At least 5% of children and adolescents in Germany are in need of psychiatric treatment. Diagnostic investigation for behavioral problems is indicated in another 10% to 18%. Two articles in Deutsches Ärzteblatt International go into the questions of what interventions help children who are avoiding school, and whether providing support for social and emotional skills can improve prosocial behavior in preschool children.
Annika Schell, Lucia Albers, and co-authors conclude in their study that an age-appropriate training program at kindergarten can improve children's social and emotional skills (Dtsch Arztebl 2015; 112: 647-54).These skills are often poorly developed and therefore need training. Until now, training has only been developed for elementary and secondary school children. The study presented here reports the early results of a training program developed for preschool children.
The article by Volker Reissner and co-authors investigates the outcome of interventions in children who have been avoiding school (Dtsch Arztbl Int 2015; 112: 655-62). A total of 112 school avoiders were divided into two groups, one receiving a specified form of cognitive behavioral therapy while the second (the "treatment as usual" group) received 4 weeks' treatment in various forms from child and adolescent psychiatrists in private practice. None of the interventions was shown to be superior to the other in terms of leading to a higher rate of school attendance after treatment was ended. In both groups, 60% of the study participants returned to school. However, up to 40% continued to refuse to attend school after the end of therapy.
Helmut Remschmidt introduces the theme of this issue in an editorial. The conclusion he draws is that the high rate of persistent school absenteeism is one more reason to start intervention as early as at preschool age, because nontreatment of early behavioral problems can later develop into both psychopathological problems and school avoidance.