on anxiety symptoms.
What they found
Treatments produced significant improvements in anxiety. Effects on attendance were positive but smaller and less consistent across studies.
Thrive editorial interpretation
What this may mean for families
Attendance plans need the school as an active partner. Therapy alone rarely resolves the practical side of return.
What this doesn't tell us
Important limitations
Few trials, small samples, and considerable variation in how attendance was recorded.
Evidence confidence describes how much weight this study's design can carry — not how strongly the finding applies to any individual child or family.
Therapist perspective — Thrive interpretation, not a finding of the study
Therapist Perspective
I plan the return with the school in the room. Anxiety work without a graded return plan tends to stall.
Practical family considerations
Treat the anxiety and build a graded return plan with the school.
This research summary is educational and does not replace individualized medical, psychological or therapeutic advice.
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Not all missed school is the same — and the type determines the plan
2019 · Consensus statement
Moderate confidence
Why it matters
Before any plan is made, name what kind of absence this is. Anxious avoidance needs graded return and one shared plan; it does not need consequences.